PSYCHIATRIC NURSING By: Cheryl B. Inso, RN

Introduction and History of psychiatric Nursing

Evolution of Psychiatric Mental Health Care Pre – 1960 > treatment was provided in large mental hospitals ( state or private ) usually located away from well – populated areas > length of stay was typically prolonged > clients commonly became dependent and institutionalized > family members were not part of the treatment team

Evolution of Psychiatric Mental Health Care 1960 to 1970 > the Civil Rights movement of the 1960’s served as a catalyst for focusing on the rights of the mentally ill > The Community mental health centers Act (1963) dramatically affected delivery of mental health services > focus and funding for treatment shifted from large mental hospitals to newly established community mental health centers that provided the following services:

Evolution of Psychiatric Mental Health Care Emergency care – immediate assessment and initiation of appropriate treatment 24 hour inpatient care – hospital based care for symptom stabilization Partial hospitalization – treatment programs for individuals requiring daily support but not 24 hour hospital care Outpatient care – assessment, psychotherapeutic support and medication management Consultation and education – outreach programs for community groups on mental health topics

Evolution of Psychiatric Mental Health Care 1970 to 1980 > Treatment shifted from long term hospital care to shorter inpatient stays, followed by community based treatment after discharge > Client populations decreased in large mental hospitals > homelessness became a problem for people with persistent chronic mental illness who lacked family resources and adequate social support

Evolution of Psychiatric Mental Health Care 1980 to 1990 > establishment of managed care systems which oversee the relationship among payers, providers and consumers of health care >Types of managed care systems include : a. Health Maintenance organization (HMOs) ‏ b. Independent practice organization c. Preferred provider organizations ( PPOs ) ‏

Evolution of Psychiatric Mental Health Care 1990 to 2000 > Significant changes in the delivery of mental health treatment occurred > managed care incorporated several new structures and services a. case management – involves assignment of a case manager to coordinate services for individual clients and collaborate with multidisciplinary team b. Critical pathways and care maps – serve as clinical management tool to designate the organization c. population –based community care – focuses on primary preventive services and not just illness based care

Evolution of Psychiatric Mental Health Care 2000 to present > Recovery and rehabilitation model > assertive Community treatment > evidence –based practice > complementary and alternative medicine

Psychiatric Nursing Education Key Figures  Florence Nightingale – founder of modern nursing and author of the first nursing text, Notes on Nursing, published in 1859  Harriet Bailey – wrote the first psychiatric nursing textbook, Nursing in Mental Diseases, published

Psychiatric Nursing Education  Hildegarde Peplau – wrote Interpersonal Relations in Nursing, a landmark book published in 1952 that described a framework for psychiatric nursing practice; her emphasis on nurse-patient relationships and theoretical constructs to explain patient problems provided the foundation for psychiatric nursing practice

Nursing Organizations  The National League for Nursing (NLN), established in 1937, recommended the inclusion of mental health and psychiatric nursing in nursing school curricula  The American Nurses Association (ANA), founded in 1958, established the Conference group on psychiatric mental health nursing > define the practice of psychiatric mental health nursing > first to publish standards of mental health and psychiatric nursing practice > describe two levels of psychiatric and mental health nurse practice, the generalist and the specialist

Current Trends in Psychiatric- Mental Health Nursing  Psychiatric Mental Health Nurse generalist 1. education required is a baccalaureate degree in nursing 2. certification involves a formal process regulated by the American Nurses Credentialing Center (ANCC) that validates clinical competence, designation following certification is RN,C. 3. A generalist works with individual clients, families, groups and the community to assess mental health needs, develop diagnoses and plan, implement and evaluate nursing care 4. focus of care covers the spectrum of mental health and psychiatric concerns 5. Practice settings include hospitals, home health agencies, employee assistance programs, mental health clinics, HMOs, primary care centers, homeless clinics, senior centers, emergency and crisis centers, daycare centers, schools and prisons

 Psychiatric Mental Health Nurse specialist 1. education required is a master’s degree in psychiatric –mental health nursing a. a psychiatric nurse practitioner - is an advanced-practice RN with a master’s degree who provides primary care b. A clinical nurse specialist - is a master’s prepared RN who provides direct care as a therapist or indirect care as a consultant, educator or researcher

2. Certification by the ANCC involves a formal process to validate clinical competence > advanced practice mental health nurses may also become certified as clinical specialists > the designation RN, CS, applies to both psychiatric nurse practitioners and clinical nurse specialists > specialist performs all of the functions of a generalist