OVERVIEW OF PSYCHIATRIC NURSING PRACTICE
Tricyclic Antidepressants
Evolution of Mental Health-Psychiatric Nursing Practice
 The concepts of mental health and mental illness are
culturally defined.
 Some cultures are quite liberal in the range of behaviors
that are considered acceptable, whereas others have very
little tolerance for behaviors that deviate from the cultural
norms.
 The history of psychiatric care reveals some shocking
truths about past treatment of mentally ill individual. Many
were kept in control by means that could be considered
less than humane.
Ancient Times
Those with mental disorders were viewed as being either
divine or demonic depending on the behavior.
In early Christian Times (1-1000AD)
The mentally ill were viewed as possessed. Priest would
performed exorcisms to get rid of evil spirits.
Renaissance (1300-1600)
People with mental illness were distinguished from criminals
in England.
Those considered harmless were allowed to wander the
countryside or live in rural communities.
More “dangerous lunatics” were thrown in prison.
1547, the Hospital of St. Mary of Bethlehem was officially
declares a hospital for the insane, the 1st of its kind.
BENCHMARK PERIODS IN PSYCHIATRIC HISTORY
Period of Enlightenment and Creation of Mental Institutions
(1790s)
Phillippe Pinel in France and William Tuke in England
formulated the concept of Asylum as a safe refuge or haven
offering protection at institutions where people had been
whipped, beaten and starved just because they were mentally
ill.
Sigmund Freud and Treatment of Mental Disorders
Scientific study and treatment of mental disorders began with
Sigmund Freud (1856-1939) and others such as Emil Kraeplin
(1856-1926) and Eugen Bleuler (1857-1939).
Development of Psychopharmacology
In 1950’s saw the development of psychotropic drugs (drugs
used to treat mental illness)
A. Chlorpromazine (Thorazine)
B. Lithium
Over the following 10 years:
C. Mono-amine oxidase inhibitor
D. Haloperidol (Haldol)
E.
F. Anti-anxiety agents called Benzodiazepines.
If some mental disorders are cause by chemical imbalances
then chemicals can restore the balance. People would no
longer be confined.
Resulted in destigmatization of mental illness.
Parents and others should not be blamed.
Community Mental Health – 1960’s
Community Mental Health Centers (CMHC) Act in 1963 – the
goal was deinstitutionalization of the state hospital. This act
addresses the problem of geographical location and keeping
the individual closer to the family.
Deinstitutionalization – refers to the development of state
mental hospitals.
Community Health Programs
 Emergency care
 24 hour inpatient care education
 Partial hospitalization care
 Outpatient care
 Consultation and screening services
Decade of the Brain – 1990’s
Significant change in thinking – “if we can understand the
brain, we can help millions of people suffering from mental
disorders.”
Results – augmentation of psychologic content in academic
nursing programs. It made psychiatric nursing a more viable
specialty.
HISTORICAL DEVELOPMENT OF PSYCHIATRY IN THE
PHILIPPINES
Pre-Spanish Regime
 Filipinos believed in a world that is both material and
spiritual and that a harmonious relationship should be
established. The concept of illness was based on the belief
that if spirits (powerful) from the spiritual world were
disobeyed certain bad luck is manifested in the material
world.
 Believed in healers called Babaylan (Shaman) and Sorcerer
healing thorough communicating spirits.
Spanish Rule
 Filipinos accepted that mental illness was caused by acts of
sorcery (Mangkukulam, witches, and mangagaway – devil
men)
  Sick people brought to herbolarios or church for exorcism.
 Herbolarios used various procedures – wrapping the
patient in a mat and beating with buntot pagi.
 Hysteria was treated by a boot ride and the patient was
thrown to the river. The “surprise” was thought to heal the
patient, barring drowning.
and congruent with local and cultural norms.” Townsend
(2006)
 Mental Health is a state of emotional, psychological, and
social wellness evidenced by satisfying interpersonal
relationships, effective behavior and coping, positive self-
concept, and emotional stability.
 Mental Health has many components, and a wide variety
of factors influence it.

