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Psychiatric Nursing

Complementary therapy- unconventional therapy that encompass a spectrum of beliefs and practices, herbs, visual imagery, acupuncture and massage therapy Decade of the brain- proclamation of the US Congress that explains mental illness is the disease f the brain. It underscores the importance of technological advances, neurobiology and genetics and its impact on understanding mental illness. Deinstitutionalization-caring for people outside the hospital or caring people in the community rather than in a state facility. Humanizing recommendation made by Joint Commission on Mental Health and Mental Illness (1961) that move the care of mentally ill from state institution to community mental health centers. Mental Health Movement- began 25 years ago that focuses on humane treatment of mentally ill patient, initially advocating the release from state institutions to community mental health centers Moral Treatment- humane treatment, e.g. Releasing from mechanical restraints and improving physical care. Philippe Pinel, a French Physician Benjamin Rush- an American Physician They are instrumental in promoting this movement Psychotropics- Various pharmacologic agents like antidepressants, antipsychotics, antimanic and antianxiety agents used to affect behaviour, mood and feelings. National Institute of Mental Health- federally funded agency whose goals include developing and helping various states to identify and use the most effective methods of prevention, diagnosis and intervention of mental illness though research funding and staff development and education of mental health professionals to provide mental health treatment. Neurobiology- biology of the nervous system, particularly the brain Neuroscience- the science and study of the central nervous system Perspectives and principles History of psychiatric Nursing Psychiatric Care Concepts: Therapeutic Models Biological- Behavioural Interfacing: Psychiatric Nursing Practice into Concepts Foundations of Psychiatric Nursing Nursing Process Therapeutic Communication Cultural and ethnic consideration Legal and Ethical Consideration Challenges to Nurses Today, the psychiatric- mental health nurse faces the challenge of integrating the intricacies of scientific studies, social norms, and cultural factors and their effects on human behaviour into evidence- based interventions. Though technological advances make impact on lifestyles and health, cultural factors remain an integral part of society and influence health practices and responses to life span behaviour Competencies Be Familiar about the impact of society, culture, economics and religion towards mental health Be able todescribe the evolution of psychiatry and its influence on the psychiatric mental health Know the importance of the role and purpose of professional organizations in relation to nursing practice Visualize the future of psychiatric-mental health Know the influences of advances in neurobiology and information system in psychiatric- mental health nursing Identify major issues confronting psychiatric- mental health in 21st century Evolution of Psychiatric-mental health Care Early History- mental illness is associated with sin and demonic possession. Healing is done trough rituals using herbs, ointments and precious stones. The condition is perceived as incurable, treatment sometimes are brutal. Middle Ages Those who don't live with their families are forced to live in the street and beg for food or imprisoned Charity or religious groups dispensed foods or donations and run alms houses and general hospitals where the insane was admitted . 14th century, London England, Mary of Bethlehem was built and the first mental asylum and became the sanctuary or refuge for the destitute and afflicted. Mary of Bethlehem became the model for similar institutions.

