Test1PPT Chapter 01

Chapter 1
Foundations of Psychiatric–
Mental Health Nursing
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Mental Health
• Difficult to define
• No single, universal definition
• Many components influenced by factors
• Dynamic, ever-changing state
• Influencing factors:
– Individual (personal)
– Interpersonal (relationship)
– Social/cultural (environmental)

Mental Illness
• Includes disorders that affect:
– Mood
– Behavior
– Thinking
• These often indicate signs of distress and/or impaired

functioning.

Mental Illness (cont.)
• General criteria for diagnosis:

– Dissatisfaction with characteristics, abilities,
accomplishments
– Ineffective or unsatisfying relationships
– Dissatisfaction with one’s place in the world
– Ineffective coping with life events
– Lack of personal growth

Diagnostic and Statistical Manual of
Mental Disorders
• DSM: Taxonomy of American Psychiatric Association
• Purposes:
– Standardize nomenclature, language
– Identify defining characteristics or symptoms
– Assist in identifying underlying causes

DSM Classification
• Allows the practitioner to identify all factors that relate to

a patient’s condition:
– Major psychiatric disorders
– Medical conditions
– Psychosocial and environmental problems

Question
• Is the following statement true or false?
• The definition of mental health is standardized and

universally accepted.

Answer
• False
• Rationale: There is no single universal definition of

mental health, which has many components and is
influenced by myriad factors.

Historical Perspectives
• Ancient times
– Sickness as displeasure of gods; punishment for
sins; viewed as demonic or divine
– Aristotle and imbalances of the four humors (blood,

water, yellow and black bile); balance restoration via
bloodletting, starving, and purging
– Early Christians’ view as possession by demons

Historical Perspectives (cont.)
• Period of enlightenment (1790s)
– Creation of asylums; moral treatment
– Dorothea Dix
• Sigmund Freud: scientific study, treatment of mental

illness

Historical Perspectives (cont.)
• Psychopharmacology (1950s): development of

psychotropic drugs
• Community mental health movement

– Deinstitutionalization
– Legislation for disability income
– Changes in commitment laws

Mental Illness and the 21st Century
• Current state
– More than 26% of Americans aged 18 years and
older have diagnosable mental disorder (NIMH,
2008)
– 15 million adults, 4 million children and adolescents

with impaired daily activities
– Economic burden exceeds that by all types of cancer.

(cont.)
• Current state (cont.)
– Leading cause of disability in the United States and
Canada for those 15 to 44 years of age
– Increasing number of both adults and

children/adolescents are being treated for mental
illness.
– Treatment still lagging in homeless and those with

substance abuse problems
(cont.)
• Issues and concerns:
– “Revolving-door” effect due to deinstitutionalization
– Shorter hospital stays, decompensation,

rehospitalization, dual diagnoses

(cont.)
• Issues and concerns (cont.):
– Homelessness (1/3 estimated to have serious mental
illness; over 1/2 with substance abuse problems)
– Increase in physical illness comorbidities
– Lack of adequate community resources

Question
• Which statement best reflects the current state of mental

health and mental illness?
– A. Mental health-care costs exceed the costs for
cancer care.
– B. Most adults and children receive adequate
mental health care.
– C. Community resources for the homeless with
mental illness are adequate.
– D. Deinstitutionalization has reduced the
revolving-door effect.

Answer
• A. Mental health-care costs exceed the costs for cancer

care.
• Rationale: The economic burden of mental illness

exceeds that for all types of cancer care.
– Only 1 in 4 adults and 1 in 5 children received the

necessary mental health care. Community resources
for homeless clients with mental illness are
inadequate. Deinstitutionalization has led to the
“revolving-door” effect.
Objectives for the Future
• Healthy People 2020 objectives:
– Increase number of people identified, diagnosed,
treated, helped to live healthier lives
– Decrease rates of suicide, homelessness
– Increase employment for those with serious mental
illness
– Provide more services for incarcerated persons with
mental health problems

Community-Based Care
• Lack of appropriate number of community mental health

centers to provide services
• Development of community support programs

– Availability, quality of services highly variable
– Inaccurate anticipation of extent of people’s needs
– Despite flaws, positive aspects making them
preferable for treatment

Cost Containment and Managed Care
• Managed care movement (early 1970s)
• Development of utilization review firms/managed care

organizations (1990s); case management
• Separation of mental health care from physical care for

insurance coverage

Cost Containment and Managed Care
(cont.)
• Mental health-care management through privately owned

behavioral health-care firms
– If no private insurance, reliance on counties of
residence for payment
• HCFA: Medicare, Medicaid
• Mental health parity, insurance coverage

Cultural Considerations
• Culturally diverse population
• Cultural differences influencing mental health, treatment

of mental illness
• Changes in family structure

Question
• Community-based programs are preferable for treating

many people with mental illness.

