Introduction to historical development in nursing

2. “A state of complete physical, mental
and social well-being
without the absence of disease or infirmity.”
WORLD HEALTH ORGANIZATION

3. “The successful performance of mental function,
resulting in productive activities, fulfilling
relationships, and the ability to adapt to
change and cope with adversity”

4. A state of emotional, psychological, and
social wellness evidenced by satisfying
interpersonal relationships, effective
behaviour, and coping, positive self-concept,
and emotional stability.

5.  Self-governance
 Progress toward growth or self-realization
 Tolerance of uncertainty
 Self-esteem
 Reality orientation
 Mastery of environment
 Stress management

6. FACTORS INFLUENCING MENTAL
HEALTH

7. kcbengan/SACRNursing/2004
 Biologic makeup
 Sense of harmony in life
 Emotional resilience/hardiness
 Spirituality
 Positive identity

8. kcbengan/SACRNursing/2004
 Sense of community
 Access to adequate resources
 Intolerance of violence
 Support of diversity among people

9. kcbengan/SACRNursing/2004
 Effective
communication
 Ability to help others
 Intimacy
 Balance of
separateness and
connection

10. 1) An appropriate perception of reality.
2) The ability to accept oneself, others and human
nature.
3) The ability to manifest spontaneity.
4) The capacity for focusing concentration on problem
solving.
5) A need for detachment and desire for privacy.
6) Independence, autonomy and a resistance to
enculturation.

11. 7) A frequency of peak experiences that validates
the worthwhileness, richness and beauty of
life.
8) An identification with humankind
9) The ability to achieve satisfactory
interpersonal relationships.
10) Creativeness
11) A democratic character structure and strong
sense of ethics.

12. 1) A positive attitude towards self.
2) Growth, development and the ability to
achieve self – actualization
3) Integration
4) Autonomy
5) Perception of reality
6) Environmental mastery

13. The Mental Health Continuum
 Depending on the circumstances in your life at any
given time, your state of mental health may be
located at any point along the continuum below.
 On the continuum, states of mental health are
differentiated by the amount of stress/distress and
impairment involved.
 The lines differentiating states of mental health are
not precise because it is not clear at which exact
point a concern becomes a problem, or a problem
becomes an illness.

15.  Most of us, most of the time, will be somewhere on
the left half of the continuum – experiencing
reasonably good emotional health and negotiating
life events that, while stressful, do not feel
unmanageable.
 In this state of well-being, the stress and discomfort
caused by the everyday ups and downs of life do not
impair daily functions such as eating, sleeping, or
problem-solving.
 Generally we resolve these stresses ourselves,
without seeking professional help.

16.  But when major negative life events occur, or more
serious or prolonged problems arise, coping becomes
progressively more difficult.
 During these times you may experience what are
identified on the right side of the continuum as
“mental health problems.”
 Within the category identified as “mental health
problems,” there are two major mental health
states: emotional problems and mental illness.

17. Emotional problems or concerns:
 When emotional discomfort or distress begins to
noticeably impair your daily functioning (e.g., changes
in appetite or sleeping habits, lack of concentration),
you are experiencing emotional problems.
 This experience may be commonly referred to as a
“rough patch”, a “low point”, or “the blues.”
 Some people in this area of the continuum may be
diagnosed with mild or temporary medical disorders
such as “situational depression” or “general anxiety.”

18.  Self-care strategies and the support of friends and
loved ones can be especially helpful during these
times.
 In addition, many people experiencing this level of
distress and impairment seek professional counseling to
help them return to a state of emotional well-being.

19. “A clinically significant behavioral or
psychological syndrome experienced by a
person, marked by distress, disability, or the
risk of suffering, disability, or loss of
freedom”
(American Psychiatric Association)

20. 1) Change in one’s thinking, memory, perception,
feeling and judgement resulting in changes in
talk and behavior which appear to be a deviant
from previous personality or from the norms of
community.
2) The change in behavior causes distress and
suffering to the individual or others or both.
3) Changes and the consequent distress causes
disturbances in day to day activities, work and
relationship with important others.

