PowerPoint Presentation to

Accompany Videbeck’s Psychiatric

Mental Health Nursing
Third Edition
 Chapter 1
Foundations of Psychiatric
Mental Health Nursing
Mental Health
• WHO definition: state of complete
physical, mental, and social wellness, not
merely absence of disease or infirmity
• State of emotional, psychological, and
social wellness evidenced by:
– satisfying interpersonal relationships
– effective behavior and coping
– a positive self-concept
– emotional stability
CRITERIA OF MENTAL HEALTH

• Autonomy ad independence
• Maximization of one’s potential
• Tolerance to life’s uncertainties
• Self-esteem
• Mastery of environment
• Reality orientation
• Stress management
Factors Influencing a Person’s Mental Health
• Individual factors:
– biologic makeup, autonomy and independence, self-
esteem, capacity for growth, vitality, ability to find
meaning in life, emotional resilience or hardiness, a sense
of belonging, reality orientation, and coping or stress
management abilities

• Interpersonal factors:
– effective communication, ability to help others, intimacy,
and a balance of separateness and connectedness

• Social/cultural factors:
– a sense of community, access to adequate resources,
intolerance of violence, support of diversity among people,
mastery of the environment, and a positive, yet realistic,
view of one’s world
Mental Illness

• Historically viewed as possession by

demons, punishment for religious or
social transgressions, weakness of will
or spirit, and violation of social norms
• Today seen as a medical problem,
although some stigma from previous
beliefs remains
Mental Illness (cont’d)
• Mental disorder is “a clinically
significant behavioral or psychological
syndrome or pattern that occurs in an
individual and that is associated with
distress or disability or with a
significantly increased risk of suffering
death, pain, disability, or an important
loss of freedom” (American
Psychological Association [APA])
 Diagnostic and Statistical Manual of
Mental Disorders, 4th edition, Text
Revision
The DSM-IV-TR is a taxonomy published
by APA and is used by all mental health
professionals. It describes all
mental disorders according to
specific diagnostic criteria.
The DSM-IV-TR is based on
a multiaxial classification
system:
 PURPOSE
1. To provide a standardized nomenclature and language
for all mental health professionals
2. To present defining characteristics or symptoms that
differentiate specific diagnoses
3. To assist in identifying the underlying causes of
disorders
► Axis I: all major psychiatric
disorders except mental retardation
and personality disorders (depression,
schizophrenia, anxiety and substance
related disorders
► Axis II: mental retardation,
personality disorders, maladaptive
personality features, and defense
mechanisms
► Axis III: current medical conditions
► Axis IV: psychosocial and
environmental problems, including
problems with primary support group,
social environment, education,
occupation, housing, economics,
access to health care, legal system

► Axis V: Global Assessment of

Functioning (GAF) score
Historical Perspective
• Ancient times: sickness represented
displeasure of the gods, punishment
for wrongdoing; treatments included
starving, urging, bloodletting
• Period of Enlightenment (1790s) saw
the creation of asylums or safe havens
to offer protection
• Sigmund Freud and others studied
mental disorders scientifically by the
1900s
Historical Perspective (cont’d)

• Psychotropic drugs first available in

1950

• Deinstitutionalization began with the

Community Mental Health Centers Act
of 1963
Mental Illness in the 21st Century
• 56 million Americans have a mental
illness (DHHS, 2002)
• Hospital stays shorter, but more
numerous: revolving door
• Increased aggression among mentally
ill clients
• An increased number of people with
mental illness are incarcerated
Mental Illness in the 21st Century (cont’d)

• Homeless population of persons with

mental illness, including substance
abuse, is growing
• Most health care dollars still spent on
inpatient psychiatric care; community
services not adequately funded
• Healthy People 2010 mental health
objectives strive to improve care of
mentally ill persons
Mental Illness in the 21st Century (cont’d)

• Community-based care includes

community support services, housing,
case management, residential services
outside the hospital (see Chap. 4)
• Cost containment efforts include
utilization review, HMOs, managed
care, case management
• Cultural considerations: diversity
increasing in U.S. in terms of ethnicity
and changing family structures
Psychiatric Nursing Practice

• Psychiatric nursing practice emerged in

1873 when Linda Richards said, “The
mentally sick should be at least as well
cared for as the physically sick”
• 1882 was first formal training of nurses
in mental health
• First psychiatric textbook in 1920
• This is a relatively new field in
comparison with other areas
Psychiatric Nursing Practice (cont’d)

• Standards of Psychiatric-Mental Health

Clinical Nursing Practice developed in
1973, revised in 1982, 1994, 2000
• Psychiatric Mental Health Nursing
Phenomena of Concern: 12 areas of
concern that mental health nurses
focus on when caring for clients
Student Concerns
• Saying the wrong thing
• What student will be doing
• Fear of no one talking to student
• Bizarre or inappropriate behavior
• Physical safety
• Seeing someone known to the student
Self-Awareness Issues
• Everyone has values, beliefs, ideas;
nurses need to know what theirs are,
not to change them, but to prevent
unknown or undue influence on their
nursing practice
• Hints to increase self-awareness: keep
a journal, talk to trusted coworkers,
examine points of view other than
one’s own