15th 17th Century Skepticism still prevails They were thought to have no feelings and were believe to lack understanding Asylum became repositories of chronic cases Care in the institution are custodial that was administered by attendants who are also ill treated. Witch hunt and execution persisted until the end of the 17th century 18th Century French and American Revolutions , inspired by the desire to broadened human rights, freedom and fair treatment provide the catalyst for transforming societys attitude toward the mentally ill and poor. Benjamin Rush (American Physician 1745-1813) Need for pleasant surroundings, diversional and moral treatment Bloodletting, administration of hot and cold baths, harsh purgatives and emetics Shock will regain the sanity Tranquilizer chairGyrator Tranquilizer Chair- extremities were strapped down was that a reduction in motor activity and pulse rate produced calming effects. Phillippe Pinel 1745-1826 ( Frenchman Kindness and moral treatment, proved that releasing the insane from chain and providing moral treatment improved the condition of the insane Place incharged of Bicarte, an insane hospital His compassionate endeavour brought sweeping changes in institutions for mentally ill and reformation of societal attitude, thus creating optimism about its curability William Tuke 1732-1822 (English merchant) Devout member of Society of French Tukes descendants played major role in increasing public awareness of the vile living conditions and treatment of mentally ill His efforts were instrumental in raising money to establish homes, including the York Retreat that provided comfort, security and safety for mentally ill. Franz Antton Mesner (1745-1815) Austrian Physician Mesmerism- suggestive healing stemmed from ancient trances which later became the basis for hypnosis. A dream like trance to explore the basis for neurosis. 19th Century: The Evolution of the Psychiatric Nurse The building of psychiatric Hospital at Williamsburg, Virginia in 1773 marks the evolution of psyche nursing. Shattuck (1948)- a noted physician wrote in his Report of the Sanitary Commission Of Massachusetts of 1850 that nurses rather than physicians, play the greater role in caring, preventing disease and promoting health. 1817, McLean Asylum in Massachusetts became the first institution to provide humane treatment emphasizing environment of understanding, promoting sense of contentment, mental and physical health. Daily exercises, activities involving useful tasks were part of the daily rituals which offer opportunities for learning and spiritual growth. Dorothea Lynde Dix 1802-1887- A retired school teacher led the crusade to brought the attention to the public about the condition of the jailed mentally ill who were chained, caged and deprived of heat. Her undertakings revitalized humane treatment of mentally ill. 20th Century: Era of psychiatry Society's increase concerns Welfare reform and enactment of child labor laws Transformations encouraged medicine to take the lead and explore the basis of mental illness trough scientific and clinical studies Adolph Mayer 1866- 1950 Psychiatrist from Sweden initiated the psychobiological theory and dynamic concept of psychiatric care. Physical and maturational changes Study of the whole environment to determine its effect on the total personality Centred on treatment rather on disease Integration of biochemical, genetic, psychosocial, and environmental stresses on mental illness Mental illness resulted from maladaptation to his environment Common sense psychiatry- based on the ways that client could realistically improve life situation

Clifford Beers 1876-1943 He was treated for mental illness, contribute to preventive care trough his classic work A Mind That Found itself, which was published in 1908. This work provide descriptive count of his tormenting experience in mental institutions. Had major role in establishing Mental Hygiene Movement in New Haven Connecticut in 1908, promoting early detection of mental illness. Emil Kreplin1856-1926 A noted psychiatrist in Munich Devised classification of mental disorders that give momentum to the advancement of psychiatry He shifted from emphasis on research to observation and in condition known as praecox dementia and mania. Eugene Bleuler 1857-1939 One of Kreplin student coined the name schizophrenia and included the 4 As as: Apathy, Associative Looseness, Autism, and Ambivalence. His noted treatise Dementia Praecox or Group of Schizophrenias delineated the complexity of schizophrenia. Sigmund Freud 1856- 1939 Viennese neurologist Revolutionized Psychoanalysis, psychosexual theories, neurosis which are basis for treatment and personality development Term catharsis, dream interpretations and explanation for hysteria Technique focuses increasing awareness of the unconscious aspects of the clients personality Carl Gustav Jung 1875- 1961 A Swiss Psychiatrist Has his own Analytical theory of neurosis, different from Freud Proposed and originated the concept of extrovert and introvert personality Integrated spiritual concept, reasoning, ancestral emotional trends and mysticism and the creative notion of human being. Karen Horney 1885- 1952 Objected to Freuds notion that neurosis and personality development were based on biological drives. Neuroses stem from cultural factors and impaired interpersonal relationships. This broadened the psychodynamic concepts and stressed the impact of disturbed interpersonal relationship in maladaptive responses. Harry Stack Sullivan 1892- 1949 Postulated the hypothesis of interpersonal theory Stimulated the development of multidisciplinary approaches to psychiatry Milieu therapy Surmised that anxiety could be reduced through meaningful interpersonal relationship that stresses the process of effective communication His theory influenced psychiatric nursing practice and became integral part of nursing education. Hildegard Peplau In 1952 advanced the therapeutic use of self in her text Interpersonal Relations in Nursing : A Conceptual Framework for Psychodynamic Nursing Expanded the work of Sulllivan and applied it to nursing She defined nursing as an interactive, exploratory, caring, and health promoting process 4 delineated overlapping phases on NPI: orientation, identification, exploration, and resolution. Asserted that NPI are opportunities to build mutual understanding and identify goals that have impact on client outcomes and responses. Somatic Therapy 1930 Used to managed anxiety in clients suffering from agitated and psychotic disorders Synonymous to biological therapy Hypoglycaemic shock in treating schizophrenia Metrazol shock Electro shock Psycho surgery- frontal lobotomy Brought optimism to psychiatry and revolutionized psychiatric nursing that stemmed from the advent of drugs. Psychotropics