21. Primitive beliefs regarding mental illness:
 Individual had been dispossessed of his/her
soul
Mgt: Returning the soul to the client
 Broken a taboo or sinned against another
individual or god
Mgt: Ritualistic purification

22. Evil spirits or super natural/magical powers
entered the body:
Mgt:
 Exorcism (prayer, noise making)
 Brutal beating, starvation, Burning, amputated
and tortured
 Oral preparation of a purgative made from sheep
dung and wine
 Trephining (A circular opening made on the skull
by means of crude stone instruments to let out
evil spirits)

23.  It is a branch of medicine that deals with the
diagnosis, treatment and prevention mental
illness.
 Psychiatric assessment typically involves a mental
status examination and taking a case history, and
psychological tests may be administered.
 Physical examinations may be conducted and
occasionally neuroimages or other
neurophysiological measurements taken.

25.  Starting in the 5th century BC, mental disorders,
especially those with psychotic traits, were
considered supernatural in origin.
 This view existed throughout ancient Greece and
Rome. Early manuals written about mental
disorders were created by the Greeks.

26.  In 4th century BC, Hippocrates theorized that
physiological abnormalities may be the root of
mental disorders.
 Religious leaders and others returned to using
early versions of exorcisms to treat mental
disorders which often utilized cruel, harsh, and
other barbarous methods.

27.  The first psychiatric hospitals were built in the
medieval Islamic world from the 8th century.
 The first was built in Baghdad in 705, followed by Fes
in the early 8th century, and Cairo in 800.
 Unlike medieval Christian physicians who relied on
demonological explanations for mental illness,
medieval Muslim physicians relied mostly on clinical
observations.

28.  They made significant advances to psychiatry
and were the first to provide psychotherapy and
moral treatment for mentally ill patients, in
addition to other forms of treatment such as
baths, drug medication, music therapy and
occupational therapy.
 In the 10th century, the Persian physician
Muhammad ibn Zakariya Razi (Rhazes) combined
psychological methods and physiological
explanations to provide treatment to mentally ill
patients.

29.  His contemporary, the Arab physician Najab ud-
din Muhammad, first described a number of
mental illnesses such as agitated depression,
neurosis, and sexual impotence (Nafkhae
Malikholia), psychosis (Kutrib), and mania (Dual-
Kulb).

30.  In the 11th century, another Persian physician Avicenna
recognized 'physiological psychology' in the treatment of
illnesses involving emotions, and developed a system for
associating changes in the pulse rate with inner feelings,
which is seen as a precursor to the word association test
developed by Carl Jung in the 19th century.
 Avicenna was also an early pioneer of neuropsychiatry, and
first described a number of neuropsychiatric conditions
such as:
 hallucination,
 insomnia, mania, nightmare, melancholia,
 dementia, epilepsy, paralysis, stroke,
 vertigo and tremor.

31.  Psychiatric hospitals were built in medieval Europe from
the 13th century to treat mental disorders but were
utilized only as custodial institutions and did not provide
any type of treatment.
 Founded in the 13th century, Bethlem Royal Hospital in
London is one of the oldest psychiatric hospitals. By
1547 the City of London acquired the hospital and
continued its function until 1948.

32.  In 1656, Louis XIV of France created a public system of
hospitals for those suffering from mental disorders, but
as in England, no real treatment was being applied.
 Thirty years later the new ruling monarch in England,
George III, was known to be suffering from a mental
disorder. Following the King's remission in 1789, mental
illness was seen as something which could be treated
and cured.

33.  By 1792 French physician Philippe Pinel introduced
humane treatment approaches to those suffering from
mental disorders. William Tuke adopted the methods
outlined by Pinel and that same year Tuke opened the
York Retreat in England.
 That institution became known as a model throughout
the world for humane and moral treatment of patients
suffering from mental disorders.

34.  It inspired similar institutions in the United
States, most notably the Brattleboro Retreat and
the Hartford Retreat (now the Institute of
Living).

35.  Universities often played a part in the administration of
the asylums.
 Due to the relationship between the universities and
asylums, scores of competitive psychiatrists were being
molded in Germany.
 Germany became known as the world leader in psychiatry
during the nineteenth century. The country possessed more
than 20 separate universities all competing with each
other for scientific advancement.

36.  In the United States in 1834, Anna Marsh, a physician's
widow, deeded the funds to build her country's first
financially-stable private asylum. The Brattleboro Retreat
marked the beginning of America's private psychiatric
hospitals.
 In 1838, France enacted a law to regulate both the
admissions into asylums and asylum services across the
country.
 By 1840, asylums as therapeutic institutions existed
throughout Europe and the United States.

