PSYCHIATRIC NURSING
It is the process whereby the nurse assists mentally ill persons, as individuals or in groups, in developing a more
positive self-concept, a more harmonious pattern of interpersonal relationships, and a more productive role in
society.
The care of the mentally ill is no longer exclusively rendered in hospitals, but rather is being focused more and more
in community-based situations.
MENTAL HEALTH
A state of well being in which a person is able to cope with the normal stresses of daily life and his ability
to realize his potentials. (WHO Definition)
Margaret Mead, world famous anthropologist, has written that mental health is actually determined by a set of ratios
involving the emotional, social and psychological strengths with which an individual is fortified; the events which he
has experienced throughout life; the pressures which he has experienced throughout life; the pressures which he
is currently undergoing, and the expectations which society has established for him.
The individual’s level of self-acceptance and the way he perceives reality are usually mentioned as two other
capacities significant in the development of mental maturity.
Has been defined as “that state in the interrelationship of the individual and his environment in which personality
structure is relatively stable, and the environmental stresses are within its absorptive capacity.” (cited by Sia 2010,
Marmor, 1950)
CHARACTERISTICS OF A MENTALLY HEALTHY PERSON (cited by Sia 2010, Taylor 1990)
Self-acceptance – Accepts his strengths and limitations realistically, works to maximize strengths and minimize
limitations.
Perceives reality accurately
Exhibits environmental mastery – Capacity to feel in control of self and environment
Self-determination or autonomy – Engages in independent thinking and action.
Achieves a unifying, integrated outlook in life – Confident and sure of his role and direction in life.
MENTAL HEALTH INDICATORS (JAHODA):
Positive attitude toward self
Autonomy
Perception of reality
Integration
Growth, development and ability to achieve self-
actualization
Environmental mastery
MENTAL ILLNESS
It is thought to be a unique response involving an individual’s personality as it interacts with his
environment at a time when he is particularly vulnerable to disease.
A state of imbalance characterized by a disturbance in person’s thoughts, feelings and behavior.
Poverty and abuses are major factors which increases the risk of mental illness in the home.
FACTORS THAT MAY CONTRIBUTE TO MENTAL ILLNESS
1. Genetic Factors – the individual inherits the family milieu into which he is born and the cultural
forces with which he will be required to deal.
2. Organic Factors –this factor suggest that personality plays an important role in behavioral
response even when brain tissue is involved. Traumatic brain damage is one of the common
organic problems to which the human organism reacts with abnormal mental symptoms.
3. Psychogenic factors –are involved with the individual’s subjective and emotional feelings about
himself. These include feelings of self-esteem, security, well-being, personal value, guilt and
inferiority.
4. Causative factors related to age – There are some periods in life when the individual is more
vulnerable emotionally than others.
The following are the critical periods:
a) Adolescence – the adolescent’s desperate need to belong to his age group causes him
to be influenced greatly by the social standards of his peers.
b) Involutional period of women – this critical period during the late forties for women and
during the late fifties for men. In this period, declining activity of the reproductive function,
which many men and women consider to distinguish them as being manly or womanly.
c) Old age ( after the age of 60) – This is an extremely critical period in the lives of many
individuals because of the feelings of insecurity brought on by the changes in life style
caused by retirement, the threat of financial dependency resulting from the loss of income,
and the fear of the loss of physical competence.
5. Interpersonal factors – refer to the relationships that individual develops with significant factors.
6. Cultural factors – the culture into which one is born superimposes upon the individual many values
and ideas with which he must cope for the remainder of his life.
7. Childhood Experiences
PSYCHIATRIC NURSING
Interpersonal process whereby the professional nurse practitioner through the therapeutic use of
self, assist an individual, family, group or community to promote mental health, to prevent mental
illness and suffering, to participate in treatment and rehabilitation of the mentally ill and if necessary
to find meaning in these experiences.
It is both a Science and an Art
o Science
The use of different theories in the practice of nursing, these serves as the science of
psychiatric nursing
o Art
The therapeutic use of self is considered as the art of psychiatric nursing
The core of psychiatric nursing is:
o The interpersonal process, that is human to human relationship.
