Psychiatric Nursing

Health (WHO)
 It is a state of complete physical, mental, and social well- being and not merely the
absence of disease and infirmity.

Mental Hygiene
 The branch of psychiatry that deals with the science and practice of maintaining and
restoring mental health, and of preventing mental disorder through education, early
treatment, and public health measures.

Mental Hygiene
 Science of maintaining mental health and preventing disorders to help people function
at their full mental potential

6 techniques to take care of our mental hygiene

by: Edward G. Brown
1. Transcend the environment
2. Cultivate constructive acceptance
3. Visualize the ideal self
4. Use positive affirmation
5. Practice psychological counterpunching
6. Change your internal computer chip

Mental Health
 It is a state of emotional, psychological and social wellness evidence by satisfying
interpersonal relationships, effective behavior and coping, a positive self-concept and
emotional stability.
 It is a psychological state of well-being, characterized by continuing personal growth, a
sense of purpose in life, self- acceptance, and positive relations with others.
 It is the absence of mental illness.
 It is the ability to solve problems, fulfill one’s capacity for love and work, cope with crisis
without assistance beyond the support of family and friends, and maintain a state of
well-being by enjoying life’s setting goals and realistic limits, and becoming
independent, interdependent, or dependent as the need arises without permanently
losing one’s independence.

Factors influencing mental health

 Inherited characteristics
 Nurturing childhood
 Life’s circumstances

Ways to maintain mental health

 Good interpersonal communication
 Ego defense mechanisms
 Significant others or support people.
 Involvement in physical activities

Characteristics of Mental Health

 Accepts self and others
 Is able to cope with or tolerate stress
 Can return to normal functioning if temporarily disturbed
 Is able to form close and lasting relationship
 Uses sound judgment to make decisions.
 Accepts responsibility for actions
 Is optimistic
 Recognizes limitations (abilities and deficiencies)
 Can function effectively and independently
  Is able to distinguish imagined circumstances from reality
 Is able to develop potential talents to fullest extent
 Is able to solve problems
 Can delay gratification
 It reflects a person’s approach to life by communicating emotions, giving and receiving,
working alone as well as with others, accepting authority, displaying a sense of humor,
and coping successfully with emotional conflict.

Mental Disorder (APA)

 It is a clinically significant behavioral or psychological syndrome or pattern that occurs in
an individual and that is associated with present distress or disability or with a
significantly increased risk of suffering death, pain, disability or an important loss of
freedom.

Characteristics of Mental Illness

 Feels inadequate
 Has poor self- concept
 Is unable to cope
 Exhibits maladaptive behavior
 Is unable to establish a meaningful relationship
 Displays poor judgment
 Is irresponsible or unable to accept responsibility for actions
 Is pessimistic
 Does not recognize limitations, exhibits dependency needs because of feelings of
inadequacy.
 Is unable to perceive reality
 Does not recognize potentials and talents because of poor self-concept.
 Avoids problems rather than coping with them or attempting to solve them
 Desires or demands immediate gratification
 It reflects a person’s inability to cope with stress, resulting in disruption, disorganization,
inappropriate reactions, unacceptable behavior, and the inability to respond according
to the person’s expectations and the demands of society.

Psychiatry
 It is the science of curing or healing of the psyche.
 It is the medical specialty that is derived from the study, diagnosis, treatment and
prevention of mental disorders.

Psychiatric Nursing
 It is the ‘diagnosis and treatment’ of human responses to actual and potential mental
health problems.
 It is a specialized area of nursing practice, employing theories of human behavior as its
science and purposeful use of self as its art. (ANA)
 It is an interpersonal process that strives to promote and maintain behavior which
contributes to integrated functioning. (Gail Stuart)
 It is an interpersonal process whereby the professional nurse practitioner assists an
individual, family and community to promote health, to prevent or cope with the
experience of mental illness and suffering and if necessary to find meaning in these
experiences. (Travelbee)

Selected nursing interventions that are commonly used in psychiatric nursing

o Active listening
o Anger control assistance
o Assertiveness training
o Behavior management
o Body image enhancement
o Caregiver support
o Communication enhancement
 o Delusion management
o Eating disorders management
o Grief work facilitation
o Hallucination management
o Impulse control training
o Milieu therapy
o Mood management
o Role enhancement
 Sleep enhancement
 Spiritual support
 Substance abuse treatment
 Suicide prevention
 Teaching

Philosophical beliefs related to the effective practice of Psychiatric Nursing

 The individual had worth and dignity
 The goal of the individual is one of growth, health, autonomy, and self- actualization.
 Every individual has the potential to change and the desire to pursue personal goals.
 The person functions as a holistic being that acts on, interacts with, and reacts to the
environment as a whole person. Each part affects the total response.
 All people have common, basic, and necessary human needs.
 All behavior is meaningful
 Behavior consists of perceptions, thoughts, feelings and actions
 Individuals vary in their coping capacities, which depend on genetic endowment,
environmental influences, nature and degree of stress and available resources.
 Illness can be a growth- producing experience.
 All people have a right to equal opportunity for adequate care regardless of gender,
race, religion, ethics, sexual orientation, or cultural background.
 Mental health is a critical and necessary component of comprehensive health care
services.
 The individual has the right to participate in decision- making.

