1. Period of Enlightenment
Introduction to Psychiatric Nursing ➢ Mentally ill were treated humanely
Psychiatric Nursing (NCM 117) ➢ Asylum – developed from humane efforts of
Philippe Pinel and Tuke which means
protection, social support or sanctuary from
MENTAL HEALTH stresses of life
➢ Results in the development of hospital
• WHO defines health as a state of complete
physical, mental, and social wellness, not merely
the absence of disease or infirmity.
• Mental health is a state of emotional, 2. Period of Scientific Study
psychological, and social wellness evidenced by ➢ Sanctuary to treatment
satisfying interpersonal relationships, effective ➢ Freud, Kraepelin and Bleuler studied people
behavior and coping, positive self-concept, and objectively
emotional stability. ➢ Freud – Psychoanalysis (Id, Ego, Superego)
➢ Kraepelin made contributions to the
MENTAL ILLNESS classification of mental illness
➢ Bleuler coined the word “Schizophrenia”
➢ Mental illness includes disorders that affect
mood, behavior, and thinking, such as
depression, schizophrenia, anxiety disorders,
and addictive disorders. 3. Period of Psychotropic Drugs
INTRODUCTION TO PSYCHIATRIC NURSING Discovery of Psychotropic Drugs
Psychiatric Nursing is an interpersonal process that ➢ Antipsychotic
promotes and maintains behaviors that contribute to ➢ Antimanic
integrated functioning. ➢ Antidepressant
The patient maybe an individual, family, group, As a result:
organization or community. ➢ Hospital stays were shortened
Psychiatric Nursing is a specialized area of nursing ➢ Hospital environment were improved
practice, employing the wide range of explanatory
theories of human behavior as its science and
purposeful use of self as its art (as defined by the Scope 4. Period of Community Mental Health
and Standards of Psychiatric-Mental Health Nursing ➢ CMH programs goals
Practice) ➢ Emergency care
➢ 24-hour in-patient care
HISTORY OF PSYCHIATRIC NURSING ➢ Partial hospitalization care
➢ Linda Richards is the 1st American psychiatric ➢ Out-patient care
nurse. Graduated 1873 from New England ➢ Consultation and education
Hospital for women and children in Boston.
➢ Hildegarde Peplau is the mother of Psychiatric
Nursing. DEINSTITUTIONALIZATION refers to the depopulating of
state mental hospitals which changed the locus of
Psychiatric Nursing began to emerge as a profession in treatment from large hospitals to the community.
the late 19th century and by the 20th century it had
evolved into a specialty with unique roles and functions
AECB
, 5. Decade of the Brain
➢ Increased brain research – increases interest
in biologic explanations for mental disorder
➢ Significant changes in public awareness
➢ Nursing with significant augmentation of
psychobiologic content in academic nursing
programs.
➢ Psychiatric nursing as specialty
➢ Brought psychiatric nursing in the
mainstream of psychiatric care
3 INTERVENTION TOOLS USED BY THE STUDENTS IN
THE PSYCHIATRIC SETTING
➢ Self
➢ Psychotropic drugs
➢ Environment (Milieu)
Psychotherapeutic NPR
• Communication skills
• Respect and a desire to help
• Understanding
• Mental mechanism
• Adaptation styles
• Coping strategies
• Therapeutic intervention skills
Psychopharmacology
• Therapeutic versus toxic dosage levels
• Use during pregnancy
• Use with older adults
• Side effects
• Interactions
• Patient teaching
Milieu Management
• Safety
• Structure
• Norms
• Setting limits
• Balance
• Environmental modification
AECB
, Active listening means refraining from other internal
Introduction to Therapeutic Communication mental activities and concentrating exclusively on what
Psychiatric Nursing (NCM 117) the client says
➢ Active observation means watching the
COMMUNICATION is the process people use to speaker’s nonverbal actions as he or she
exchange information: communicates.
• Verbal is what is said, or content VERBAL COMMUNICATION SKILLS (7%)
• Nonverbal are behaviors such as facial Use concrete messages
expression, tone of voice, hesitancy, distance
from speaker, or process ➢ Specific and clear
• Context include environment or situation, and ➢ Abstract messages are unclear and vague and
culture require interpretation
• Congruency is when content and process agree ➢ Elicit more accurate responses and avoid the
• Incongruency is when content and process do need to go back and rephrase unclear questions
not agree; therefore, nonverbal is more ➢ Rephrasing and asking again interrupts the flow
accurate of a therapeutic interaction
THERAPEUTIC COMMUNICATION involves interpersonal
Therapeutic communication techniques facilitate
interactions between the nurse and the client. It focuses interaction and enhance communication between client
on the client’s specific needs and is used to: and nurse. Techniques that encourage the client to
• Establish the therapeutic relationship discuss his or her feelings or concerns in more depth
• Identify the client’s most important concerns include:
• Assess the client’s perceptions • Exploring “Tell me more”
• Recognize the client’s needs • Focusing “Which is more disturbing?” ; “Is this
• Guide the client toward satisfaction where will we be focusing?”
