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Objectives.

Objectives. Describe at least two personality traits and personal issues in yourself that could affect your ability to interact with clients in the clinical setting? Articulate how self-awareness can be an effective tool in the clinical setting?. Questions???????????.

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Objectives.

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  1. Objectives. • Describe at least two personality traits and personal issues in yourself that could affect your ability to interact with clients in the clinical setting? • Articulate how self-awareness can be an effective tool in the clinical setting?

  2. Questions??????????? • What was your initial reaction when you were told that you have posting in psychiatric ward ? How did you feel? How did you resolve your feelings? • Are you more comfortable performing tasks or relating to people? • Are you flexible or do you prefer an orderly routine? • Are you an introvert or extrovert?

  3. Question Answer? • Your first assignment in the psychiatric clinical setting is to provide care for a female client who appears sad and verbalizes hopelessness to the staff. You are uncertain how to approach the client. Which of the following actions would be the most effective?

  4. Ask a peer to introduce you to the client. • Wait for the client to approach you to avoid bothering the client. • Ask a staff member what approach is usually effective with the client. • Discuss your feelings with your instructor before approaching the client.

  5. QA? • One of your peers states that your assigned client looks like a drug addict. Which of the following best describes your peer? • Introvert • Judgmental attitude • Extrovert • Prejudice

  6. Unit I- Topics • Perspectives of mental health nursing, evolution of mental health services, treatments and nursing practices. • Prevalence and incidence of mental health problems and disorders • Nature and scope of mental health nursing • Role and function of mental health nurse in psychiatric setting and factors affecting the level of nursing practice • Concepts of normal and abnormal behavior

  7. Introduction Two major purposes: • To introduce the concepts of mental health and mental illness • To describe the historical development of the role of the psychiatric nurse.

  8. Perspectives of Mental Health Nursing • The concept of caring for the sick, ‘nurturing’, or ‘nursing’ existed since times immemorial, the mentally ill were tortured, persecuted, ridiculed, neglected and shunned.

  9. Before 1860, the emphasis in psychiatric institutions was on custodial care. • Untrained people controlled (not cared) the mentally ill. • Psychiatric care as such was non-existent. • But psychiatry evolved through ages and attained the stage that is today.

  10. Concept of mental health • Mental health is a positive state in which one is responsible, displays self-awareness, is self-directive, is reasonably worry free, and can cope with usual daily tensions. • Such individuals function well in society, are accepted within a group, and are generally satisfied with their lives.

  11. MENTAL HEALTH- Definition • Mental health is defined as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community. WHO,2014.

  12. Cultural beliefs influence how mental health and mental illness are determined. • For instance, acceptable behavior in one cultural group may or may not be tolerated in another group.

  13. Factors Influencing Mental Health • Inherited characteristics • Nurturing during childhood • Life circumstances

  14. INDICATORS OF MENTAL HEALTH • In the health care and public health arena, more emphasis and resources have been devoted to screening, diagnosis, and treatment of mental illness than mental health. • Little has been done to protect the mental health of those free of mental illness.

  15. Three domains- Indicators Of Mental Health • Emotional well-being • such as perceived life satisfaction, happiness, cheerfulness, peacefulness. • Psychological well-being • such as self-acceptance, personal growth including openness to new experiences, optimism, hopefulness, purpose in life, control of one’s environment, spirituality, self-direction, and positive relationships. • Social well-being • social acceptance, beliefs in the potential of people and society as a whole, personal self-worth and usefulness to society, sense of community.

  16. Characteristics Of Mentally Healthy Person A mentally healthy person: • has an ability to make adjustments. • has a sense of personal worth, feels worthwhile and important. • solves his problems largely by his own efforts and makes his own decisions. • has a sense of personal security and feels secure in a group, shows understanding of other people’s problems and motives. • has a sense of responsibility

  17. CONTD... • can give and accept love. • lives in a world of reality rather than fantasy. • shows emotional maturity in his behaviour, and develops a capacity to tolerate frustration and disappointments in his daily activities. • has a variety of interests and generally lives a well-balanced life of work, rest and recreation.

  18. MENTAL ILLNESS • Mental illness is defined as “collectively all diagnosable mental disorders” or “health conditions that are characterized by alterations in thinking, mood, or behaviour (or some combination thereof) associated with distress and/or impaired functioning.”