Emerged in 1950 with the advent of Thorazine ( Chlorpromazine) and Tofranil ( Imipramine) that revolutionized the treatment of mental illness and generated tremendous changes in the role of psychiatric health nurse. These major tranquilizers and psychodynamic approaches led to Community Mental Health Movement in 1960 Mental Health Movement Mid 20th Century Date 1946 Event Passage of Mental Health Act Changes Formation of NIMH Supported research: Crisis intervention, psychiatric diagnosis, prevention and treatment of mental health, education of nurses and specialist Legislative support for educating mental health professional Changes Deinstitutionalization: increase access to care in own community Advent of third generation psychotropic; increased popularity of biological therapy Advances in technology and neurobiology

1961 Date 1963 1970-80

Presidents Commission on Mental illness and Health Event Community Mental Health Movement Explosion of interest in biological markers/neurobiological basis of mental illness and treatment Decade of the Brain


Mental Health Movement To improve mental health services Gained support thru federal funding Gained momentum from experiences in treating soldiers in WW II, progressed from primitive stage f confinement to interpersonal relations. Nurses role in the team became more active. Nurses visibility in the field, they gained respect for their innovative contributions 1961 legislative actions took place emphasizing prevention, primary care, and rehabilitation for mentally illness with the aim of reducing long term hospitalization Deinstitutionalization and Community Based Care They believed that provision of comprehensive psychiatric services to clients, families, communities and various cultures is important. Leininger (1969)- primary prevention is critical to minimizing and reducing the prevalence of metal illness that involves understanding and researching unique individual needs and responses within diverse cultures and societies. How would Psychiatric Nursing be integrated to community Mental Health Movement? 3 Keys Nursing education and experiences Nursing role and function Relationship of nursing with others mental health discipline Findings Psychiatric nurses role in OPD- 10 % were included as part of the team (Glittenberg, 1963) Inconsistent educational preparation. Lack of respect for those with MA and Phd degree Almost 50 % of the nurses participated in home visits, initial assessment and co therapy (Glittenburg, 1963) Most of the nurses functioned as generalist and their role as psyche nurses were under rated (Stokes et al,1969) Analysis Psyche nurses were invaluable resource and member of the team regardless of educational preparations Need for to increase dialogue and collabration with other discipline for understanding and comprehensive service New Psychotherapy Self Actualization (Maslow 1960) Transactional Analysis (Eric Berne)

Gestalt Therapy (Fritz Pearls) These therapies broke away from long psychotherapy and evolved in decade wherein people wanted variety of and quick solutions to ld problems. Focus in here and now rather then in past experiences and in touch with reality Era of theorist who asserted the relevance of mental health and self actualization and responsibility for life choices.

Transactional analysis (Eric Berne)