Answer
• True
• Rationale: Although there are flaws in the system,

community-based programs have positive aspects that
make them preferable for treating many people with
mental illness.

Psychiatric Nursing Practice
• Linda Richards: first American psychiatric nurse
• McLean Hospital, Belmont, MA: site of first training for

nurses to work with persons with mental illness
• Expansion of role with development of somatic therapies

Psychiatric Nursing Practice (cont.)
• First psychiatric nursing textbook (Nursing Mental

Diseases) published in 1920
• Johns Hopkins: first school of nursing to include

psychiatric nursing course (1913)
• National League for Nursing (1950) requiring schools to

include psychiatric nursing experience

• H. Peplau: therapeutic nurse–client relationship;

interpersonal dimension (foundation for current practice)
• J. Mellow: focus on client’s psychosocial needs, strengths
• American Nurses Association and Standards of Care (see

Box 1.3)
• Psychiatric–Mental Health Nursing Phenomena of Concern

(see Box 1.2)

• Basic-level functions • Advanced-level functions
– Counseling – Psychotherapy
– Milieu therapy – Prescriptive authority
for drugs
– Self-care activities
– Consultation, liaison
– Psychobiologic
interventions – Evaluation
– Health teaching
– Case management
– Health promotion,
maintenance
Student Concerns and Psychiatric–Mental
Health Clinical Experience
• Saying the wrong thing

• Knowing what to do
• Being rejected or not talking to the student
• Asking personal questions
• Handling bizarre, inappropriate, or sexually aggressive
behavior
• Handling feeling unsafe

Student Concerns and Psychiatric–Mental
Health Clinical Experience (cont.)
• Seeing someone known on the unit
• Dealing with similar problems or backgrounds

Question
• The National League for Nursing required schools to

include a psychiatric nursing experience before the first
nursing school included a psychiatric nursing course in its
curriculum.

Answer
• False
• Rationale: Johns Hopkins was the first school of nursing

to include a course in psychiatric nursing in its
curriculum; this was done in 1913. It was not until 1950
that the National League for Nursing required schools to
include an experience in psychiatric nursing.

Self-Awareness Issues
• Everyone has unique or different values, ideas, and

beliefs.
• Possible conflict between personal values/beliefs, those

of client
• Need to accept differences; view each client as

worthwhile regardless of opinions or lifestyle
• Self-awareness through reflection

Test1PPT Chapter 01

Diunggah oleh

Informasi Dokumen

Judul Asli

Hak Cipta

Format Tersedia

Bagikan dokumen Ini

Bagikan atau Tanam Dokumen

Opsi Berbagi

Apakah menurut Anda dokumen ini bermanfaat?

Apakah konten ini tidak pantas?

Hak Cipta:

Format Tersedia

Test1PPT Chapter 01

Diunggah oleh

Hak Cipta:

Format Tersedia

Chapter 1

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

• These often indicate signs of distress and/or impaired

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

• General criteria for diagnosis:

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

• DSM: Taxonomy of American Psychiatric Association

– Identify defining characteristics or symptoms

– Assist in identifying underlying causes

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Allows the practitioner to identify all factors that relate to

– Major psychiatric disorders

– Psychosocial and environmental problems

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Is the following statement true or false?

• The definition of mental health is standardized and

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Rationale: There is no single universal definition of

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

– Aristotle and imbalances of the four humors (blood,

– Early Christians’ view as possession by demons

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Period of enlightenment (1790s)

– Creation of asylums; moral treatment

• Sigmund Freud: scientific study, treatment of mental

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Psychopharmacology (1950s): development of

• Community mental health movement

– Legislation for disability income

– Changes in commitment laws

– 15 million adults, 4 million children and adolescents

– Economic burden exceeds that by all types of cancer.

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

– Increasing number of both adults and

– Treatment still lagging in homeless and those with

• Issues and concerns:

– “Revolving-door” effect due to deinstitutionalization

– Shorter hospital stays, decompensation,

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

– Increase in physical illness comorbidities

– Lack of adequate community resources

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Which statement best reflects the current state of mental

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

• A. Mental health-care costs exceed the costs for cancer

• Rationale: The economic burden of mental illness

– Only 1 in 4 adults and 1 in 5 children received the

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Lack of appropriate number of community mental health

• Development of community support programs

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Managed care movement (early 1970s)

• Development of utilization review firms/managed care

• Separation of mental health care from physical care for

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Mental health-care management through privately owned

• HCFA: Medicare, Medicaid

• Mental health parity, insurance coverage

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Culturally diverse population

• Cultural differences influencing mental health, treatment

• Changes in family structure