ARELLANO UNIVERSITY Pag-asa St.

, Caniogan, Pasig City College of Nursing

LECTURE NCM 105 CARE OF CLIENTS WITH MALADAPTIVE PATTERN OF BEHAVIOR

I. OVERVIEW OF PSYCHIATRIC NURSING A. What is Psychiatric Nursing? It is a branch of Nursing which focuses on the care of the person, regardless of age, with a mental disorder (whether psychosis or neurosis) A field of nursing practice in which the plan of care emphasizes mental health and the treatment of the patients mental disorder or the palliation of its symptoms and An integral part of the nursing curriculum that teaches the proper management of mental disorders and maintaining mental health. B. What is Mental Health and Mental Illness? Mental Health: No clear-cut definition, defined how society sees it People who fail to fulfill roles and carry out responsibilities are viewed as ill No single universal definition of mental health exists WHO: Health- as a state of complete physical, mental, and social wellness, not merely the absence of diseases or infirmity Factors influencing a persons mental health can be categorized as individual, interpersonal, and social/cultural INDIVIDUAL: personal factors (biological makeup, autonomy and independence, self-esteem, capacity for growth, vitality, ability to find meaning in life, emotional resilience or hardiness, sense of belonging, reality orientation, and coping or stress management abilities) INTERPERSONAL: relationship (effective communication, ability to help others, intimacy, and a balance of separateness and connectedness)

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SOCIAL/CULTURAL:environmental (sense of community, access to adequate resources, intolerance of violence, support of diversity among people, mastery of the environment, positive yet realistic view of ones world) Mental Illness: American Psychiatric Association (2000) defines Mental disorder as a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress. General criteria to diagnose : - dissatisfaction with ones characteristics, abilities, and accomplishments -ineffective or unsatisfying relationships -dissatisfaction with ones place in the world -ineffective coping with life events -lack of personal growth Good Mental Health (intact) A- utonomy and independence T- olerance to lifes complexion and uncertainties M- astery of the environment O- utlook that is positive S- elf-esteem (an important criterion) P- otentials are realized and maximized H- appy with the self and can laugh at ones mistakes E- motionally flexible and resilient R- eality testing is intact (most crucial of all criterion listed) E-volving, re-inventing or self-programming C. Evolution of mental health psychiatric nursing practice BENCHMARKS IN PSYCHIATRIC HISTORY Before: mentally ill were often regarded no better than wild animals Rosenblatt: ABCs of community response A-ssistance B-anishment C-onfinement I. Benchmark I: Period of Enlightenment (1790s) Start of the era of the modern Psychiatric care Dawn of Enlightenment, ASYLUMS were

established Pinel and Tuke developed the concept of asylum ASYLUM- can mean protection, social support, or sanctuary Currently: provokes an image of mistreatment and neglect A place of refuge to a place of torment. Eastern Lunatic Asylum in Williamsburg, Virginia (1773)- 1st asylum in the US Others: Frankford Asylum near Philadelphia (1813) Bloomingdale Asylum in NY (1818) Hartford Retreat in Connecticut (1824) Dorothea Dix (1802-1887)- 1st major reformers in the US, instrumental in developing concept of asylum, played an important role in opening 32 state hospitals Today, a renewed interest in asylum as a place of rest and restoration exists. Four Ps: P-arents P-rofessionals P-atients P-ublic Wasow (1993) Some peoples illnesses are so severe that they will always need an asylum. A continuum of care is needed: from total freedom total hospitalization, reflecting the diverse needs of mentally ill people. II. Benchmark II: Period of Scientific Study Toward the last 3rd of the 19th century Shift from sanctuary to treatment Sigmund Freud (1856-1939) -He had the greatest impact on worlds view on mental illness -He described human behavior in psychological terms -He developed a theory of motivation -He explained the importance of dreams -He proposed to unlock the hidden parts of the mind Emil Kraepelin (1856-1926) -He made tremendous contributions to the classification of mental disorders Eugene Bleuler (1857-1939) - He coined the term Schizophrenia and added a note of optimism to its treatment

