Saint Mary’s University

Bayombong, Nueva Vizcaya

School of Health & Natural Sciences

NURSING DEPARTMENT
Course No. NCM 117 Lecture
Subject: Care of Client with Maladaptive Patterns of Behavior, Acute and Chronic
Yr. Level: BSN 3
Contact Hours/Credit Units: 4 hours/week(4units)

CHAPTER 1
Introduction to Psychiatric Nursing
I. Introduction:
Mental health nursing is a specialty of nursing that focuses on identification, prevention and treating
individuals of all ages who are experiencing short – term or long-term psychological distress.

II. Learning Objectives:

1. State the mental health treatment during the key periods from prehistoric times to the present.
2. Describe mental health and mental illness.
3. State the difference between psychopathology and psychiatric nursing.
4. Discuss the three interventions in psychotherapeutic management in the continuity of patient
care.
5. Understand the legal constitutional rights of a patient.
6. Differentiate the methods of psychiatric admission.
7. Explain the role of the different health care team.
8. Execute the different role of a psychiatric nurse.
9. Discuss the nature of self-awareness.
III. Core Content of the Chapter:
Historical Perspective:

Prehistoric times:
In the prehistoric times, mentally ill persons were treated by tribal rites. If this failed, they were left
alone to die of starvation or to be attacked by wild animals.

Greek and Roman Era:

Their temples were used to house mentally ill persons that have fresh air, pure water and
sunlight. Sometimes they were treated with kindness, while at times treatment was harsh and
barbaric. They were treated by bleeding and purging.

Middle ages:
The treatment of the mentally ill was left to the priests, the superstitious beliefs flourished. They
were flogged, fettered scourged and starved in the belief that the devils that possessed them
could be driven out.
Sixteenth century:
The mentally ill were locked up in jails, dungeons, or lunatic asylum where the curious could pay
to watch the “performance” of the sick inmates. The harmless inmates were forced to seek charity
on the streets as beggars.

Seventeenth century:
God and Satan were still thought to be engaged in a battle for the possession of one’s soul. The
dungeons were the only place where violent mentally ill person could be committed. Purging and
bleeding was the favorite therapeutic procedures done. The whip was religiously applied by the
cell keepers.

Eighteenth century:
In 1792, Frenchman Philippe Pinel was instrumental in proving the error of treating mentally ill
persons inhumanely. Benjamin Rush, the “Father of American Psychiatry,” began working in
1783. He believed that the phases of the moon influenced the person’s behavior which he called
“The Lunar Theory of Insanity.” At the same time he invented the “tranquilizer.” Although mentally
ill patients were relegated to the cellar, they were assured clean beddings and warm rooms.

Nineteenth century:
The most shocking to people of today was placing the poor and the mildly demented on the
auction block, where those with a strongest back and the weakest mind were sold to the highest
bidder. The returns of the sale are being kept in the town’s treasury.

Dorothea Dix, a teacher raised money to build suitable hospital for mentally ill persons. The
institution was designed to provide a homelike environment that would also be safe. And because
of the remoteness of the setting the institution had to produce its own food, heat and other
necessities. Patients were able to work on the farm, in the kitchen, laundry, machine shop, on the
grounds or wards. For some patients, this responsibility proved therapeutic because it provided
meaningful activity, which increased their sense of self-esteem and group cohesiveness. Having
no contact with the outside world the patient adapted to their surroundings and their roles in the
hospital to the extent that they resisted returning to their homes.

Twentieth century:
Overt change in the hospital system of mental health care began. The government believed that it
was necessary to acquire more knowledge concerning the cause, prevention and treatment of
mental illness and professionally trained workers were needed to improve the care and treatment
of the mentally ill persons.

MENTAL HEALTH:
Is a “state of complete physical, mental, and social wellness, not merely the absence of disease”
The person is in a state of emotional, physical, and social well-being fulfills life responsibilities,
function effectively in daily life, and are satisfied with their interpersonal relationships and to
themselves.

MENTAL ILLNESS:
Mental disorder is a behavior or pattern that occurs in an individual associated with present
distress or with an increased risk of suffering death, pain, disability or an important loss of
freedom.

FACTORS CONTIBUTING TO MENTAL ILLNESS:

A. INDIVIDUAL:
1. Biological
2. Anxiety
3. Worries
4. Fears
5. Loss of meaning in one’s life.
 6. Disharmony in life.

B. INTERPERSONAL:
1. Ineffective communication
2. Excessive dependency
3. Withdrawal from relationship
4. Loss of emotional control

C. CULTURAL AND SOCIAL:

1. Lack of resources
2. Violence
3. Homelessness
4. Poverty
5. Discrimination

PSYCHOPATHOLOGY:
It is a systemic study of mental disorder.

PSYCHIATRIC NURSING:
It is a process where in a nurse assist a person, individual, or in group to develop a positive self-
concept, satisfying interpersonal relationship and satisfactory role in a society.

PSYCHOTHERAPEUTIC MANAGEMENT IN THE CONTINUUM OF CARE:

A. THERAPEUTIC NURSE-PATIENT RELATIONSHIP:
1. Communication skills
2. Mental mechanism
3. Adaptation styles
4. Coping strategies
5. Therapeutic intervention skills.

B. PSYCHOPHARMACOLOGY:
1. Therapeutic and the toxic effect.
2. Drug used during pregnancy.
3. Drug used with the elderly.
4. Drug’s side effects.
5. Patient health teaching.