The American Psychiatric Association (APA) defines metal

EARLY 19TH CENTURY – organized care and treatment for
mental illness was established at the Hospicio de San Jose as a
result of Spanish naval authorities requesting a place for
confinement of their mentally ill sailors.
AMERICAN ERA – two American physicians were reported to
have provided treatment to mentally ill patients of the Civil
Hospital located in Calle Iris (Claro M.Recto).
1904 – Insane department opened at the San Lazaro Hospital
for the use of mentally ill patients from Hospicio de San Jose.
st
Dr. Elias Domingo – head of the unit and was the 1 physician
to obtaining in psychiatry in the U.S. Assisted by Filipino and
American nurses trained in psychiatric nursing care.
1918 – Construction of the city sanitarium for patient residing
in Manila. The insane department provided services for
patients outside Manila.
health as “A state of being that is relative rather than absolute.
The successful performance of mental functions shown by
productive activities, fulfilling relationships with other people,
and the ability to adapt to change and to cope with adversity.”
Aspects of Mental Health:
 Emotional Intelligence
 Emotions are skills for living.
 Important to recognize our emotions-know
ourselves.
 Have emotional self-control.
 Recognize emotions in others.
 Handles Relationships.
 Resiliency – emerge and grow from negative life
events.
 Spirituality – that part of us that deals with
relationships, values and addresses questions of
purpose and meaning in life.

THE SIX CRITERIA OF IDEAL MENTAL HEALTH (M. Jehoda)

JAPANESE OCCUPATION – Donated an electroshock apparatus
to the hospital and became a famous treatment modality due 1) Accurate perception of reality
to scarcity of medication. 2) Positive self-image
3) Autonomy
LIBERATION PERIOD AND ERA OF THE REPUBLIC – The National 4) Self-actualization
Psychopathic Hospital was renamed the National Mental 5) Hardiness- capacity to resist stress and anxiety.
Hospital with Dr. Jose Fernandez as OIC. 6) Flexibility – the ability to withstand change.

PRESENT DAY PSYCHIATRY

Use of Somatic Therapies SEVEN SIGNS OF MENTAL HEALTH
A. Lithium for treatment of mania 1. Happiness
B. Benzodiazepine prescribed for non-psychotic disorders 2. Control over behavior
C. Imipramine like drugs and MAOI prescribed for the 3. Appraisal of reality
treatment of depression and severe states of anxiety. 4. Effectiveness in work
D. Serotonin specific reuptake inhibitors and serotonin- 5. Healthy self-concept
norepinephrine reuptake inhibitors where included in the 6. Satisfying Relationships (give and receive love)
treatment of depression. 7. Effective coping strategies