37.  However, during the mid-nineteenth century the
new and dominating ideas that mental illness all
came crashing down.
 Psychiatrists and asylums were being pressured by
an ever increasing patient population.
 Overcrowding was rampant in France where asylums
would commonly take in double their maximum
capacity. Increases in asylum populations may have
been a result of the transfer of care from families
and poorhouses.

38.  The 20th century introduced a new psychiatry into
the world. The different perspectives of looking at
mental disorders began to be introduced.
 The career of Emil Kraepelin somewhat model this
hiatus of psychiatry between the different
disciplines.

39.  Kraepelin initially was very attracted to psychology
and ignored the ideas of anatomical psychiatry.
Following his acceptance for a professorship of
psychiatry, and later his work in a university
psychiatric clinic
 Kraepelin's interest in pure psychology began to fade
and he introduced a plan of a more comprehensive
psychiatry.Kraepelin also began to study and promote
the ideas of disease classification for mental disorders,
an idea introduced by Karl Ludwig Kahlbaum.

40.  The initial ideas behind biological psychiatry, stating
that these different disorders were all biological in
nature, evolved into a new idea of "nerves" and
psychiatry became a sort of rough neurology or
neuropsychiatry.
 Following Sigmund Freud's death, ideas stemming from
psychoanalytic theory also began to take root.
 The psychoanalytic theory became popular among
psychiatrists because it allowed the patients to be
treated in private practices instead of asylums.

41.  ECT was "discovered" when Ugo Cerletti, psychiatrist,
visited a Rome slaughterhouse to see what could be
learned from the method that was employed to butcher
hogs.
 In Cerletti's own words, "As soon as the hogs were
clamped by the [electric] tongs, they fell unconscious,
stiffened, then after a few seconds they were shaken by
convulsions....
 During this period of unconsciousness (epileptic coma),
the butcher stabbed and bled the animals without
difficulty....

42. Lobotomy
 Lobotomy is a surgical practice where parts of the
frontal lobes are intentionally destroyed. Violent
criminals calm down, highly depressed people don't
seem so depressed any longer, and manics finally
mellow out.
 But they wander aimlessly, drool uncontrollably, and
have very little left of whatever "personality" they
once had.

43.  This period of time saw the reemergence of biological
psychiatry. Psychopharmacology became an integral
part of psychiatry starting with Otto Loewi's discovery
of the first neurotransmitter, acetylcholine.
 Neuroimaging was first utilized as a tool for psychiatry
in the 1980s.
 The discovery of chlorpromazine's effectiveness in
treating schizophrenia in 1952 revolutionized
treatment of the disease, as did lithium carbonate's
ability to stabilize mood highs and lows in bipolar
disorder in 1948.

44.  While psychosocial issues were still seen as valid,
psychotherapy was seen to be their "cure."
 Genetics were once again thought to play a role in
mental illness. Molecular biology opened the door
for specific genes contributing mental disorders to
be identified.
 By 1995 genes contributing to schizophrenia had
been identified on chromosome 6 and genes
contributing to bipolar disorder on chromosomes 18
and 21

45. 1773: The first mental hospital in the US was built in
Williamsburg, Virginia
1793: Phillip Pinel removed the chains from mentally
ill patients confined in Bicetre, a hospital outside
Paris, the first revolution in psychiatry
1812:The first American text book in psychiatry was
written by Benjamin Rush, who is referred to as
the father of American Psychiatry

46. 1908: Clifford Beers, an ex- patient of mental
hospital wrote the book, “The Mind That found
Itself” based on his bitter experiences in the
hospital
1912: Eugene Bleuler, a Swiss psychiatrist coined the
term Schizophrenia
1912: The Indian Lunacy Act passed
1927: Insulin shock treatment was introduced for
schizophrenia
1936: Frontal lobotomy was advocated for the
management of psychiatric disorders

47. 1938: Electro Convulsive Therapy (ECT) was used for
the treatment of psychoses
1939: Development of psychoanalytical theory by
Sigmund Freud led to new concepts in the treatment
of mental illness.
1946: The Bhore committee presented the situation
with regard to mental health services. Based on the
recommendations 5 hospitals were set up at Amritsar
(1947), Hyderabad(1953), Srinagar(1958),
Jamnagar(1960) and New Delhi(1966). An All India
Institute of Mental Health was set up at Bangalore
(National Institute of Mental Health and
Neurosciences (NIMHANS).

