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OVERVIEW OF PSYCHIATRIC NURSING PRACTICE E.

Tricyclic Antidepressants
Evolution of Mental Health-Psychiatric Nursing Practice F. Anti-anxiety agents called Benzodiazepines.

 The concepts of mental health and mental illness are If some mental disorders are cause by chemical imbalances
culturally defined. then chemicals can restore the balance. People would no
 Some cultures are quite liberal in the range of behaviors longer be confined.
that are considered acceptable, whereas others have very Resulted in destigmatization of mental illness.
little tolerance for behaviors that deviate from the cultural Parents and others should not be blamed.
norms.
 The history of psychiatric care reveals some shocking Community Mental Health – 1960’s
truths about past treatment of mentally ill individual. Many
were kept in control by means that could be considered Community Mental Health Centers (CMHC) Act in 1963 – the
less than humane. goal was deinstitutionalization of the state hospital. This act
addresses the problem of geographical location and keeping
Ancient Times the individual closer to the family.
Those with mental disorders were viewed as being either
divine or demonic depending on the behavior. Deinstitutionalization – refers to the development of state
mental hospitals.
In early Christian Times (1-1000AD)
The mentally ill were viewed as possessed. Priest would Community Health Programs
performed exorcisms to get rid of evil spirits.  Emergency care
 24 hour inpatient care education
Renaissance (1300-1600)  Partial hospitalization care
People with mental illness were distinguished from criminals  Outpatient care
in England.  Consultation and screening services
Those considered harmless were allowed to wander the
countryside or live in rural communities. Decade of the Brain – 1990’s
More “dangerous lunatics” were thrown in prison.
1547, the Hospital of St. Mary of Bethlehem was officially Significant change in thinking – “if we can understand the
declares a hospital for the insane, the 1st of its kind. brain, we can help millions of people suffering from mental
disorders.”
BENCHMARK PERIODS IN PSYCHIATRIC HISTORY Results – augmentation of psychologic content in academic
nursing programs. It made psychiatric nursing a more viable
Period of Enlightenment and Creation of Mental Institutions specialty.
(1790s)
Phillippe Pinel in France and William Tuke in England HISTORICAL DEVELOPMENT OF PSYCHIATRY IN THE
formulated the concept of Asylum as a safe refuge or haven PHILIPPINES
offering protection at institutions where people had been
whipped, beaten and starved just because they were mentally
Pre-Spanish Regime
ill.
 Filipinos believed in a world that is both material and
spiritual and that a harmonious relationship should be
Sigmund Freud and Treatment of Mental Disorders
established. The concept of illness was based on the belief
Scientific study and treatment of mental disorders began with
that if spirits (powerful) from the spiritual world were
Sigmund Freud (1856-1939) and others such as Emil Kraeplin
disobeyed certain bad luck is manifested in the material
(1856-1926) and Eugen Bleuler (1857-1939).
world.

Development of Psychopharmacology
 Believed in healers called Babaylan (Shaman) and Sorcerer
In 1950’s saw the development of psychotropic drugs (drugs
healing thorough communicating spirits.
used to treat mental illness)
A. Chlorpromazine (Thorazine)
Spanish Rule
B. Lithium
 Filipinos accepted that mental illness was caused by acts of
Over the following 10 years:
sorcery (Mangkukulam, witches, and mangagaway – devil
C. Mono-amine oxidase inhibitor
men)
D. Haloperidol (Haldol)
 Sick people brought to herbolarios or church for exorcism. and congruent with local and cultural norms.” Townsend
(2006)
 Herbolarios used various procedures – wrapping the  Mental Health is a state of emotional, psychological, and
patient in a mat and beating with buntot pagi. social wellness evidenced by satisfying interpersonal
relationships, effective behavior and coping, positive self-
 Hysteria was treated by a boot ride and the patient was concept, and emotional stability.
thrown to the river. The “surprise” was thought to heal the  Mental Health has many components, and a wide variety
patient, barring drowning. of factors influence it.