III. Benchmark III: Period of Psychotropic Drugs Start around 1950s chlorpromazine (Thorazine) antipsychotic, imipramine (Tofranil)antidepressant were introduced IV. Benchmark IV: Period of Community Mental Health Innacurate start of era YEAR AND LEGISLATIVE ACT: 1946-Pres. Harry Truman signed the National Mental Health Act enabling 1947- Hill-Burton Act: Allocated funds for general hospitals to develop psychiatric units 1949- the establishment of the National Institute of Mental Health 1961- Pres. John F. Kennedy: Joint Commission on Mental Illness and Health established 1963- Community Mental Health Centers Act A deliberate shift was made from institutional to extrainstitutional care: the GOAL was deinstitutionalization of the state hospital system population V. Benchmark V: Decade of the Brain Started in the 1990s Increase in brain research coincided with an increased interest in biologic explanations for mental disorders Nursing responded to this challenge with a significant augmentation of psychobiologic content in academic nursing program It crystallized the fact that some behavior are caused by biologic irregularities and not willful contrariness, or worse This brought back nursing into the mainstream of psychiatric care. D. The Mental Health Nurse 1. Evolution of the Psychiatric Nursing role and functions 1873- Linda Richards developed better nursing care in psychiatric hospitals and organized nursing services and educational programs in state mental hospitals in Illinois. She was as first American Psychiatric Nurse. She states that Mentally sick should be at least as well cared for as the physically sick. 1882- first school to prepare nurses for the mentally ill opened at McLean Hospital in Waverly, Massachusetts. A 2-year program prepared nurses

as custodial, focused on the patients physical needs 1913- Johns Hopkins became the first school of nursing to include fully developed course for psychiatric nursing in the curriculum 1935-37- emergence of various somatic therapies (insulin shock therapy, psychosurgery and electroconvulsive therapy) became important factors in psychiatric nursing. These techniques required medical-surgical skills of nurses. 1947- eight graduate program in psychiatric nursing had been started 1950- role emergence, the role of psychiatric nursing emerges, the difference between psychiatric and general duty nurses were defined. Weiss described the attitude of a nurse (Attitude therapy) contributes to the patients recovery 1951- June Mellow wrote in her work activities she called as nursing therapy 1952- Tudor described in her study a nurse-patient relationship which she described as characterized by unconditional care, few demands and anticipatory of patients needs 1952- Dr. Hildegard Peplau, a dynamic leader who shaped psychiatric nursing , published a book, Interpersonal Relations in Nursing, in which she described the first theoretical framework for psychiatric nursing and the specific skills, activities, and roles of psychiatric nurses. Peplau defined nursing as a significant, therapeutic process. She saw nurses emerge in various roles: a resource person; a teacher; a leader in local, national, and international situations; a surrogate parent; and a counselor. 1962- Peplau furthermore clarified psychiatric nursings position and directed its future growth. In Interpersonal Techniques: the Crux of Psychiatric Nursing, she differentiated the role of general practitioners who were nurses from psychiatric nurses whom she identified as counselor or psychotherapist, specialist and expert clinical practitioners with graduate degree in Psychiatric nursing 1960s- focus of psychiatric nursing began to shift to primary prevention and implementation of care and consultation in the community. - psychiatric nursing was changed to psychiatric and mental health nursing as stimulated by the Community Mental Health Centers Act of 1963 - This legislation prompted growing awareness of

treating people in the community and preventing hospitalization as possible 1970s- Psychiatric nurses became pacesetters in specialty nursing practice, they develop standards and statements on scope of practice; & establish generalist and specialist certification - Likewise, nursing profession was defining caring as a core element of all nursing practice, and the contributions of psychiatric nursing was embraced by all specialty groups - Psychosocial nursing emerged as nonpsychiatric nursing subjects integrated with psychiatric nursing course. However, due to the integration psychiatric clinical rotations were replaced with psychosocial aspects of the care of physically ill patients in general medicalsurgical units, students opportunity to care of psychiatric patients were lessened 1980s- an era of exciting scientific growth in the area of psychobiology- understanding the brain. However, it lacked integration and found limited clinical usefulness. - Psychiatric nurses were slow to shift away from primarily psychodynamic models of the mind to more balance psychobiological models of psychiatric care 1990s- Psychiatric nurses saw the need to become realigned with care and caring, which represents the art of psychiatric nursing and complement the high technology of current health care practices Contemporary practice - Psychiatric nursing is an interpersonal process that promotes and maintains patient behavior that contributes to integrated functioning. - The patient may be an individual, family, group, organization, or community - ANAs Scope and Standards of PsychiatricMental Health Nursing Practice defines psychiatric nursing as a specialized area of nursing practice, employing the wide range of explanatory theories of human behavior as its science and purposeful use of self as its art - The Center for Mental Health Services officially recognizes psychiatric nursing as one of the five core mental health disciplines. The other four disciplines are marriage and family therapy, psychiatry, psychology and social work. E. Interdisciplinary Qualities:

 Nurse-patient partnership evolved and expands the dimension of the professional psychiatric nursing role. These elements include clinical competence, patient-family advocacy, fiscal responsibility, interdisciplinary collaboration, social accountability, and legal-ethical parameters. 2. Essential qualities of a Psychiatric Nurse: A-cceptance T-herapeutic use of self T-alking to one self (introspection) I-nterest (must be genuine) T-esting oneself (constantly challenging oneself with new experiences U-nderstanding and caring D-ealing well with others personal beliefs and issues E-mpathy F. The mental health illness continuum