Introduction to

Psychiatric Nursing

Mr.Narayan K Ghorpade
M.Sc Department of Psychiatric Nursing
Asst ,professor
Bharati Vidyapeeth University
College of Nursing ,Sangli
Maharashtra ( India)
 History Concepts

 How were mentally ill treated prior to1790’s?

 Banishment (sending away from place)
 Confinement( restraining or Arrest )

 What were attitudes toward them?

 Possessed by the devil

 Lacked basic human qualities

St. Mary of Bethlehem Hospital, London
(“Bedlam”) Opened to lunatics 1403

Visitors pay for “entertainment”

 History Concepts

 Period of Enlightenment begins in 1790’s

 Concept of “ Asylum” (sanctuary):

 If we treat patients humanely and

respectfully, they will improve.
 Mental illness worsens with stress

 First mental hospitals (“asylums”) in US in 1820’s

 History Concepts

 Who was Dorthea Dix?

A nurse who was one of the first major
reformers in the United States.
Helped develop the concept of an asylum
Direct role in opening 32 state hospitals
Dorthea Dix Asylum in North
Carolina
 Austin, Texas
State Insane Asylum 1851
 Era of Psychotropic Drugs

 Medications first available in 1950s, i.e.

chlorpromazine (Thorazine) for
Schizophrenia, Lithium for Mania
 Hope for previously “incurable” mental
illnesses and enhanced quality of life.
 Community Mental Health
Movement
 Response to the overcrowding and bureaucracy of
public mental hospitals.
 Chronically mentally ill “warehoused” and often
abused, neglected
 1963 Community Mental Health Act
 Concept: Patients can be treated better, cheaper in
community
 Massive deinstitutionalization: All State Hospitals in
some states closed
 Results: Increased acuity and strain on
emergency services, increased number
of homeless mentally ill
 ETHICAL ASPECTS: SOCIAL VALUES
(Consider what effect each of these values
has on mental health care)

 Individual Freedom
 Money
 Paternalism vs Libertarianism
 Paternalism believes that an authority knows what is best for
you
 Libertarianism believes that the individual knows what is
best for them
 No other area of nursing is so affected by social
values as psychiatric nursing
 A Nurse Needs to Know About:

 How to adapt legal principles to mental health

settings:
 safeguarding nursing practice from charges of negligence, false
imprisonment, assault, or battery
 DUTY TO WARN
 Mental health professionals must warn others of a client’s
threat of suicide or of harm to self or others
 Rights of Psychiatric/Mental
Health Patients
 Right to refuse treatment
 Right to informed consent ( and the right to
know about rights)
 Right to confidentiality
 Right to receive visitors and telephone calls
 Right to be treated with respect
 Right to be treated in the least restrictive
environment
 Rights of Mentally Ill Patients

 Basic Needs:
 Warmth: clothing a blanket

 Food

 Access to the outdoors

 Contact with family, legal representative

 Do NOT have right to all possessions
(When can access to possessions be restricted?)
 PSYCHOTHERAPEUTIC
MANAGEMENT

 TOOLS ARE:

SELF  DRUGS  ENVIRONMENT

 Therapeutic Use of SELF (Nurse-Client Relationship)

 DRUGS: Psychopharmacology
 ENVIRONMENT: Therapeutic Milieu
NURSE ON THE MENTAL HEALTH
TEAM

 Mental Health Team:

 Psychiatrist
 Nursing staff: includes licensed nurse, tech
 Psychiatric Social Worker
 Psychologist
 Therapeutic Recreation and Expressive Arts personnel
 Client and Family
 Other: Substance abuse counselor, employment specialist,
dietician, etc.