The ego-state (PAC) Model Parent ( exteropsyche)- a state in which people behave, feel, and think in response to an unconscious mimicking of how their parents acted, or how they interpreted their parents actions. Ex. A person may shout at someone out of frustrations because they learned from influential figure in childhood the lesson that this seem to be the way of relating that work. Adult (neo psyche)- a state of the ego which is most like a computer processing information and making predictions absent of major emotions that could affect its operation. Learning to strengthen the adult is a goal of TA. While a person is in the adult ego state, he is directed towards an objective appraisal of reality. Child ( archeopsyche)- a state in which people behave, feel and think similarly to how they did in childhood. Ex. A person receives a poor evaluation at work may respond by looking at the floor and crying or pouting as they used to when scolded as a child. Conversely a person who receives a good evaluation may respond with a broad smile and joyful gestures of thanks. The child ego state is the source of emotions, creations, spontaneity and intimacy. Subdivision of Ego state Parental figure- nurturing ( permission giving, security giving) or more criticizing (comparing to family traditions and ideals in generally negative ways. Childhood figure- either more natural (free) or more Adapted to others. This subdivisions categorize individuals pattern of behavior, feelings and ways of thinking that can be functional (benificial or positive) or dysfunctional/ counterproductive (negative) 4 Types of Diagnoses of Ego state Behavioral- attitude exhibited Social- pattern of norms adapted Historical- looking back on past Phenomenological- finding reasons and considering it as almost true Contextual diagnosis combination of the different types of ego diagnosis Transactions Are flow of communications specifically the unspoken psychological flow of communication that runs in parallel. Runs simultaneously both at explicit and psychological level. Ex. Sweet caring voice with sarcastic intent. To read the real communication requires both surface and non verbal reading. Strokes- are the recognition, attention or responsiveness that one person gives another. It could be positive (warm fuzzies) or negative (cold pricklies). The key idea is that people hunger for recognition and that lacking positive strokes will seek whatever kind they can, even if the recognition is negative kind. Transactions can be experience as positive or negative depending on the nature of the strokes with in them. However , a negative transaction is preferred to no transaction at all because of a fundamental hunger for stroke. Kinds of Transactions Reciprocal- when both partners are addressing the ego state the other is in. Also called ansaction Ex. 1 A : Have you been able to write the report? (Adult to Adult) B: Yes, Im about to e-mail that to you. (Adult to Adult.

Ex. 2 A; Would you like to skip this meeting and go watch a film with me? (child to child) B: Id love to, I dont want to work anymore, what should we go and see? (Child To Chid)

Ex.3 A: You should have your room tidy by now! (Parent to child)

B: Will you stop able hassling me Ill do it eventually!. Child to parent)

Crossed Transactionscommunication failures are typically caused by crossed transactions where partners address ego states rather than their partner. Ex 1a A: Have you been able to write the report? (Adult to adult) B: Will you stop hassling me? Ill do it eventually! (child parent) A may respond with a parent to child transaction A: If you dont change your attitude, youll get fired Ex. 2a; A: Is your room tidy yet? (Parent to child) B: Im just going to do it actually. (Adult to adult. Duplex or covert transactions- where the explicit social conversation occurs in parallel with implicit psychological transactions A: I need you to stay late at the office with me. (Adult words), body language indicates sexual intent (flirtatious child) B: Of course. (Adult response to adult statement), winking or grinning. (Child accept the hidden motive) Theory of Transactional Analysis Theory of personality and systematic psycho therapy for personal growth and personal change As theory of personality- TA describes how people are structured psychologically that uses its best known model ( ego state). The same model helps explain how people function and express their personality Theory of communication- extended to the analysis of the systems and organizations. Theory for child development- explain how our adult patterns of life originated in childhood or the idea of Life Script Life Script- or childhood script- the assumption that we continue to re-play childhood strategies even this results in pain or defeat, thus offering a theory of psychopathology. In practical application- use in diagnosis and treatment of many types of psychological disorders and provides a method of therapy. In education- use by teachers to remain in clear communication during counselling, consultancy, management and communication.