  19. MENTAL HEALTH NURSING • Mental health nursing involves the diagnosis and treatment of human responses to actual or potential mental health problems. • Comprehensive services focus on prevention of mental illness, health maintenance, management of and referral for mental and physical health problems, diagnosis and treatment.

  20. Historical Development • The origins of most of psychiatry's concepts begin with prehistoric times when primitive people believed spirits possessed the body and had to be driven out to effect a cure. • Before the 5th century BC, the Greeks, Romans, and Arabs believed that emotional disorders were an organic dysfunction of the brain.

  21. Pythagras (580-510BC)- concept that brain is the seat of intellectual activity. • Hippocrates (460-375 BC) described a variety of personalities, or temperaments, and proposed that mental illness was a disturbance of four body fluids, or humours.

  22. Aristotle (382 -322 BC) concluded that the mind was associated with the heart. • Galen (130-200 AD), a Greek physician, stated that emotional or mental disorders were associated with the brain.

  23. Asclepiades- Father of Psychiatry • Treatment approaches- good nutrition, good physical hygiene, music, and recreational activities such as riding, walking, and listening to the sounds of a waterfall. • Fresh air, sunshine, and pure water were thought to promote healing for the mentally ill.

  24. Middle Ages to 1773: • suffered a setback as mentally ill individuals were excluded from society and confined in asylums or institutions. • Various theories- pertaining to demonic possession also were advanced. • Specifically, persons who displayed abnormal behaviour were considered lunatics, witches, or demons possessed by evil spirits.

  25. Superstition, magic, and witchcraft prevailed as patients were locked in asylums, flogged, starved, tortured, or subjected to bloodletting. • Beheading, hanging, and burning at the stake were common occurrences. • During this same period, physicians described symptoms of depression, paranoia, delusions, hysteria, and nightmares.

  26. Persons displaying such symptoms were thought to be incompetent and potentially dangerous. • The first mental hospital, Bethlehem Royal Hospital, opened in England in 1403. • Harmless inmates sought charity on the streets. • 1773- The first mental hospital in Virginia, US.

  27. 1793- Philip Pinel- first revolution in Psychiatry( removed the chains of mentally ill) • 1812- Benjamin Rush(father of American psychiatry) first American textbook of psychiatry. • 1908- Clifford Beers- The Mind That Found Itself- book changed conditions of mental hospital.

  28. 1912- Eugene Bleuler- Swiss Psychiatrist coined the term Schizophrenia. • 1938- ECT used • 1939- Sigmund Freud- Theory and therapy of psycho analysis. • 1949- Lithium used for Mania • 1952- Chlorpromazine- Revolution in Psychopharmacology

  29. Psychiatric Nursing History-1773 to 1956: • The 18th century is regarded as an era of reason and observation. • According to Peplau (1956), the historical development of psychiatric nursing began in 1773. • Peplau- Mother of Psychiatric Nursing

  30. Phase 1: The Emergence of Psychiatric Nursing (1773 to 1881) • Special institutions for individuals with psychiatric disorders were built. • Benjamin Rush wrote the first American textbook on psychiatry. • Attendants were hired to socialize with patients. • Philippe Pinel classified clients according to their observable behaviors.

  31. Schools of nursing were established in Boston and Philadelphia by 1872. • Dorothea Lynde Dix devoted time to improving conditions for the mentally ill.

  32. Phase 2: Development of the Work Role of the Psychiatric Nurse (1882 to 1914) • Training schools for nurses in the psychiatric setting were established at McLean Hospital in Belmont, Massachusetts and at Buffalo State Hospital in New York (1882). • Trained nurses were employed in state mental hospitals (1890). • First undergraduate psychiatric nursing program was established. • National Society for Mental Hygiene was founded in 1909. • Large state mental hospitals were built in rural areas.

  33. Phase 3: Development of Undergraduate Psychiatric Nursing Education (1915 to 1935) • Linda Richards, the first graduate nurse in the United States, suggested that mentally ill clients receive the same quality care as physically ill clients. • Harriet Bailey wrote the first psychiatric nursing textbook, Nursing Mental Diseases. • John Hopkins- First school of nursing had fully developed Psychiatric nursing course • Insulin shock therapy, electroconvulsive therapy, and prefrontal lobotomy were introduced in the psychiatric clinical setting.