Clientele of psychiatric nursing:
o Individual, family, community, both mentally ill and healthy person.
MENTAL HYGIENE
It is the science that deals with measures to promote mental health, prevent mental illness and
suffering and facilitate rehabilitation.
DEFINITION OF PERSONALITY
Personality – includes the individual’s biological and intellectual endowment, the attributes that
had been acquired through experience, and his conscious and unconscious reactions and feelings.
FREUDS PSYCHOANALYTIC MODEL (1856 – 1939)
It was Freud who first proposed that childhood experiences are crucial in the development of personality
and that personality is primarily shaped during childhood. Freud also believed that at each stages of
personality development, the libidinal energy is focused at certain areas of the body. The person derives
pleasure and expresses needs through the area of the body where the libidinal energy is concentrated.
Levels of consciousness (Freud)
Conscious – part of the mind that is aware of the here and now as it relates to the individual
and his environment. It only functions when the individual is awake. It is concerned with
thoughts, feelings and sensations.
Preconscious and subconscious – is that part of the mind in which ideas and reactions are
stored and partially forgotten – it is not economical for human beings to burden the conscious
mind with a multitude of facts that are infrequently used and currently not in demand.
Unconscious – largest part of the mind and is sometimes compared to the large hidden part
of an iceberg that floats under the water. It is the storehouse for all the memories, feelings
and responses experienced by the individual during his entire life.
Freud did not exactly invent the idea of the conscious and subconscious. But it was him who made them
famous and he added another part of the mind, which is the unconscious.
Structure of Personality (Freud)
Id
Is part of and derived from the unconscious. It is unlearned, primitive, selfish and the source
of all psychic energy. It contains the instinctual drives, included in which we are the drive for
self-preservation, the drive to reproduce and the drive for group association.
When the new individual is born he is said to be a bundle of id, seeking only to satisfy his
needs and to find release for psychological tensions
It operates on the basis of pleasure principles, that is to say, the id presses for avoidance
of pain at all cost and seeks to maintain pleasure.
Primary process according to Freud is the translation of need to drive. When a hungry
person wishes for food or fantasizes food, that person is engaging in primary process
thinking.
Ego
It promotes the individual’s satisfactory adjustment in relation to his environment. Its main
function is to effect an acceptable compromise between the crude pleasure – seeking
strivings of the id and the inhibitions of the superego.
The means through which ego achieve this goal is reality testing, meaning the ego deals
with the demands of reality as it strives to control and derive satisfaction from the
environment. This states that, “take care of a need as soon as an appropriate object is found.”
Secondary process is the problem solving mechanism of the ego. The ego controls the
demands of and mediates between the id and superego according to the demands of the
reality.
Superego
The last to develop. Its development is partially a result of the socialization process that the
child undergoes. The superego incorporates the taboos, prohibitions and ideals and
standards of parents and the other significant adults with whom the child associates. It refers
to the blindly rigid, strict moralistic part of the mind, which can be as relenting and ruthless
as the id.
It operates mostly on the unconscious levels and at this level is an inhibitor of the
Id. At the conscious levels it may be regarded as the voice of the conscience or
the phase of personality that is keenly sensitive to the demands of strict
convention.
Ego ideal- one aspect of the superego which directs behavior to simulate that of
the individuals the person admires and wishes to emulate.
School Latency During this period the child represses sexual thoughts and channels his
age (6-12 libidinal energies into the pursuit of intellectual interests.
years old) The child begins the process of emancipating himself from the family by
seeking security and companionship from peer group of the same sex.
Gang formation and fierce gang loyalties.
Normal homosexual relationship because groups of boys cling
together and shun girls. In the same way, groups of girls band together
and declare they despise boys.
Puberty Genital In this stage the focus is again on the genitals, like in the phallic stage,
(12 – 18) but this time the energy is expressed with adult sexuality.
Another crucial difference between these two stages is that, while in the
phallic gratification is linked with satisfaction of the primary drives, the
ego in the genital stage is well-developed, and so uses secondary
process thinking, which allows symbolic gratification.
The symbolic gratification may include the formation of love relationships
and families, or acceptance of responsibilities associated with
adulthood.
Heterosexual relationship may occur.