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Evolution of Mental Health Psychiatric Nursing Practice

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History and evolution of mental-health, psychiatry, and mental health nursing.

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Evolution of Mental Health Psychiatric Nursing Practice

  2. 2.  Complimentary therapies- unconventional therapies that encompasses a spectrum of practices and beliefs, including herbs, visual imagery, acupunctures, and massage therapy. Decade of brain- proclamation by the state Congress that explains mental illness as a disease of the brain. It underscores the significance of technological advances in neurobiology and genetics and their impact on understanding mental illness. Deinstitutionalization- caring for people outside the hospital who have been previously hospitalized for an extended period, caring for people in the community rather than in a state facility.
  3. 3.  Mental Health Movement- a movement that begun more than 25 years ago that focuses on humane treatment of the mentally ill, initially advocating their release from state institutions to community mental health centers. Moral treatment- humane treatment of the mentally ill; for example, releasing clients from mechanical restraints and improving physical care. Psychotropics- various pharmacologic agents, such as antidepressants and antipsychotic, antimanic and antianxiety agents used to affect behavior, mood and feelings. Neurobiology- biology of the nervous system, particularly the brain. Neuroscience- the science and study of the central nervous system.
  4. 4. Insanity was associated with demonic possession.Healers extract unseen spirits through rituals using herbs, ointments and precious stones.Mental illness was perceived as incurable, and treatment of the insane was sometimes inhumane and brutal.
  5. 5.  Mentally ill people:  Often imprisoned or forced to live in streets and beg for food.  For more humane treatment, they depend on charity of religious groups, who dispenses alms or food or other donations to the needy or poor and ran almshouses and general hospitals.
  6. 6. First mental asylum: St. Mary of Bethlehem Built in London, England during the 14th Century. Conceived as a sanctuary or refuge for the destitute and afflicted. Model for similar institutions elsewhere.
  7. 7.  Continued skepticism about the curability of mental illness. Asylums became the repositories for prolonged enclosure of the mentally ill. Insane people were treated more like animals than humans. Inhabitants were poorly clothed and fed; often chained and caged, and deprived of heat and sunlight.
  8. 8. The insane was no longer treated as less than human.The concept of asylum developed from the humane efforts of Pinel and Tuke.
  9. 9. Emphasized the need for pleasant surroundings and diversional and moral treatment of the mentally ill.Treatment include (considered controversial): bloodletting and the administration of cold and hot baths, harsh purgatives, and emetics.Considers inducement of fright or shock would cause the mentally ill to regain their insanity.
  10. 10. Invented the tranquilizer chair and the Gyrator. Tranquilizer chair- the mentally ill’s extremities is strapped down and this reduces motor and pulse rates; thought to produce calming effect. Gyrator- a form of shock therapy consisting of a rotating, swinging platform onto which the person was strapped and moved at high speed; Thought to increase cerebral circulation.Author of the first American treatise on Psychiatry: Medical Inquiries and Observations upon the Disease of the Mind.
  11. 11. Advocated kindness and moral treatment.Greatest impact came after he was placed in charge of Bicerte Hospital.Proved that releasing the insane from chains and providing moral treatment improved their prospect.
  12. 12.  William Tuke (1732-1822)  Began a 4-yaer dynasty that advocated humane treatment of the mentally ill. Franz Anton Mesmer (1734- 1815)  Renewed the art of suggestive healing that stemmed form the ancient use of trances, which became the basis of hypnosis.
  13. 13. US and other European Countries began a movement that championed reformation of ideas in establishing state hospitals.1772- First psychiatric hospital in America in Williamsburg, Virginia.
  14. 14.  1817- Mclean Asylum in Massachusetts became the first US institution to provide humane treatment for the mentally ill.  Humane treatment- emphasized an environment of understanding and promoted a sense of contentment and mental and physical health. Increased concerns and sensitivity to the needs of the mentally ill generated a need for better-educated attendants to care for severely disturbed clients.
  15. 15.  A retired school teacher from Massachusetts. Led crusade that brought attention of these conditions to the public and legislature. The result is an improvement in standards of care for the mentally ill which led to proliferation of state hospitals.
  16. 16.  The first American Psychiatric Nurse Graduate of New England Hospital for Women Developed nursing care in state hospitals and also directed a school of psychiatric Nursing in Mclean Psychiatric Asylum in 1880. Her efforts resulted to the development of school for nurses in more than 30 asylums