  34. Phase 4: Development of Graduate Psychiatric Nursing Education (1936 to 1945) • Approximately half of all nursing schools provided psychiatric nursing courses; • The National League of Nursing Education developed curriculum guidelines for psychiatric nursing graduate education. • By 1943, three university-sponsored graduate programs existed.

  35. Phase 5: Development of Consultation and Research in Psychiatric Nursing Practice (1946 to 1956) • 1952- Hildegard Peplau- Interpersonal relations in nursing • 1953- Maxwell Jones- Therapeutic Community

  36. Mental Health Services in India • BRITISH ERA: • Indian mental health is a child born to British parents and bred in Indian culture. • The Indian Lunacy Act (1912) was based on the British legislation then in force. • The history of Indian psychiatry runs parallel to British Psychiatry and the basic structure remains the same even to this day.

  37. Before British rule • During the reigns of King Ashoka, many hospitals were established for mentally ill. • A temple of Venkateswara at Tirumukkudal, Chingleput District, Tamil Nadu, contains inscription on the walls belonging to Chola period. • The inscription mentioned a hospital and a school. The hospital was named as Sri Veera Cholaeswara hospital and contained 15 beds.

  38. The first Indian mental asylum, i. e. Mandu Hospital opened by MahmoodKhilji (1436-1469) at Dhar, M. P. • First lunatic Asylum, Bombay Asylum, was built in modern India in approximately 1750 A. D. at the cost of 125/-, no traces of it is present today.

  39. In 1794, a private lunatic asylum was opened at Kilpauk, Madras. • The central mental hospital, Yerwada, Pune was opened in 1889. • First asylum for insane soldiers was started at Monghyr, Bihar(1795).

  40. The British established this hospital on 17 May 1918 with the name of 'Ranchi European Lunatic Asylum'. It had then a capacity of 174 patients (92 males and 82 females). • Later the Hospital for Mental Diseases and The Central Institute Of Psychiatry, Ranchi - for European patients and was staffed by British Army doctors.

  41. The history of the institute dates back to 1847, when the Bangalore Lunatic Asylum was founded. • In 1925, the Government of Mysore rechristened the asylum as the Mental Hospital. • The Mysore Government Mental Hospital became the first institute in India for postgraduate training in psychiatry. • All India Institute of Mental Health -1954 • NIMHANS-1974

  42. The first Indian Psychiatrist to be recognized by the Royal College of Psychiatrists is Prof. Narendra Wig. • Bhore committee report, 1946

  43. Independent India • Mental hospital @five places in India • Amristar-1947 • Hyderabad-1953 • Srinagar-1958 • Jamnagar-1960 • Delhi-1996

  44. 1954- Nur Manzil Mental Health Centre started orientation courses in Psyc.Nursing • 1956- 1 year diploma in Psy. Nsg @ NIMHANS • 1963- Community mental health centres act passed. • 1982- National Mental Health Programme • 1986-INC included Psy. Nsg in GNM syllabus. • 1987- Indian Mental Health Act

  45. Mental Health Services as on Today in India • Institutionalization Vs Deinstitutionalization • Focus shifted to Community Based Care • District Mental Health Programme • National Mental Health Policy • Revision Of Mental Health Act

  46. Current Issues & Trends in Care Demographic Changes • Type of the family(increased number of nuclear families) • Increasing number of the elderly people. Social Changes • The need for maintaining intergroup and intragroup loyalties. • Peer pressure Economic Changes • Industrialization • Urbanisation • Raised standard of living

  47. Contd… Technological Changes • Mass media • Electronic systems • Information technology Mental Health Care Changes • Increased awareness in the public regarding mental health • Need to maintain mental stability • Increased mental health problems.

  48. Educational programmes for the psychiatric nurse • Diploma in Psychiatric nursing (started in NIMHANS in 1956) • MSc in Psychiatric Nursing (started in RAK, 1976) • M.Phil. in Psychiatric nursing (started in MG University, Kottayam in 1990) • PhD in Psychiatric nursing

  49. Nursing Service • Expanded roles • Advanced practice roles • Independent practice

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