48. 1949: Lithium was first used for the treatment of
mania
1952: Chlorpromazine was introduced which brought
about a revolution in psycho-pharmacology
1963: ‘The community Mental Health centers' Act was
passed
1970s: Slow and steady reduction of beds in custodial
institutions.
1978: The Alma –Ata declaration of ‘Health for all by
2000 AD’ posed a major challenge to Indian mental
health professionals.

49. 1981:Community psychiatric centres were setup
experiment with primary mental health approach at
Raipur Rani, Chandigarh and Sakalwara, Bangalore.
1982: The Central Council of Health, India accepted
the national Mental Health Policy and brought out the
National Mental Health programme in India.
1987: The Indian Mental Health Act was passed, Two
acts were passed
 Mental Health Act 1987
 Persons with Disability Act 1955

50.  1990: The Govt.of India formed an Action Group at
Delhi to pool the opinions of mental health experts
about the National Mental health program.
 NIMHANS Bangalore has taken up the leadership in
orienting heath care professionals about the
mental health programs of our country.
 2001: Current situation analysis(CSA) was done to
evolve a comprehensive plan of action to energize
the NMHP.

51. “The diagnosis and
treatment of
human
responses to actual
or potential
mental
health problems”
(ANA, APNA, & ISPN, 2000)

52. It is a specialized area of nursing practice
employing theories of human behavior, as a
science and the purposeful use of self as an art
in the diagnosis and response to actual or
potential mental health problems
(ANA 1994)

53. Psychiatric nursing deals with the promotion of
mental health, prevention of mental illness,
care and rehabilitation of mentally ill
individuals both in hospital and community .

54.  1840s: Florence nightingale made an attempt to
meet the needs of psychiatric patients with proper
hygiene, better food, light and ventilation and use
of drugs to chemically restrain violent and
aggressive patients.
 1872: First training school for nurses based on the
Nightingale system was established by the New
England Hospital for women and children,USA
 Linda Richards the first Nurse to graduate from the
one year course, developed 12 training schools in
the USA

55.  1882: First school to prepare nurses to care for
the mentally ill was opened at Mc Lean Hospital
in Waverly.
 Two year program was started but few
psychological skills were addressed and much
importance was given to custodial care such as
personal hygiene, nutrition, medication etc
 1913: John Hopkins began the first school of
nursing to include a fully developed course for
psy.nsg in the curriculum

56.  1921: Short training courses of 3 to 6 months
were conducted in Ranchi.
 1943: Psy. Nsg course was started for male
nurses
 1946: Health survey committee’s report
recommended preparation of nursing
personnel in Psy. Nsg also.
 Training was started in the existing
institutions like mental hospitals in Bangalore
and Ranchi

57.  1950: four nurses were sent to UK by the
government of India for training in ‘mental
nurses’ diploma.
 1952: Dr.Hildegard Peplau defined the
therapeutic roles that nurses might play in the
mental health setting.
 She described the skills and roles of the psy.
Nurse in her book “interpersonal relations in
Nursing” . It was the first systematic and
theoretical frame work developed for Psy. Nsg.

58.  1953: Maxwell Jones introduced therapeutic
community.
 1956: one year post certificate course in psy. nsg
was started at NIMHANS, Bangalore
 1960: The focus began to shift to primary
prevention and implementing care and
consultation in the community
 The name psychiatric nursing changed in to
mental health nursing. 1970’s when it was known
as psychosocial nursing.

59.  1963: Journal of Psy. Nsg and Mental Health
services was published.
 1964: Mudaliar committee felt the need for
preparing large number of Psy. Nurses and
recommended inclusion of Psychiatry in the
nursing curriculum.
 1965: The Indian Nursing Council included psy.
Nsg as a compulsory course in B.Sc Nsg program
 1973: Standards of psychiatric and mental health
nursing practice were enunciated to provide a
means of improving the quality care

60.  1975: Psy. Nsg was offered as an elective subject
in M.Sc Nursing at the RAK College of Nsg, New
Delhi
 1980: Scientific advances in the area of
psychobiology, brain imaging techniques,
knowledge about neurotransmitters and neuronal
receptors , molecular genetics related psychiatry
etc. emerged.
 These contributed to the shift from psychodynamic
models to more balanced psychobiological models
of psychiatric care.