C. MILIEU MANAGEMENT:
1. Safety
2. Structure
3. Norms
4. Setting limits
5. Balance between independence and dependence
6. Environmental modification.

MOST COMMON ADOPTED PATIENT RIGHTS:

1. Right to treatment using the least restrictive alternative environment.
2. Right to confidentiality of records.
3. Right to freedom from restraints and seclusion.
4. Right to give or refuse consent to treatment.
5. Right to access to personal belongings.
6. Right to daily exercise.
7. Right to have visitors.
8. Right to use of writing materials and uncensored mail.
9. Right to use of telephone.
10. Right to access courts and attorneys.
 11. Right to employment compensation.
12. Right to be informed of rights.
13. Right to refuse ECT or psychosurgery.

RESTRAINING:
It is a direct application of physical force to a person with or without their permission with the use
of a mechanical device to control their physical activity.

SECLUSION:
It is an involuntary confinement or isolation of a person.

NURSING RESPONSIBILITY OF A PSYCHIATRIC NURSE IN RESTRAINING AND ISOLATING A

PATIENT:
1. Documentation has to be justified.
2. Alternative was considered and attempted.
3. It has to be ordered by the physician.
4. Note the type of restraint used.
5. Note the time and duration.
6. Check the patient every 15 min.
7. Check every 2 hrs. for continued needs.
8. Offer fluid every hour.
9. Exercise patients limb every 2 hrs.
10. Snacks and meals are offered to the patient.
11. Assist the patient to the comfort room.

TYPES OF PSYCHIATRIC ADMISSION:

1. Voluntary- the patient or guardian request for treatment and willingly signed an
application for treatment.
2. Involuntary- the patient refuses to sign consent and is involuntarily detained for
treatment.

TYPES OF INVOLUNTARY TREATMENT:

1. Emergency- the patient is admitted because he is dangerous to others and to
himself.
2. Temporary- the patient is involuntarily hospitalized for a maximum of 6 months.
3. Extended- the patient is admitted with unspecified period of time.

MEMBERS OF THE MENTAL HEALTH CARE TEAM:

The health care team consists of health care professionals who have their own specialties:
1. Psychiatric nurse- a registered nurse that gives comprehensive care to the patient.
2. Psychiatrist- a physician is the leader of the team, ordering the medication and
making the medical diagnosis.
3. Clinical psychologist- a person involve in diagnosing and treating an emotionally
person. They use a complex device to assist them in diagnosing a patient. Which is
called the “Rorschach test” that consist of 10 pictures of ink blots,5 black and white,
3 black and red, 2 multicolored.
4. Psychiatric social worker- a person skilled in assessing a family, environment, and
social factor that can contribute to the dysfunctional behavior of the individual and
the family. They plan and implement follow up care for the patient.
5. Activity therapist- a skilled nurse who provides activities to a specific patient to assess
their behavior.
ROLES AND FUNCTIONS OF THE NURSE:
1. A creator of a therapeutic environment
2. A socializing agent
3. A counselor
4. A teacher
5. A surrogate
6. A therapist
7. Technical nursing role

NURSE’S RESPONSIBILITY:
The nurse caring for a mentally ill patient is expected to know and anticipate the various types of
hazards which may develop as a result of the individual patient’s mental status. The nurse can be
held liable if, in the opinion of the court, the nurse was negligent in providing protection and care
constituting prevention against the development of any situation injurious to the patient. Suicide
attempts as well as accidental injuries, occurring in the hospital.

Duty to warn: To inform health care team of any harm the patient might do.

SELF AWARENESS:
It is the process by which the nurse gains recognition of his own feelings, beliefs, and attitudes.

The nurse must learn to accept the differences among people and view the patient as a worthwhile
person regardless of his opinion or lifestyle.
Self-awareness can be accomplished through reflection, spending time focusing on how one feels,
their values and beliefs.
The nurse needs to discover himself, what he believes in before trying to help others with different
views.
As a student nurse make sure personal feelings and beliefs do not interfere with or hinder the client’s
care.
As a psychiatric nurse you need to be prepared to make positive use of your own personality, your
primary tool as you work therapeutically with clients.

Psychotherapeutic therapeutic management in the continuity of patient care.

A. Environment:
Safe – avoid danger/harm
Structure – settings and ward schedules
Setting limits – limitations in the ward
Balance – independent and dependent behavior
Modification – physical features of the ward
Norms – clients behavior

B. Medication:
Therapeutic effect
Side effects
Health teaching

C. Therapeutic N-P relationship

Communication skills
Coping strategies
Therapeutic intervention

Triad of Needs:
A. Physical – nutrition, clothing, shelter, exercise and protection from body harm.
B. Psychological – love, trust and affection.
C. Social – feeling of being a member of a group and feeling of being valued member of
a family.
IV. Activity:
Short Paper
Answer the question in 200 words.
1. If you develop a mental health problem, which aspect of psychotherapeutic
management model would be most important to you? Explain why?

Short quiz

V. Bibliography:
Videbeck, S. (2014). Psychiatric-Mental Health Nursing. Wolters
Keltner, N., Bostrom C., & McGuiness T. (2012). Psychiatric Nursing. Elsevier Inc.
www.doh.gov.ph

Prepared by:
Mrs. Rosalie C. Carreon,RN,MSN
Nursing Department