Videbeck Ch 1 Foundations of Psychiatric-Mental Health Nursing

People who carry out their roles and have appropriate/adaptive behavior are “healthy”. People who fail to
fulfill roles and carry out responsibilities or who have inappropriate behavior they are “ill”

Factors affecting mental health:

 Individual – personal factors include biological makeup, autonomy and independence, self-esteem,
capacity for growth, vitality, ability to find meaning in life, emotional resilience/hardiness, sense of
belonging, reality orientation, and coping or stress management abilities
 Interpersonal – relationship factors such as effective communications, ability to help others,
intimacy, and balance of separateness and connectedness
 Societal/cultural – environmental such as sense of community, access to adequate resources,
intolerance of violence, support of diversity among people, mastery of the environment, and a
positive yet realistic view of one’s world

Mental illness includes disorders that affect mood, behavior and thinking. Often causes significant distress or
impaired functioning or both.

** Note that some of the social cultural factors can result in feelings of alienation, isolation, and
maladaptive, violent, or criminal behavior – is it illness or bad behavior?

The DSM 5 has 3 purposes:

1. To provide a standardized nomenclature and language for all mental health professionals
2. To present defining characteristics or symptoms that differentiate specific diagnoses
3. To assist in identifying the underlying causes of disorders

Aristotle believes that imbalances of the humors in the body relates to how much blood, water, black and
yellow bile exists in the body. Mental illness was then “treated” through bloodletting, starving, and purging
well through the 19th century

Christians viewed the mentally ill as possessed; treated with exorcism, incarceration in dungeons, flogging,
and starving

English renaissance – mentally ill distinguished as criminals. Those considered harmless could live wandering
the countryside or in rural communities. The more dangerous were imprisoned
 Hospital of St. Mary Bethlehem was officially declared a hospital for the insane where the public
could come pay a fee to view and mock the sub-human animal-like inmates.

US colonies – mentally ill considered evil and were punished. Witch hunts resulted in mentally ill people
being burned at the stake

Key Points:
 Mental health and mental illness are difficult to define and are influenced by one’s culture and society.
 The World Health Organization defines health as a state of complete physical, mental, and social wellness,
not merely the absence of disease or infirmity.
 Mental health is influenced by individual factors, including biologic makeup, autonomy and independence,
self-esteem, capacity for growth, vitality, ability to find meaning in life, resilience or hardiness, sense of
belonging, reality orientation, and coping or stress management abilities; by interpersonal factors, including
effective communication, helping others, intimacy, and maintaining a balance of separateness and
connectedness; and by social/cultural factors, including sense of community, access to resources, intolerance
of violence, support of diversity among people, mastery of the environment, and a positive yet realistic view
of the world.
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 Videbeck Ch 1 Foundations of Psychiatric-Mental Health Nursing

 Historically, mental illness was viewed as demonic possession, sin, or weakness, and people were punished
accordingly.
 Today, mental illness is seen as a medical problem with symptoms causing dissatisfaction with one’s
characteristics, abilities, and accomplishments; ineffective or unsatisfying interpersonal relationships;
dissatisfaction with one’s place in the world; ineffective coping with life events; and lack of personal growth.
 Factors contributing to mental illness are biologic makeup; anxiety, worries, and fears; ineffective
communication; excessive dependence or withdrawal from relationships; loss of emotional control; lack of
resources; and violence, homelessness, poverty, and discrimination.
 The DSM-5 is a taxonomy used to provide a standard nomenclature of mental disorders, define
characteristics of disorders, and assist in identifying underlying causes of disorders.
 A significant advance in treating persons with mental illness was the development of psychotropic drugs in
the early 1950s.
 The shift from institutional care to care in the community began in the 1960s, allowing many people to leave
institutions for the first time in years.
 One result of deinstitutionalization is the revolving door of repetitive hospital admission without adequate
community follow-up.
 It is estimated that one-third of the homeless population have a mental illness and one-half have substance
abuse problems.
 Treatment rates for children and adults are 68% and 57%, respectively, but only 37% for homeless individuals
and 3% for persons with a dual diagnosis of mental illness and substance abuse.
 Community-based programs are the trend of the future, but they are underfunded and too few in number.
 Managed care, in an effort to contain costs, has resulted in withholding of services or approval of less
expensive alternatives for mental health care.
 The population in the United States is becoming increasingly diverse in terms of culture, race, ethnicity, and
family structure.
 Psychiatric nursing was recognized in the late 1800s, though it was not required in nursing education
programs until 1950.
 Psychiatric nursing practice has been profoundly influenced by Hildegard Peplau and June Mellow, p. 11 p. 12
who wrote about the nurse–client relationship, anxiety, nurse therapy, and interpersonal nursing theory.
 The ANA has published standards of care that guide psychiatric–mental health nursing clinical practice.
 Common concerns of nursing students beginning a psychiatric clinical rotation include fear of saying the
wrong thing, not knowing what to do, being rejected by clients, being physically threatened, recognizing
someone they know as a client, and sharing similar problems or backgrounds with clients.
 Awareness of one’s feelings, beliefs, attitudes, values, and thoughts, called self-awareness, is essential to the
practice of psychiatric nursing.
 The goal of self-awareness is to know oneself so that one’s values, attitudes, and beliefs are not projected to
the client, interfering with nursing care. Self-awareness does not mean having to change one’s values or
beliefs, unless one desires to do so.

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