61.  1986: The Indian Nursing Council made psy.
nsg a component of General nursing and
Midwifery course
 1990: During these years integration of neuro
sciences into holistic biopsychosocial practice
of psychiatric nursing occurred.
 1991: Indian Society of Psychiatric Nurses
formed at NIMHANS, Bangalore.
 1994: The above mentioned changes led to
the revision of standards of psychiatric and
mental health nsg

62. Self-Awareness
 The NURSE gains
recognition of his/her
own feelings, beliefs,
and attitudes.
Awareness of Environment
 Includes recognition of
client needs, belief
systems, and behaviors.
 Identification of the
factors that contribute to
health and illness in the
client.
 Assessment of resources
available to the client.

64. Awareness Of Interactions With The
Environment
NURSES identify their:
 specific feelings and thoughts about clients (including
feelings of acceptance or rejection)
 evaluate the consequences of their actions toward
clients
 learn to effectively differentiate between their own needs
and client needs.

65. Human behaviour
Communication
skill
Process
Nursing
Therapeutic
Use of self

67. 1) Patient is accepted exactly as he is:
 Being non – judgmental and non – punitive.
 Being sincerely interested in the patient.
 Recognizing and reflecting on feelings which
patient may express.
 Talking with a purpose
 Listening
 Permitting patient to express strongly-held
feelings.

68. 2) Use Self – understanding as a Therapeutic
tool.
3) Consistency is used to contribute to
patient’s security.
4) Reassurance should be given in a Subtle and
Acceptable manner.

69. 5) Patient’s behavior is changed through
Emotional Experience and not by Rational
Interpretation.
6) Unnecessary increase in patient’s anxiety
should be avoided.
7) Objective observation of patient to
understand his behavior.

70. 8) Maintain Realistic Nurse – Patient
Relationship.
9) Avoid Physical and Verbal force as much as
possible.
10) Nursing care is centered on the patient as a
person and not on the control of symptoms.

71. 11) All explanations of procedures and other
routines are given according to the patient’s
level of understanding.
12) Many procedures are modified but basic
principles remain unaltered.

72. 1) Self – awareness
2) Self – acceptance
3) Accepting the patient
4) Being sincerely interested in patient care
5) Being available

73. 6) Empathizing with the patient
7) Reliability
8) Professionalism
9) Accountability
10) The ability to think critically

74. 1) Personal Skills:
a) Self – awareness
b) Adaptability

75. 2) Care values and Attitudes:
a) Self – awareness and self – esteem
b) Respecting the person’s rights
c) Listening
d) Responding with care and respect
e) Supporting with trust and confidence
f) Reassuring with explanation and honesty
g) Physically nursing the helpless with
compassion
h) Carrying out procedures skillfully
i) Working within personal and ethical
boundaries.

76. 3) Counselling Skills:
a) Unconditional positive regard/non-
judgmental approach
b) Empathy
c) Warmth and genuineness
d) Confidentiality
e) Non-verbal sensitivity, non-verbal attending,
non-verbal responding
f) Other interpersonal skills required are
paraphrasing, reflecting, clarifying,
summarizing.

77. 4) Behavioral Skills:
These are based on Pavlovian principles and
Skinner’s principles
a) To increase adaptive behavior
 Positive reinforcement
 Negative reinforcement
 Token economy

78. b) To decrease maladaptive behavior
 Extinction
 Time out
 Restraining
 Over correction
c) To teach new behavior
 Modeling
 Shaping
 Chaining
 Cueing

79. 5) Supervisory Skills:
 A good supervisor requires interpersonal and
professional skills, technical knowledge,
leadership qualities and human skills.
6) Crisis Skills:
7) Teaching Skills:

80. • Nurse
• Social Worker
• Clinical Psychologist
• Psychiatrist
• Physician
• Occupational Therapist
• Recreational Therapist
• Psychiatric Aide/Clinical Assistant

81. The Mental Health Team