ESSENTIAL COMPONENTS OF THERAPEUTIC • Restating “You’re sad” ; “You’re happy
COMMUNICATION • Reflecting “Which one do you think is better?” ;
“Will this help with what you’re feeling right
➢ Privacy and respect for boundaries: therapeutic now?”
communication is most comfortable at 3 to 6
feet; should not be less than 18 inches NONVERBAL COMMUNICATION SKILLS (93%)
➢ Touching a client may be comforting and
• Facial expression
supportive if it is permitted and welcome;
• Body language
The Nurse must evaluate whether the client
• Vocal cues
perceives touch as positive or threatening and
• Eye contact
unwanted and should never assume that
• Silence
touching a client is acceptable
➢ Active listening is what client is saying can be Remember that nonverbal communication (93%) is as
promoted by: important as verbal communication (7%)
o Facing the client
o Using moderate eye
contact
o Removing physical
barriers
o Maintaining open
body posture
o Leaning forward
AECB
, GOALS OF THERAPEUTIC COMMUNICATION SESSION
• Establishing rapport
• Identifying issues of concern
• Being empathetic, genuine, caring, and
unconditionally accepting of the person
• Understanding the client’s perception
• Exploring the client’s thoughts and feelings
• Developing problem-solving skills
• Promoting the client’s evaluation of solutions
BEGINNING THERAPEUTIC COMMUNICATION
1. Introduction and establishing a contract
(outlines the care being provided and
parameters of the relationship)
2. Finding client-centered goals (maintains the
focus on the client and provides parameters for
evaluation of effectiveness)
3. Phrasing questions appropriately
✔Asking for clarification
✔Managing client’s avoidance of the anxiety-
producing topic
4. Guiding the client in problem-solving and
empowering the client to change
AECB
Introduction to Psychiatric Nursing ➢ Mentally ill were treated humanely
Psychiatric Nursing (NCM 117) ➢ Asylum – developed from humane efforts of
Philippe Pinel and Tuke which means
protection, social support or sanctuary from
MENTAL HEALTH stresses of life
➢ Results in the development of hospital
• WHO defines health as a state of complete
physical, mental, and social wellness, not merely
the absence of disease or infirmity.
• Mental health is a state of emotional, 2. Period of Scientific Study
psychological, and social wellness evidenced by ➢ Sanctuary to treatment
satisfying interpersonal relationships, effective ➢ Freud, Kraepelin and Bleuler studied people
behavior and coping, positive self-concept, and objectively
emotional stability. ➢ Freud – Psychoanalysis (Id, Ego, Superego)
➢ Kraepelin made contributions to the
MENTAL ILLNESS classification of mental illness
➢ Bleuler coined the word “Schizophrenia”
➢ Mental illness includes disorders that affect
mood, behavior, and thinking, such as
depression, schizophrenia, anxiety disorders,
and addictive disorders. 3. Period of Psychotropic Drugs
INTRODUCTION TO PSYCHIATRIC NURSING Discovery of Psychotropic Drugs
Psychiatric Nursing is an interpersonal process that ➢ Antipsychotic
promotes and maintains behaviors that contribute to ➢ Antimanic
integrated functioning. ➢ Antidepressant
The patient maybe an individual, family, group, As a result:
organization or community. ➢ Hospital stays were shortened
Psychiatric Nursing is a specialized area of nursing ➢ Hospital environment were improved
practice, employing the wide range of explanatory
theories of human behavior as its science and
purposeful use of self as its art (as defined by the Scope 4. Period of Community Mental Health
and Standards of Psychiatric-Mental Health Nursing ➢ CMH programs goals
Practice) ➢ Emergency care
➢ 24-hour in-patient care
HISTORY OF PSYCHIATRIC NURSING ➢ Partial hospitalization care
➢ Linda Richards is the 1st American psychiatric ➢ Out-patient care
nurse. Graduated 1873 from New England ➢ Consultation and education
Hospital for women and children in Boston.
