This document discusses the history and evolution of mental health nursing. It describes how historical beliefs involved demonology, witchcraft and the establishment of asylums in the 1800s. It then discusses the evolution of psychiatric nursing with Linda Richards as the first psychiatric nurse and the establishment of psychiatric hospitals and nursing schools. Finally, it describes the contemporary approach in the mid-1900s which involved a shift to community care and the addition of psychiatric nursing to nursing curricula following the National Mental Health Act post-WWII.

1. Mental Health Nursing

2.  Historical Beliefs
 Demonology requiring exorcism, beating, torture
 Middle Ages associated mental illness with witchery
 Asylums emerged in the 1800s – institutionalized
 Evolution of Nursing
 Linda Richards – First psychiatric nurse
 Est’b psychiatric hospitals and schools of nursing
(asylums)
 Contemporary Approach
 Mid 1900s – shift to community care, psychiatric nursing
added to nursing curricula
 National Mental Health Act – post WWII

3.  American Psychiatric Association
 A state of being that is relative rather than
absolute
 Shown by productive activities, fulfilling
relationships, ability to adapt to change and
cope with adversity
 Lisa Robinson (Psychiatric Nursing Expert)
 Dynamic state in which thought, feeling, and
behavior is age appropriate and congruent with
local and cultural norms

4.  American Psychiatric Association
 A clinically significant behavioral or
psychological pattern, associated with
distress, disability, or risk of suffering
 Not an expected cultural response to an event
 Townsend
 Maladaptive responses to s tre s s o rs , AEB
thoughts, feelings, behaviors that are not
congruent with c ulture and interferes with
functioning

5.  Members of the community define norms
 Relatives typically determine “normalcy”and
define when state has changed
 Class and Education
 Lower - high incidence; low recognition
 Higher - high recognition and self labeling
 Gender
 Women are more likely to recognize symptoms of
MI and seek treatment

6.  Stressor
 Any factor that causes emotional or physical
tension; may be a responsible factor in certain
illnesses
 Stress Response - General Adaptation
Syndrome
 Alarm-Resistance-Exhaustion (review N101
lecture)
 Adaptation – responses preserve integrity and
equilibrium
 Maladaption – responses that result in disruption

7.  Primary  Secondary
 The person asks  The person assesses
themselves is this event: their skills, resources,
▪ Irrelevant – the and knowledge to deal
outcome is with the situation
insignificant  Determines coping
▪ Benign-positive - the strategies available
outcome is  Considers options
pleasurable
▪ Stressful – the
outcome is harmful,
threatening,
challenging

8.  Predisposing Factors
 Genetic influences: temperament, family
history of mental illness, personality
 Past Experiences: learned patterns of coping
due to past experiences
 Existing Conditions: Current health status,
developmental maturity, financial and
educational resources, support system

9.  The use of coping strategies in response to
stress
 Adaptive or Maladaptive
 Specific Strategies
 Awareness - recognition
 Relaxation/Meditation
 Communication – talking it out; support systems
 Problem Solving – view situation objectively,
analyze, act, evaluate
 Alternative Resources
▪ Pets/ music/ dance/ art/ exercise

10.  Anxiety
 Vague apprehension associated with feelings
of uncertainty
 Levels of anxiety
▪ Mild – tension, prepares for action/response
▪ Moderate –heightened tension; cognition impaired
and individual needs assistance
▪ Severe – Difficulty functioning even simple tasks
▪ Panic – terror, desperate, out of touch with reality

11.  Defense Mechanisms
 Protective devices used to alleviate anxiety
▪ Compensation – covering up a weakness by
emphasizing something more desirable
▪ Denial – refusal to acknowledge
▪ Displacement – transfer of feelings from target to
another
▪ Identification – increase self worth by acquiring
attributes of a positive role model
▪ Intellectualization – avoid emotions by focusing on
analysis
▪ Introjection – integration of others values into self
▪ Isolation – separating the event and emotion

12.  Defense Mechanisms con’t
▪ Projection – attributing unacceptable self-feelings to
another
▪ Rationalization – making excuses
▪ Reaction – avoids thoughts, feelings by expressing
opposite
▪ Repression – blocking unpleasant feelings
▪ Sublimation – direct impulses into constructive activities
▪ Suppression – avoiding unpleasant thoughts, feelings
▪ Undoing – symbolically cancels out an unpleasant
experience

13.  Dia g no s tic a nd Sta tis tic a l M nua l o f M nta l
a e
Dis o rd e rs – Fo urth Ed itio n – Te x t Re v is io n
 This is a tool provides guidelines and diagnostics
criteria for mental illness
 It is a multi-axial system
 Axis 1: All psychiatric disorders except personality d/o and
MR
 Axis 2: Personality disorders and MR
 Axis 3: Medical conditions
 Axis 4: Environmental issues or psychosocial problems that
may impede treatment
 Axis 5: Global Functioning Scale – Townsend, page 26