Traits of Mental Health

MENTAL HEALTH AND MENTAL ILLNESS
Ability to:
What is Mental Health?
a) Deal with conflicting emotions
b) Live without undue fear, guilt, or anxiety
 Defined as “The successful adaptation to stressors from
c) Take responsibility for one’s own actions
the internal or external environment, evidenced by
d) Think clearly
thoughts, feelings, and behaviors that are age-appropriate
e) Negotiate each development task
MENTAL ILLNESS
Defines as “Maladaptive responses to stressors from the
internal or external environment, evidenced by thoughts,
feelings, and behaviors that are incongruent with the local and
cultural norms and interfere with the individual’s social,
occupational or physical functioning.”
Horwitz describes cultural influences that affects how
individuals view mental illness. These include:
I. Incomprehensibility – the inability of the general
population to understand the motivation behind the
behavior.
II. Cultural Relativity – the “normality” of behavior is
determined by culture.
III. Behavior is categorized as “normal” or “abnormal”
according to one’s cultural or societal norms.
In the DSM-IV-TR (APA, 2000), the APA defines mental illness
or mental disorder as:
“A clinically significant behavioral pattern or psychological
syndrome or pattern that occurs in an individual and that is
associated with present distress (e.g., a painful symptom) or
disability (i.e., impairment in one or more important areas of
functioning), or with significantly increased risk of suffering
death, pain, disability, or an important loss of freedom and is
not merely an expectable response to a particular event.”
MENTAL HEALTH NURSE – provides treatment, care and
support for people with emotional, mental and behavioral
problems.
Tasks and Duties
 Assessed and treats a person using a nursing framework
such as theory of interpersonal relations.
 Works within a multidisciplinary team.
 Assist people with self-care and other daily activities.
 Provides advice and support, facilitating and integrating a
recovery approach.
 Provides education for users and their families on mental
illness, available services, and strategies to cope with
illness.
 Leads and assists in therapy groups.
 May give evidence in court.
 Visits people in their community
 May be involved in Mental Health Nursing Research
Skills
Mental Health Nurses are skilled in the specialized use of
communication, counselling, drugs used in psychiatry,
applying specialty knowledge in the provision of clinical
assessment, monitoring therapeutic interventions, treatment
and referral to other health professionals.
Personal Qualities
Mental Health nurses must be concerned for others, mature,
and responsible, and able to work well under pressure.
They should also be patient and good at listening, and able to
deal with people from variety of backgrounds and cultures.
INTERDISCIPLINARY TEAM
 Regardless of treatment setting, rehabilitation program,
or population, an interdisciplinary (or multidisciplinary)
team approach is most useful dealing with the
multifaceted problems of client with mental illness.
 Different member of the team have expertise in specific
areas. By collaborating, they can meet clients’ needs
more effectively.
 Members of the interdisciplinary team includes the
psychiatrist, psychologist, psychiatric nurse, psychiatric
social worker, occupational therapist, recreational
therapist, and vocational rehabilitation specialist.
Roles
1. Psychiatrist – The primary function of the psychiatrist is
diagnosis of mental disorders and prescription of
medical treatments.
2. Psychologist – (Ph.D.) prepared to practice therapy,
conduct research, and interpret psychological tests.
Psychologist may also participate in the design of
therapy programs for groups of individuals.
3. Psychiatric Nurse – gains experience in working with
client with psychiatric disorders after graduation from
an accredited program of nursing and completion of
the licensure examination. The nurse has a solid
foundation in health promotions, illness prevention,
and rehabilitation in all areas, allowing him or her to
view the client holistically.
 The nurse is also an essential team member in
evaluating the effectiveness of medical treatment,
particularly medications.
 Registered nurses who obtained a master’s degree
in mental health may be certified as clinical
specialists of licensed as advanced practitioners,
depending on individual state nurse practice acts.
Advanced practice nurses are certified to prescribe
drugs in many states.
4. Psychiatric Social Worker – Most psychiatric social
workers are prepared at the master’s level, and they
 are licensed in some states. Social workers may practice 3) Coping strategies
therapy and often have the primary responsibility for 4) Therapeutic intervention skills
working with families, community support and referral.
2. Psychopharmacology
5. Occupational Therapist – may have an associate degree  Therapeutic v/s toxic dosage levels
(certified occupational therapy assistant) or a  Use during pregnancy
baccalaureate degree (certified occupational therapist).  Use with the Elderly
Occupational therapy focuses on the functional abilities  Side effects
of the client and ways to improve client functioning  Interactions
such as working with arts and crafts and focusing on  Patient teaching
psychomotor skills.
3. Milieu Management
6. Recreation Therapists – Many recreation therapists  Safety
complete a baccalaureate degree, but in some  Structure
instances persons with experience fulfill these roles.  Norms
The recreation therapist helps the client to achieve a  Setting limits
balance of work and play in his/her life and provides  Balance
activities that promotes constructive use of leisure or - Independence vs. Dependence
unstructured time.  Environment Modification