➢ Hildegarde Peplau is the mother of Psychiatric
Nursing. DEINSTITUTIONALIZATION refers to the depopulating of
state mental hospitals which changed the locus of
Psychiatric Nursing began to emerge as a profession in treatment from large hospitals to the community.
the late 19th century and by the 20th century it had
evolved into a specialty with unique roles and functions
AECB
, 5. Decade of the Brain
➢ Increased brain research – increases interest
in biologic explanations for mental disorder
➢ Significant changes in public awareness
➢ Nursing with significant augmentation of
psychobiologic content in academic nursing
programs.
➢ Psychiatric nursing as specialty
➢ Brought psychiatric nursing in the
mainstream of psychiatric care
3 INTERVENTION TOOLS USED BY THE STUDENTS IN
THE PSYCHIATRIC SETTING
➢ Self
➢ Psychotropic drugs
➢ Environment (Milieu)
Psychotherapeutic NPR
• Communication skills
• Respect and a desire to help
• Understanding
• Mental mechanism
• Adaptation styles
• Coping strategies
• Therapeutic intervention skills
Psychopharmacology
• Therapeutic versus toxic dosage levels
• Use during pregnancy
• Use with older adults
• Side effects
• Interactions
• Patient teaching
Milieu Management
• Safety
• Structure
• Norms
• Setting limits
• Balance
• Environmental modification
AECB
, Active listening means refraining from other internal
Introduction to Therapeutic Communication mental activities and concentrating exclusively on what
Psychiatric Nursing (NCM 117) the client says
➢ Active observation means watching the
COMMUNICATION is the process people use to speaker’s nonverbal actions as he or she
exchange information: communicates.
• Verbal is what is said, or content VERBAL COMMUNICATION SKILLS (7%)
• Nonverbal are behaviors such as facial Use concrete messages
expression, tone of voice, hesitancy, distance
from speaker, or process ➢ Specific and clear
• Context include environment or situation, and ➢ Abstract messages are unclear and vague and
culture require interpretation
• Congruency is when content and process agree ➢ Elicit more accurate responses and avoid the
• Incongruency is when content and process do need to go back and rephrase unclear questions
not agree; therefore, nonverbal is more ➢ Rephrasing and asking again interrupts the flow
accurate of a therapeutic interaction
THERAPEUTIC COMMUNICATION involves interpersonal
Therapeutic communication techniques facilitate
interactions between the nurse and the client. It focuses interaction and enhance communication between client
on the client’s specific needs and is used to: and nurse. Techniques that encourage the client to
• Establish the therapeutic relationship discuss his or her feelings or concerns in more depth
• Identify the client’s most important concerns include:
• Assess the client’s perceptions • Exploring “Tell me more”
• Recognize the client’s needs • Focusing “Which is more disturbing?” ; “Is this
• Guide the client toward satisfaction where will we be focusing?”
ESSENTIAL COMPONENTS OF THERAPEUTIC • Restating “You’re sad” ; “You’re happy
COMMUNICATION • Reflecting “Which one do you think is better?” ;
“Will this help with what you’re feeling right
➢ Privacy and respect for boundaries: therapeutic now?”
communication is most comfortable at 3 to 6
feet; should not be less than 18 inches NONVERBAL COMMUNICATION SKILLS (93%)
➢ Touching a client may be comforting and
• Facial expression
supportive if it is permitted and welcome;
• Body language
The Nurse must evaluate whether the client
• Vocal cues
perceives touch as positive or threatening and
• Eye contact
unwanted and should never assume that
• Silence
touching a client is acceptable
➢ Active listening is what client is saying can be Remember that nonverbal communication (93%) is as
promoted by: important as verbal communication (7%)
o Facing the client
o Using moderate eye
contact
o Removing physical
barriers
o Maintaining open
body posture
o Leaning forward
AECB
, GOALS OF THERAPEUTIC COMMUNICATION SESSION
• Establishing rapport
• Identifying issues of concern
• Being empathetic, genuine, caring, and
unconditionally accepting of the person
• Understanding the client’s perception
• Exploring the client’s thoughts and feelings
• Developing problem-solving skills
• Promoting the client’s evaluation of solutions
BEGINNING THERAPEUTIC COMMUNICATION
1. Introduction and establishing a contract
(outlines the care being provided and
parameters of the relationship)
2. Finding client-centered goals (maintains the
focus on the client and provides parameters for
evaluation of effectiveness)
3. Phrasing questions appropriately
✔Asking for clarification
✔Managing client’s avoidance of the anxiety-
producing topic
4. Guiding the client in problem-solving and
empowering the client to change
AECB