  17. 17.  Exploration of the reasons for mental disease accelerated with contributions from numerous theorists and researchers who laid the foundation for understanding and demystifying mental illness.
  18. 18.  Initiated psychobiological theory and dynamic concept of psychiatric care. Theory centered on treatment rather than disease and integrated biochemical, genetic, psych osocial, and environmental stresses on mental illness.
  19. 19.  Had been treated for mental illness. Contributed to preventive care though his classic work, A Mind That Found Itself, published in 1908. Played a major role in establishing Mental Health Movement in New Haven, Connecticut, in 1908 and promoting the early detection of mental illness.
  20. 20.  Devised a classification of mental disorders. Shifted from an emphasis on research in the pathobiological laboratory to the observation and research in conditions known as praecox dementia and mania.
  21. 21.  Coinedthe term schizophrenia and included its characteristics the four As: apathy, associative looseness, autism, and ambivalence.
  22. 22.  Development of psychoanalysis, psychosexual theories, and neurosis. Psychoanalysis- a method that serves as the basis for treatment and a theory for personality development.
  23. 23.  Founded analytic psychology. Proposed and originated the concepts extroverted and introverted personality. Integrated spiritual concepts, reasoning, ancestral emotional trends, and mysticism , and the creative notion of human beings.
  24. 24.  Objected to Freud’s notions that neurosis and personality development were based on biological drives. Her theory suggested that neuroses stem from cultural factors and impaired interpersonal relationships.
  25. 25.  Postulated the Hypothesis of interpersonal theory and the development of multidisciplinary approaches to psychiatric and milieu therapy. He surmised that anxiety could be reduced through a meaningful interpersonal relationship that stresses the process of effective communication.
  26. 26. A deliberate shift from institutional care in state hospitals to community facilities. Community mental health centers: provides less restrictive treatment located closer to homes, families and friends.
  27. 27.  Declared by the US Congress as the Decade of the Brain Increase in brain research; increased interest in biologic explanations for mental disorders. Significant changes in public awareness which enabled clinicians to address relatively complex topics with patients and families. Nursing responed by significant augmentation of psychobiologic content in academic nursing programs and a torrent of continuing education programs.
  28. 28.  “Nursing Mental Diseases” Written by Harriet Bailey in 1920 In 1937, psychiatric nursing became a part of the curriculum of general nursing programs.
  29. 29.  Hildegard Peplau Developed a model for psychiatric nursing practice Wrote the book “Interpersonal Relationship in Nursing” (1952), heavily influenced by Harry Stack Sullivan. Emphasizes the interpersonal dimension of practice. Wrote a history of psychiatric nursing Single most important figure in psychiatric nursing
  30. 30.  The Diagnostic and Statistical Manual of Mental Disorders (DSM): outlines the signs and symptoms required in order for clinicians to assign a specific diagnosis to a patient. Has been published in six editions since its inception in 1952
  31. 31.  DSM-I 1952 DSM-II 1968 DSM-III 1980 DSM- IIIR (REVISED) 1987 DSM-IV 1994 DSM-IV-TR (TEXT REVISION) 2000
  32. 32.  Axis I: Clinical disorders (e.g., schizophrenia, major depression, bipolar disorder) Axis II: Personality or developmental disorders (e.g., paranoid and borderline personality disorders, mental retardation) Axis III: General medical conditions that relate to axis I or II or have bearing on treatment (e.g., neoplasms, endocrine disorders) Axis IV: Severity of psychosocial stressors (e.g., divorce, housing, educational issues) Axis V: Global assessment of functioning, on a scale of 0 to 100 (e.g., score of 30 means that the patient’s behavior is highly influenced by delusions and hallucinations)
  33. 33.  Was established thru Public Works Act 3258 Was first known as Insular Psychopathic Hospital, situated on a hilly piece of land in Barrio Mauway, Mandaluyong, Rizal and was formally opened on December 17, 1928. Later known as National Mental Hospital November 12, 1986: was given its present name National Center for Mental Health thru Memorandum Circular No. 48 of the Office of the President
  34. 34.  January 30, 1987: categorized as Special Research Training Center and Hospital under the DOH Today: ◦ Bed capacity: 4,200 ◦ Daily average in-patients: 3, 400 ◦ 46.7 hectares ◦ 35 pavilions/ cottages ◦ 52 wards ◦ Personnel: 1,993 ◦ Doctors: 116 ◦ Nurses: 375 ◦ Administrative staff: 651 ◦ Medical Ancillary Personnel: 196
  35. 35.  A special training and research hospital mandated to render a comprehensive (preventive, promotive, curative and rehabilitative) range of quality mental health services nationwide. Gives and creates venues for quality mental health education, training and research geared towards hospital and community mental health services nationwide.