117 Foundations

Notes on 117 (from book)
FOUNDATIONS OF PSYCHIATRIC-MENTAL HEALTH NURSING
Health
- a state of complete physical, mental, and social wellness, not merely the absence of disease or
infirmity.
- positive state of well-being;
- fulfill life responsibilities, function effectively in daily life, and are satisfied with their interpersonal
relationships and themselves.
Mental health
- a state of emotional, psychological, and social wellness evidenced by satisfying interpersonal

relationships, effective behavior and coping, positive self-concept, and emotional stability.
- a dynamic, or ever-changing, state
- Factors influencing a person’s mental health
1. Individual/personal - person’s biologic 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.
2. Interpersonal/relationship - effective communication, ability to help others, intimacy, and a
balance of separateness and connectedness.
3. Social/cultural or environmental - 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 one’s world.
Mental illness
- disorders that affect mood, behavior, and thinking

- Mental disorders often cause significant distress or impaired functioning, or both
- Individuals experience dissatisfaction with self, relationships, and ineffective coping.
- Factors contributing to mental illness
1. Individual factors - biologic makeup, intolerable or unrealistic worries or fears, inability to
distinguish reality from fantasy, intolerance of life’s uncertainties, a sense of disharmony in life,
and a loss of meaning in one’s life.
2. Interpersonal factors - ineffective communication, excessive dependency on or withdrawal from
relationships, no sense of belonging, inadequate social support, and loss of emotional control.
3. Social/cultural factors - lack of resources, violence, homelessness, poverty, an unwarranted
negative view of the world, and discrimination such as stigma, racism, classism, ageism, and
sexism (some of these can result in isolation, feelings of alienation, and maladaptive, violent, or
criminal)
Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5)
- describes all mental disorders, outlining specific diagnostic criteria for each based on clinical
experience and research.
- 3 purposes:
1. To provide a standardized nomenclature and language for all mental health professionals
2. To present defining characteristics or symptoms that differentiate specific diagnoses
3. To assist in identifying the underlying causes of disorders
History
1950 - First drugs: Chlorpromazine (Thorazine): antipsychotic drug, and lithium: an antimanic agent
Deinstitutionalization
- accomplished the release of individuals from long-term stays in state institutions, decrease in
admissions to hospitals & development of community-based services as an alternative to hospital
care.
- Negative effect: number of admissions to those beds correspondingly increased by 90% (revolving
door effect); people with severe and persistent mental illness have shorter hospital stays, but they
are admitted to hospitals more frequently
Managed care
- a concept designed to purposely control the balance between the quality of care provided and the
cost of that care.
- people receive care based on need rather than on request; those who work for the organization
providing the care assess the need for care.
- began in the early 1970s in the form of health maintenance organizations, which were successful in
some areas with healthier populations of people.
Case management
- management of care on a case-by-case basis

- represented an effort to provide necessary services while containing cost
- client is assigned to a case manager (coordinates all types of care needed by client)
- Theory: designed to decrease fragmented care from a variety of sources, eliminate unneeded overlap
of services, provide care in the least restrictive environment, and decrease costs for the insurers
- Reality: expenditures are often reduced by withholding services deemed unnecessary or by
substituting less expensive treatment alternatives for more expensive care, such as hospital
admission.
1920 - first psychiatric nursing textbook (Nursing Mental Diseases by Harriet Bailey)
1913 - first school of nursing to include a course in psychiatric nursing in its curriculum (Johns Hopkins)
1950 - National League for Nursing required nursing schools to include an experience in psychiatric nursing
Two early nursing theorists shaped psychiatric nursing practice: Hildegard Peplau and June Mellow.
- Peplau published Interpersonal Relations in Nursing (1952) and Interpersonal Techniques: The Crux
of Psychiatric Nursing (1962). She described the therapeutic nurse–client relationship with its phases
and tasks and wrote extensively about anxiety. The interpersonal dimension that was crucial to her
beliefs forms the foundations of practice today.
- Mellow’s work (1968), Nursing Therapy, described her approach of focusing on clients’ psychosocial
needs and strengths; contended that the nurse as a therapist is particularly suited to working with
those with severe mental illness in the context of daily activities, focusing on the here and now to
meet each person’s psychosocial needs.
Standards of care
- American Nurses Association (ANA)

- authoritative statements by professional organizations that describe the responsibilities for which
nurses are accountable. They are not legally binding unless they are incorporated into the state nurse
practice act or state board rules and regulations.
- When legal problems or lawsuits arise, these are used to determine safe and acceptable practice and
to assess the quality of care
- Form the basis for specialty areas to write standards for practice.
Phenomena of concern
- American Psychiatric Nurses Association (APNA)

- describe the 13 areas of concern that mental health nurses focus on when caring for clients
- The standards of care incorporate the phases of the nursing process, including specific types of
interventions for nurses in psychiatric settings; outlines standards for professional performance,
quality of care, performance appraisal, education, collegiality, ethics, collaboration, research, and
resource utilization
Phenomena of concern for psychiatric–mental health nurses
• Promotion of optimal mental and physical health and well-being and prevention of mental illness
• Impaired ability to function related to psychiatric, emotional, and physiologic distress
• Alterations in thinking, perceiving, and communicating because of psychiatric disorders or mental
health problems
• Behaviors and mental states that indicate potential danger to self or others
• Emotional stress related to illness, pain, disability, and loss
• Symptom management, side effects, or toxicities associated with self-administered drugs,
psychopharmacologic intervention, and other treatment modalities
• The barriers to treatment efficacy and recovery posed by alcohol and substance abuse and
dependence
• Self-concept and body image changes, developmental issues, life process changes, and end-of-life
issues
• Physical symptoms that occur along with altered psychological status
• Psychological symptoms that occur along with altered physiologic status
• Interpersonal, organizational, sociocultural, spiritual, or environmental circumstances or events that
have an effect on the mental and emotional well-being of the individual and family or community
• Elements of recovery, including the ability to maintain housing, employment, and social support, that
help individuals reengage in seeking meaningful lives
• Societal factors such as violence, poverty, and substance abuse
Areas of Practice
Basic-Level Functions
• Counseling
➢ Interventions and communication techniques
➢ Problem-solving
➢ Crisis intervention
➢ Stress management
➢ Behavior modification
• Milieu therapy
➢ Maintain therapeutic environment
➢ Teach skills
➢ Encourage communication between clients and others
➢ Promote growth through role modeling
• Self-care activities
➢ Encourage independence
➢ Increase self-esteem
➢ Improve function and health
• Psychobiologic interventions
➢ Administer medications
➢ Teach
➢ Observe
• Health teaching
• Case management
• Health promotion and maintenance
Advanced-Level Functions
• Psychotherapy
• Prescriptive authority for drugs
• Consultation and liaison
• Evaluation
• Program development and management
• Clinical supervision

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Notes on 117 (from book)

FOUNDATIONS OF PSYCHIATRIC-MENTAL HEALTH NURSING

- a state of emotional, psychological, and social wellness evidenced by satisfying interpersonal

- disorders that affect mood, behavior, and thinking

Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5)

- management of care on a case-by-case basis

- American Nurses Association (ANA)

- American Psychiatric Nurses Association (APNA)

Phenomena of concern for psychiatric–mental health nurses

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