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Overview of Psychiatric-Mental Health Nursing I

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Overview of Psychiatric-Mental Health Nursing I © Jones and Bartlett Publishers. NOT FOR SALE OR DISTRIBUTION PART Overview of Psychiatric-Mental Health Nursing I CHAPTER 1 Introduction to Psychiatric-Mental Health Nursing Cecelia M. Taylor CHAPTER 2 Issues and Trends in Psychiatric-Mental Health Nursing Karen A. Ballard CHAPTER 3 The Psychiatric Nursing Assessment Christine Carniaux Moran CHAPTER 4 Neurobiologic Considerations in Psychiatric Care Karan Kverno and Sherry Goertz CHAPTER 5 Psychopharmacology Beth Harris CHAPTER 6 Crises, Psychiatric Emergencies, and Disasters Winifred Z. Kennedy CHAPTER 7 Legal and Ethical Considerations Amy Wysoker CHAPTER 8 Self-Help Groups: Options for Support, Education, and Advocacy Edward J. Madara CHAPTER 9 Holistic Nursing and Complementary Modalities Jeanne Anselmo and Julia Balzer Riley CHAPTER 10 Family and Intimate Partner Violence Cynthia Mitzeliotis and Winifred Z. Kennedy 1 444344_CH01_001-020.indd4344_CH01_001-020.indd 1 99/28/07/28/07 112:16:312:16:31 PPMM © Jones and Bartlett Publishers. NOT FOR SALE OR DISTRIBUTION 444344_CH01_001-020.indd4344_CH01_001-020.indd 2 99/28/07/28/07 112:16:422:16:42 PPMM © Jones and Bartlett Publishers. NOT FOR SALE OR DISTRIBUTION CHAPTER Introduction to Psychiatric- Mental Health Nursing Cecelia M. Taylor 1 LEARNING OBJECTIVES After reading this chapter, you will be able to: · Discuss the impact on psychiatric-mental · Describe the evolution of psychiatric-mental health nursing of the works of Peplau, health nursing care. Orlando, King, Orem, and Riehl-Sisca. · List the members of the contemporary multi- · Describe the characteristics of individual disciplinary treatment team and describe the therapy, family therapy, group therapy, milieu distinctive abilities of each professional therapy, crisis intervention, and somatic member. therapies. · Explain two key concepts from each of the psychoanalytic, interpersonal, and behavioral conceptual models. KEY TERMS Anticipatory guidance Levels of consciousness Psychosexual theory of Anxiety Milieu therapy personality development Apathy Moral therapy Punishment Behavioral model Multidisciplinary treatment Response cost Classical conditioning team Security operations Cognitive model Need for satisfaction Selective inattention Conceptual model Need for security Self-care defi cit nursing theory Coping mechanisms Negative reinforcement Self-concept Crisis Neurobiologic model Situational crises Developmental crises Nurse-patient relationship Somatic therapies Dynamisms Operant conditioning Somnolent detachment Ego defense mechanisms Personality, structure of Structural family therapy Extinction Positive reinforcement Therapeutic community Family systems therapy Preoccupation Genogram Psychoanalytic model Group therapy Psychodynamic nursing Individual therapy The use of the term patient in the fi rst half of this chapter refl ects historical usage. 3 444344_CH01_001-020.indd4344_CH01_001-020.indd 3 99/28/07/28/07 112:16:462:16:46 PPMM © Jones and Bartlett Publishers. NOT FOR SALE OR DISTRIBUTION 4 CHAPTER 1 Introduction to Psychiatric-Mental Health Nursing History The inhumane treatment of mentally ill per- sons peaked in the seventeenth century when Society has always adopted measures designed to petty criminals and those who were mentally ill change the behavior of persons with mental illness. were confi ned together in almshouses. Treatment In prehistoric times, those measures were likely to consisted of drastic purgings, bleedings, and have been tribal rites that, if unsuccessful, probably whippings. led to the abandonment of the ill person. During the Greek and Roman eras, the sick were treated in the temples, and treatment ranged from humane The Eighteenth and Nineteenth Centuries care to fl ogging, bleeding, and purging. In the eighteenth century, Europe, particularly The plight of mentally-ill persons continued to France, underwent political and social reform. In be poor in the Middle Ages, when their care was 1792, Phillipe Pinel, the medical director of the determined by mistaken religious beliefs. The men- Bicêtre asylum outside Paris, introduced a new tally ill were believed to be possessed by devils that treatment regimen termed moral therapy. Advo- could be exorcised by whippings and starvation. cates of moral therapy believed that mental ill- When the church stopped treating mentally ill per- ness was related to immorality or faulty upbring- sons during the sixteenth century, they were im- ing, and that a therapeutic environment could prisoned in almshouses, which were a combination correct these weaknesses. Instead of harsh con- of a jail and an asylum. Those who were violent and fi nement, patients were kept busy with work, mu- delusional were placed in jails and