Use of Psychiatric –Mental Health Nursing Skills in Career Opportunities

Obstetric Nursing
o Helping the mother in labor and support person cope with anxiety or stress during labor
and delivery.
o Providing support to the bereaved parents in the event of fetal demise, inevitable
abortion, or the birth of an infant with congenital anomalies.
o Providing support to a mother considering whether to keep her child or give the child
for adoption.

Forensic Nursing
o Providing services to incarcerated clients
o Acting as consultant to medical and legal agencies
o Serving as an expert witness in a court
o Providing support for victims of violent crimes.

Oncologic Nursing
o Helping cancer patients or other terminally ill individuals on oncologic units work
through the grieving process.
o Providing support groups to families of terminally ill patients.

Industrial (Occupational Health) Nursing

o Implementing or participating in industrial substance abuse programs for employees
and their families.
o Providing crisis intervention during an industrial accident or the acute onset of a
physical or mental illness
 o Teaching stress management

Public Health Nursing

o Assessing the person both physically and psychologically (e.g. the newly diagnosed
diabetic client may develop a low self- concept, or the recovering stroke client may
exhibit symptoms of depression due to slow recovery)

Office Nursing
o Assisting the client by explaining somatic or emotional concerns during the assessment
process
o Providing support with the problem- solving process when people call the office and the
physician is unavailable.
o Acting as community resource person

Emergency Room Nurse

o Providing crisis intervention as the need arises (e.g. during natural disasters, accidents,
or unexpected illnesses causing increased anxiety, stress or immobilization)

Roles and functions of mental health and psychiatric nurse

 The mental health and psychiatric nurse provides direct care to patients with mental or
emotional disorders, including:
 Promoting self-care and independence.
 Assisting with problem solving to facilitate activities of daily living.
 Aiding communication and interpersonal relations
 Helping the client examine behaviors the test alternatives.
 Teaching about the disorder
 Administering prescribed medications and treatments
 The nurse is also responsible for constructing and maintaining a therapeutic
environment.
 Patient and family teaching
 She also coordinates in diverse aspects of care
 Acting as an advocate on behalf of the patient and family, she:
 Teaches about rights and responsibilities
 Shares information about self- help groups
 Responsibilities associated with primary prevention include:
 Teaching principles of mental health
 Teaching how to recognize and reduce stress
 Promoting effective family functioning
 Participating in community activities related to mental health promotion.

DSM 5
RELEASED IN 2013 BY APA
 It is the listing of officially recognized mental disorders.
 Is intended to assist researchers, health care providers, insurance providers, regulatory
institutions, and other parties in the medical field in guiding treatment of mental health
issues.
 7 Biggest Changes from DSM IV-TR to DSM 5
1. Modification of Artificial Categorization
 The use of multi-axial system to group disorders into 5 categories is no longer
used
 The categorization has been simplified to clarify relationships between different
disorders
2. The Autism Spectrum
 The previous categories of autism were Asperger’s, childhood disintegrative
disorder, and pervasive developmental disorder are no longer used.
 It is now unified as Autism spectrum disorder
3. Elimination of Childhood Bipolar Disorder
 In response to an observed trend of harmful over-diagnosis and over-treatment
of childhood bipolar disorder, the DSM 5 removes this disorder and replaces this
with Disruptive Mood Dysregulation Disorder (DMDD), it does provide a new
diagnosis that more accurately matches a set of symptoms characterized by
extreme temper outbursts
4. Revisions of ADHD Diagnosis
 DSM 5 broadens the ADHD diagnosis, allowing for adult-onset and relaxing the
strictness of the criteria to more accurately reflect new research on this bipolar.
Given that adults have more developed brains and generally greater impulse
control, adults can now be diagnosed with ADHD if they have fewer signs and
symptoms than children do.
5. Increasing Detail on PTSD Diagnosis
 Partly due to the wars in Iraq and Afghanistan, medical researchers have gained
a great deal more insight into PTSD in the last 15 years.
 The DSM-5 reflects this increased understanding, adds nuance for children with
PTSD, and describes four main types of symptoms:
1. Arousal
2. Avoidance
3. Flashbacks
4. Negative impacts on thought patterns and mood
6. Reclassification of Dementia
 In DSM-5, both dementia and the category of memory/ learning difficulties
called amnestic disorders have been subsumed into a new category,
neurocognitive Disorder.
 The DSM-5 splits this disorder into 2 broad severities (major and mild) to
encourage early detection and treatment of these issues
7. Intellectual Disability
 To reflect common language, the issues previously referred to as “mental
retardation” are now classified as “intellectual disability”
 It also uses the term Intellectual Development Disorder.
 The diagnostic criteria for this disorder has also been updated to more strongly
focus on adaptive functioning, rather than IQ score