Philosophy of TA People are OK- thus each person has validity, importance, equality of respect. Every one ( with very few exceptions, such as those that have sever brain damage) has the capacity to think. People decide their story and destiny, therefore decisions can be changed. Freedom from historical maladaptations in the childhood script is needed in order to become free from inappropriate, authentic but displaced emotions that are not fair and is not an honest reflection of here and now. Echoes of childhood sufferings; pity-me and other mind games, compulsive behaviour and repetitive dysfunctional life patterns must be dealt with. Changes under TA means to move toward autonomy (freedom from childhood script), spontaneity, intimacy, problem solving as opposed to avoidance or passivity. Considering cure as ideal rather than merely making progress and learning new choices Phenomena behind the transaction Life position- general feelings about life (unconscious as opposed to conscious) that colors every dyadic transactions Im not OK, Youre OK (I-U+) Im not OK, Youre not OK (I-U-) Im OK, Youre not OK (I+U-) Im OK, Youre OK (I+U+) 2a. Im not OK but you are worse (I-U) Im not OK, Youre irrelevant (I-U?) 4a. Im a bit more OK than you are (I++U+) Im OK youre irrelevant (I+U?) Life (Childhood )script A Life plan directed to a reward Decisional and responsive. Decided upon childhood in response to the perception of the world as a means of living with and making sense with the world. It is not just a thrust on the person of the environment. Reinforced by parents Most part is outside the awareness How we navigate, what we look for, reality redefined (distorted) to match our filters. Mythos A legend of the origin, core belief and purpose A person begin writing his own story(script) at young age, revised as he go along the core story is selected at age 7 but passes out of awareness. A life script might be to be hurt many times and suffer and make other feel bad when I Die that could result the person setting up for this, by adapting behaviours in childhood that produce exactly this effect Redefining Distortion of the reality when one deliberately (but unconscious) distort things to match proffered way of seeing the world. Thus a person who's script involves struggling alone against the cold world may redefine others kindness by concluding that others are trying to get something by manipulation Discounting To take something as worthless than it is. Thus to give a substitute reaction which does not originate as a here and now. Adult attempt to solve the actual problem or choose not to see evidence that would contradict ones script. Type of discount include; passivity, over adaption, agitation, incapacitation, anger and violence Injunctions and Drivers Embeded into schids life script and belief Dont be Dont be who you are Dont be a child Dont row up Dont make it in your life (dont succeed) Dont do anything Dont be important Dont belong Dont be close Dont be well (Sane) Dont think Dont feel You deserve to have it happen, so it doesnt happen to me

Five Drivers Please me/others Be perfect Be strong Try hard Hurry up Be careful This explains why some changes is difficult. Ex. In creating script a child will often attempt to jungle these. Its Ok for me to go o living so long as I try hard. When he stop trying hard to be with his family, the injunction you dont have the right to exist which was suppressed by their script will now be exposed and be a vivid threat, will feel massive psychological pressure which he doesnt understand, then return to trying hard in order to feel safe and justified in existing. Ways of Structuring Time 1.Withdrawal- no exchange of strokes 2.Rituals- series of transactions that are complementary, stereotype and based on social programming. Ex 4 strokes rituals A: Hi! B: Hi! How are you? A: Getting along. What about you? B: Fine. See you around. Pastimes- series of transactions that is reciprocal, semi- ritualistic and intended as time structuring activity, no covert purpose and carried out usually by 2 people. Usually shallow and harmless. Small talk is an ex. 4. Activity- work together for common goal. 5. Intimacy- allows one to exchange the strongest stroke without playing the game, no covert purpose, personal, relating to other person and unconditional Games Series of transactions that is reciprocal, ulterior and proceeds towards a predictable outcome. Often characterized by switch of role. Played by Parent, adult and Child ego state. Each game always have a payoff for those playing like earning sympathy, satisfaction, vindication, or emotion that usually reinforce the life script Antithesis- the way to break the game People who are accustomed to the game are willing to play the role of a different actor from what they are originally were. Analysis of the Game Flexibility- ability to change the currency Tenacity- persistence with which the people play and stick to their games and the resistance to breaking it. Intensify- easy are played in relax way, Hard played in tensed and aggressive way. Based on the degree of acceptability First degree- socially acceptable in the players social circle Second degree- games that the player wants to conceal though they might ot cause irreversible damage. Third degree- games that could lead to drastic harm to one or more of the parties concerns Games are studied acc. To Aim Roles Social and Psychological Paradigm Dynamics Advantage to player Commonly Found Games YDBYB; Why dont you, Yes but IFWY: If it werent for you WAHM: Why does this always happens to me? SWYMD: See what you made me do? UGMIT: You got me into this. LHIT: Look how hard Ive tried. ITHY: Im only trying to help you LYAHF: Let you and him fight NIGYYSOB: No I got you, you son of a bitch