The American Psychiatric Association (APA) defines metal


EARLY 19TH CENTURY – organized care and treatment for
health as “A state of being that is relative rather than absolute.
mental illness was established at the Hospicio de San Jose as a
The successful performance of mental functions shown by
result of Spanish naval authorities requesting a place for
productive activities, fulfilling relationships with other people,
confinement of their mentally ill sailors.
and the ability to adapt to change and to cope with adversity.”
AMERICAN ERA – two American physicians were reported to Aspects of Mental Health:
have provided treatment to mentally ill patients of the Civil
Hospital located in Calle Iris (Claro M.Recto).  Emotional Intelligence
 Emotions are skills for living.
1904 – Insane department opened at the San Lazaro Hospital  Important to recognize our emotions-know
for the use of mentally ill patients from Hospicio de San Jose. ourselves.
 Have emotional self-control.
st
Dr. Elias Domingo – head of the unit and was the 1 physician  Recognize emotions in others.
to obtaining in psychiatry in the U.S. Assisted by Filipino and  Handles Relationships.
American nurses trained in psychiatric nursing care.  Resiliency – emerge and grow from negative life
events.
1918 – Construction of the city sanitarium for patient residing  Spirituality – that part of us that deals with
in Manila. The insane department provided services for relationships, values and addresses questions of
patients outside Manila. 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 assessment, monitoring therapeutic interventions, treatment
and referral to other health professionals.
Defines as “Maladaptive responses to stressors from the
internal or external environment, evidenced by thoughts, Personal Qualities
feelings, and behaviors that are incongruent with the local and Mental Health nurses must be concerned for others, mature,
cultural norms and interfere with the individual’s social, and responsible, and able to work well under pressure.
occupational or physical functioning.” They should also be patient and good at listening, and able to
deal with people from variety of backgrounds and cultures.
Horwitz describes cultural influences that affects how
individuals view mental illness. These include: INTERDISCIPLINARY TEAM

I. Incomprehensibility – the inability of the general  Regardless of treatment setting, rehabilitation program,
population to understand the motivation behind the or population, an interdisciplinary (or multidisciplinary)
behavior. team approach is most useful dealing with the
II. Cultural Relativity – the “normality” of behavior is multifaceted problems of client with mental illness.
determined by culture.  Different member of the team have expertise in specific
III. Behavior is categorized as “normal” or “abnormal” areas. By collaborating, they can meet clients’ needs
according to one’s cultural or societal norms. more effectively.
 Members of the interdisciplinary team includes the
In the DSM-IV-TR (APA, 2000), the APA defines mental illness psychiatrist, psychologist, psychiatric nurse, psychiatric
or mental disorder as: social worker, occupational therapist, recreational
“A clinically significant behavioral pattern or psychological therapist, and vocational rehabilitation specialist.
syndrome or pattern that occurs in an individual and that is
associated with present distress (e.g., a painful symptom) or Roles
disability (i.e., impairment in one or more important areas of
functioning), or with significantly increased risk of suffering 1. Psychiatrist – The primary function of the psychiatrist is
death, pain, disability, or an important loss of freedom and is diagnosis of mental disorders and prescription of
not merely an expectable response to a particular event.” medical treatments.

MENTAL HEALTH NURSE – provides treatment, care and 2. Psychologist – (Ph.D.) prepared to practice therapy,
support for people with emotional, mental and behavioral conduct research, and interpret psychological tests.
problems. Psychologist may also participate in the design of
therapy programs for groups of individuals.
Tasks and Duties
 Assessed and treats a person using a nursing framework 3. Psychiatric Nurse – gains experience in working with
such as theory of interpersonal relations. client with psychiatric disorders after graduation from
 Works within a multidisciplinary team. an accredited program of nursing and completion of
 Assist people with self-care and other daily activities. the licensure examination. The nurse has a solid
 Provides advice and support, facilitating and integrating a foundation in health promotions, illness prevention,
recovery approach. and rehabilitation in all areas, allowing him or her to
view the client holistically.
 Provides education for users and their families on mental
illness, available services, and strategies to cope with  The nurse is also an essential team member in
illness. evaluating the effectiveness of medical treatment,
 Leads and assists in therapy groups. particularly medications.
 May give evidence in court.  Registered nurses who obtained a master’s degree
 Visits people in their community in mental health may be certified as clinical
 May be involved in Mental Health Nursing Research specialists of licensed as advanced practitioners,
depending on individual state nurse practice acts.
Skills Advanced practice nurses are certified to prescribe
Mental Health Nurses are skilled in the specialized use of drugs in many states.
communication, counselling, drugs used in psychiatry,
applying specialty knowledge in the provision of clinical 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,