dungeons. King sic, or other diversions. Moral therapy required Henry VIII offi cially dedicated Bethlehem Hospital that attendants treat patients with kindness and in London as a lunatic asylum. Bethlehem Hospital keep them involved in the treatment program soon became known as the notorious “Bedlam,” (Wasserbauer & Brodie, 1992). The Quakers, un- whose hideous practices were immortalized by der the Brothers Tuke, established the York Re- Hogarth, the famous cartoonist (Figure 1-1). The treat and brought about the same dramatic re- keepers at Bedlam were allowed to exhibit the most forms in England. The development of moral boisterous patients for 2 pence a look. The more therapy and its reliance on attendants were the harmless inmates were forced to seek charity on the beginnings of current psychiatric nursing care. streets of London; the “Bedlam beggars” of Shake- The fi rst place identifi ed as a “poorhouse, speare’s King Lear were based on these prisoners workhouse, and house of correction” in the Unit- (Taylor, 1994). ed States opened in New York City in 1736. In 1756, under the guidance of Benjamin Franklin, the Pennsylvania Hospital was completed. One of the fi rst two patients admitted was described as a “lunatic.” Although patients with a mental illness were relegated to the cellar, they were assured clean bedding and warm rooms. Benjamin Rush (1745–1813), a humanitarian and the “father of American psychiatry,” began working at Pennsyl- vania Hospital in 1783. The fi rst public psychiatric hospital in Amer- ica was built in Williamsburg, Virginia, in 1773 and is known today as Eastern Psychiatric Hospi- tal. Most states, even as late as 1830, did not have facilities for treatment of the mentally ill, al- though a number of excellent private hospitals existed (most notably the Hartford Retreat, founded in 1818). Dorothea Lynde Dix (1802–1887) was a schoolteacher who volunteered to tutor individu- als confi ned to jails and poorhouses. She was hor- Figure 1-1 Bedlam, as depicted by William Hogarth. Note the well-dressed ladies, who made social visits to the prison to rifi ed by the conditions in these facilities, and in view the spectacle of the inmates as entertainment. 1841 began a campaign to convince state legisla- 444344_CH01_001-020.indd4344_CH01_001-020.indd 4 99/28/07/28/07 112:16:562:16:56 PPMM © Jones and Bartlett Publishers. NOT FOR SALE OR DISTRIBUTION History 5 tures that suitable hospitals, not jails, were re- patient who was hospitalized several times, wrote quired for those with mental illnesses. Twenty a book about his experiences titled A Mind That states in the United States and the Canadian gov- Found Itself. The book’s revelations led to the ernment responded directly to her appeals by au- founding of the National Committee for Mental thorizing the construction of large institutions Hygiene. The committee, for the fi rst time, es- for the mentally ill. This was the beginning of the poused the prevention of mental illness and early state hospital system in the United States. intervention. The original intent of the state hospital sys- The most signifi cant psychiatric revolution in tem was to treat those with mental illness and the early twentieth century was a direct result of then discharge them to the community or the the work of Sigmund Freud (1856–1939). Freud care of their families. Because so little was known made great contributions to the understanding of about mental illness at that time, the goals of human behavior. Before his theories were intro- treatment and discharge were not able to be duced, human behavior, particularly the behavior achieved. Consequently, state hospitals rapidly of persons with mental illnesses, was shrouded in became overcrowded with chronically mentally superstition, secrecy, and stigma. Freud brought ill patients. Paradoxically, the same state hospitals the subject of human behavior to the public’s at- that were supposed to alleviate the suffering of tention. His theories served as a springboard for violent persons who were previously imprisoned the scientifi c study of human behavior. Although contributed to the ultimate demise of moral ther- much of Freudian theory is no longer embraced apy, because this treatment could not be imple- in scientifi c circles, some of his concepts have be- mented in overcrowded settings. come so integrated into the mainstream that they In 1844, the Association of Medical Superin- have become part of everyday language (e.g., ego, tendents was formed as psychiatry began to de- conscience, unconscious). velop as a profession and as physicians became The National Mental Health Act, passed in increasingly responsible for the administration 1946, was one of the most progressive actions ad- of asylums. This organization became the Ameri- dressing mental illness the United States has ever can Medico-Psychological
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