The logic of the game is subjective; parent state might interact with another's child rather than adultadult. The Drunk or the Alcoholic Transactional object of the drunk aside from the personal pleasure obtained by drinking, could be seen as being to set up a situation wherethe child can be severely scolded not only by the internal parent but also by the parental figure in the environment. (Alcoholic- Rescuer) Rackets Dual strategy of getting permitted feelings. While covering up feelings which we truly feels, but we regard as not allowed. Familiar set of emotions- learned and enhanced during childhood, experience in many different stress situation and maladaptive in adult as a means of problem solving. Ex. Meeting a guy who is hurtful and taking advantage of good will. Phenomenon Related to Rituals (Strokes) If a person exchange fewer strokes the other person may feel that he is either preoccupied or acting high and mighty If a person exchange strokes more than expected, the other person might wonder whether he is trying to butter him up or get good terms for some vested interest. If 2 people dont meet for a long time, a backlog of strokes get built up, they may exchange a large number of strokes to catch up. Gestalt Therapy Something that has a particular quality when considered as a whole that cannot be seen if considered only a part Built on 2 central ideas;1) that the most helpful focus of the psychotherapy is the experiential present moment 2.) that everyone is caught in webs of relationship, thus knowing ourselves against the background of our relationships to others. Focuses on the process (what is actually happening) and the content( what is being talked about) Emphasis is on what is being done, thought and felt at present moment (both client and therapist) rather than what was, might be, could be should have been) Awareness of practice (mindfulness) by which perceiving, feeling, are understood to be conducive to interpreting, explaining and conceptualizing Distinction between direct experience versus indirect or secondary interpretation is develop in the process. Objective Of Gestalt therapy Enable the client to become more fully and creatively alive and to become free from blocks and unfinished business that my diminish satisfaction, fulfilment growth and experiment with new ways.

21st- Neuroscience and Genetics Research opportunities that give opportunities fir greater understanding of the link between behaviour and emotions, brain and genes. 1990- Complexity of human behaviour and underlying neurobiological processes. Contemporary mental health integrates neuroscience, genetic research and environmental factors. These factors appear to increase the risk for vulnerable population to suffer from schizo, bipolar, Alzheimer's and pervasive developmental disorder Specific treatment modalities that meet individual needs Plethora of pharmacologic agents, complementary therapies and diverse psychotherapies offer new approaches to research and evidenced based mental health care Information system: internet and Cyberspace Use of internet to learn about their health, illness and make choices on complementary therapies Nurses must be able to talk to clients regarding their health concerns and treatment options via this channel because this generate success (auspicious) Provide nurses new avenues to assess human experience and form therapeutic relationship Telemedicine Interviewing the client using telemedicine set up or conversing with the television Provides accesses to clinical experts and health care services Disadvantage; high investment cost, privacy issues lacks face to face contact, lack of protocol standardization, uncertainty about reimbursement. Instant gratification is always almost expected Nurses should have proactive response by developing innovative communication skills and apprised of the latest treatment

Complementary Treatment Aroma therapy Acupuncture Biofeedback Massage therapy Herbs Nutritional approach These therapies offer client as sense of independence in choosing treatment in combination with the conventional one Nurses must be familiar with the advantages and risks Cultural Consideration Culture reflects one's individuality, personal expression and it influences ones perception Nurses brings beliefs and values from both their culture and profession, so nurses must recognize and appreciate differences and understand the facet and health-illness continuum Nurses should have cultural competency skills as it is needed in meeting the needs of client with diverse culture Cultural competency- process that entails cultural awareness and knowledge and application in all facets of health care The Future Enormous technological, socio-economic, scientific discoveries and changes that requires expanded knowledge in neuroscience and genetics from developmental perspective and intricate informational system. Nurses must be proactive Nurses should recognize and be adapted to the impact of discoveries and cyber space on nurses and clients and in their communication patterns as these are transitions in the future. Social changes like violence, poverty, illness affects human relation and coping patterns that tremendous demands. Overwhelming societal demands compromise individual coping skills consequently increasing personal and societal violence. Lifestyle changes and transforming attitudes towards mentally ill continue to parallel societys participation in economic, social and legislative issues Soaring and poor access to health Cultural Consideration Culture reflects one's individuality, personal expression and it influences ones perception Nurses brings beliefs and values from both their culture and profession, so nurses must recognize and appreciate differences and understand the facet and health-illness continuum Nurses should have cultural competency skills as it is needed in meeting the needs of client with diverse culture Cultural competency- process that entails cultural awareness and knowledge and application in all facets of health care Psychiatric Nursing; Evolution of Specialty Evolve from a role of providing humane, clean environment to assessing stress response and evaluating interventions. In doing so nurses play a pivotal role in determining and promoting developmental progression and personal needs towards establishment and maintenance of health Documented nursing care showed that the attitude of the servants is important in creating relaxed environment Linda Richard in collaboration with Dr. Edwards Cowles Of McLean Asylum several Schools in General and Mental Hospital were established. A 2 year training program that focused on custodial care and little emphasis in developing psychosocial skills. Hildegard Peplau- Interpersonal Relation in Nursing : A conceptual Framework for Psychodynamic Nursing. June Mellow/ Gwen Tudor- influence of NCR and NCP n clients outcome. Tudor defines PN as interpersonal process of observation, intervention and evaluation, the 3 major functions of a nurse; facilitator of communication, social interation and self care, nurses attitude and response Nursing theorist Hildegard Peplau ( 1952 )- IPR June Mellow/ Gwen Tudor- influence of NPI and NP on client outcome. Major function of nurse as facilitator of communication, social interaction, and self-care, significance of social context on the nurses attitude. These are instrumental in legitimizing the role of psychiatric nurse and establishing foundations for current therapeutic interventions. Trends in psychiatric Mental Health Nursing Future trends will be determined by the complex demand of technology, client advocacy, cultural, societal and economic transition