PSYCHOTHERAPEUTIC MANAGEMENT IN THE CONTIUUM OF When one component is missing from the equation,
CARE treatment is compromised. In other words, all the component
A model for nursing care that balances the three primary of the psychotherapeutic management equation must be
interventions used by psychiatric nurses: present if patients are to fully realize the benefits of effective
nursing intervention. However, one component may take
1. The Therapeutic Nurse-Patient relationship – use of precedence at a given point in time.
words
2. Psychopharmacology – use of drugs (supported by CONTINUUM OF CARE
PSYCHOPATHOLOGY – systematic study of mental
disorders) Levels of car through which an individual can move depending
3. Milieu Management – environment upon his/her need a given point in time. The services span
from health promotion through prevention, treatment and
There are five basic categories into which psychiatric rehabilitation. The continuum of care provides consumers a
treatment can be divided: wide range of treatment modalities to assist the individual in
achieving his or her optimal level of functioning.
1. The use of words – which encompass all forms of
psychotherapy. One model that includes prevention is the Mental Health
2. The use of drugs – psychotropic drugs Intervention Spectrum for Mental Disorders.
3. The use of environment – Milieu Setting
4. Somatic Therapies – a therapeutic approach that uses INTERVENTIONS GOAL EXAMPLES
physiological or physical interventions to effect
behavioral changes. Promoting the Stress
5. Behavioral Conditioning – therapeutic approach that health of individuals management
helps patient modify behavior by modifying or Universal and groups who are classes, self-
changing old patterns of behavior. Prevention identifies as not esteem
being at risk for any workshops,
of the mental wellness
PSYCHOPATHOLOGY
disorders. programs.
1. Therapeutic Nurse-Patient Relationship
Programs for School breakfast
 Communication Skills individuals and and lunch
 Respect and a desire to help groups who are at programs,
 Understanding Selective risk for developing children of
1) Mental Mechanism Prevention mental disorders divorce groups,
2) Adaptation Styles due to grief groups,
 psychological, depression every 2 hours for children and adolescents ages 9-17,
economic and screening and every hour for children younger than 9 years old.
environmental programs
factors. Commitment Issues
Nurses are accountable for their actions in relation to
these issues and violation can result in malpractice
Early identification Children of lawsuits. Nurses must be aware of the kinds of
Indicated of mentally ill,
behaviors that place them at risk for malpractice.
Prevention Individuals having employee
Developing and maintaining a good interpersonal
biological assistance
predisposition for programs, walk-in relationship with the client and his or her family
or early symptoms clinics, crisis appears to be a positive factor when the question of
of a mental services, shelters. malpractice is being considered.
disorder.

Diagnosing and Hospital based

Treatment treating of care, community
Prevention individuals with based care, home
mental disorders. care

Decreasing Self-help groups,

Maintenance disability and psycho,
Intervention preventing relapse educational
of individuals and groups,
groups with mental vocational
disorder. rehabilitation,
special skills
training.

LEGAL ISSUES IN PSYCHIATRIC/MENTAL HEALTH NURSING

Legal and ethical issues in psychiatric/mental health nursing
center around the following:

The right to CONFIDENTIALITY

This is a basic one, and especially so in psychiatry.
Nurses working in psychiatry must guard the privacy of
their client with great diligence.

Informed Consent
According to law, all individuals have the right to decide
whether to accept or reject treatment. A health care
provider can be charged with assault or battery for
providing life sustaining treatment to a client when the
client has not agreed to it. An example of a treatment
in the psychiatric are that require informed consent is
Electroconvulsive Therapy.

Restraint and Seclusion

A Bill of Right for Psychiatric Patients include “the right
to freedom from restraint or seclusion except in an
emergency situation.”
Orders for restraints or seclusion must be reissued y a
physician every four hours for adults age 18 and older,