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PowerPoint Presentation to Accompany Videbecks 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

Factors Influencing a Persons Mental Health Individual factors:


biologic makeup, autonomy and independence, selfesteem, 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 ones 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 (contd) 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:

Axis I: all major psychiatric disorders except mental retardation and personality 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 (contd)


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 (contd)

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 (contd)

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 (contd)

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 ones own