Research to provide and direct basis for understanding mental illnessin areas of neurobiology, molecular and and cellular neuroscience, genetics, psychodynamics, psychosocial rehabilitation, exploration of life span and cultural issues Lifestyle pattern will continue to affect societal, cultural, economic and legislative agenda and HCDS. Concepts of Psyche Practice Re-examine future roles in meeting societal needs Advocate evidence based practice revaluing biological knowledge and reacquainted with care and caring. (Angela Mc Bride1990). According to her the areas that need change are the following; Closing the gap the relevance of neurobiology of mental illness Revamping nursing curricula interfacing psychiatric mental health with biological and behavioural science Nurses re associating themselves with caring by; a. being responsive to clients rahter than being judgemental b. Using the concept of nurturing as one that encompasses the protection of clients rights c. Having health care system that fosters effective communication at all level of cares d. Exploring ethical issues and values with professional commitment of working with mentally ill client Directions for Nursing Education Addition of new knowledge without deleting the old ones Provide clear identity and enhance clinical and classroom exposure in BSN programs Mc Cabe recommends the ff; 1. Reconceptualise what constitute the core of Psychiatric Nursing content (Generalist and Advance) 2. Identify critical competencies that reflect the core content, role and scope of the practice Identify and standardize measurable clinical outcome based on content and competencies 4. Establish a national research agenda that expands and builds psychiatric nurse unique knowledge base. 5. Integrating core concepts like relatedness, regulation, vulnerability, integrity and efficacy that provide a theoretical framework that encompasses the education need of a practitioner. Topics of course work: sleep cycles, circadian rhythm, stress related response, neurological assessment, psycho-social and neurological factors to compliance, s/s of violence neurobiological bases of mental illness All Health Care Professionals need to meet the challenges of the year 2005 ( ONeil 1993). A health care system with limited resources, client centered and treatment outcome, care provider accountability. Societal Changes Redefining the role of nurses Mental illness is increasing, so the society is faced with vast challenges that must address deteriorating social structures, global epidemic of AIDS, personal and work place violence, inadequate access to health care and rising poverty level , low salaries and unemployment, family breakdown, internet Nurses as prime advocates for health promotion and prevention across the life span from admission to discharge considering the complexity of a patient. Nurses must learn how to navigate complex healh care system. Health Care Trends Case management Telemedicine Assertive community health programs Home health Mobile crisis unit Therapeutic foster care Nursing intervention; interdisciplinary care Psychoeducation, Presriptive authority Psychotherapy Medication clinic Dual diagnosis group Collaboration of Nursing organization Revolutionized the scope and standard of practice Form powerful and collaborative partnership Addressing legislative issues affecting nursing practice Crucial in making successful advances and changes within a transforming society abd health care system Responding proactively to he needs of psychiatric- mental health nurse