NCM 117: PSYCHIATRIC NURSING LECTURE functionality (e.g. anxiolytics, antipsychotics,
antidepressants)
● Most important thing to remember: it’s the study of
PRELIMS
human behavior.
○ Apart from the cognition and affect, generally
what we deal with in psychiatry is the
Lesson 1:
PSYCHIATRIC NURSING behavior of the client
○ Your knowledge could also affect your
behavior
● A specialized area of nursing practice employing ○ With knowledge, we will not be alarmed
theories of human behavior as its science and when dealing with these disorders because
purposely use of self as its art we know how to prevent it which is also
○ One of the theories responsible for this reflected on the behavior
definitions is Joyce Travelbee ○ We are not being lax but we just know how
○ The person to actually note that psychiatric to prevent or control the behavior from
nursing is the usage or the science of happening
helping other individuals by using self is
noted by Joyce Travelbee Basic Principles of Psychiatric Nursing
- Also responsible for the theory ● We have to be vigilant all the time in the
Therapeutic use of self mental facility
- There are no other individual that ○ Because in just a second the client
can actually correct the problem but may change their mood
yourself ○ We always have to be self aware
- Simple concept: I can't help you if and conscious of what we are doing
you are not going to help yourself ○ Know where your clients are
- To achieve the goal of having an ○ Some clients are not hostile but
adapted behavior in the society you some are, hence, we always have
have to be adjusted in the to be conscious
environment and you have to use ○ E.g. when a patient hides their
yourself (you have to compose, toothbrush and stabs themselves
organize yourself) because they are suicidal = we
- Usage of yourself in order to adjust need to take note of the things our
and adapt clients are doing because we could
● Includes the continuous and comprehensive services be liable if they are hurt (even by
necessary for the promotion of optimal mental health, themselves) while you are on duty
prevention of mental illness, health maintenance, ○ We cannot go alone with a patient =
management and referral of mental and physical always buddy system or by pair
health problems, the diagnosis and treatment of ○ If there is an invite coming from the
mental disorders and their sequelae, and client we do not have to reject them
rehabilitation. right away we just need to tell them
○ Common stigma in dealing with the rules (e.g. we are not allowed to
psychiatrically challenged individuals is that go inside your rooms) = not
they are hostile right away rejection but just presenting facts
○ Right after the disorder it is not just the (these are the things that we can do
disorder that we have to focus on, it includes and what we are not allowed to do)
the acceptance and the side effects ○ We have to be aware of the
promoted by the treatment or medications protocols imposed by the institution
○ Medications in psychiatry are considered as ● Accept and respect the client regardless of his
“dirty medications”. These are medications behavior
that have more side effects compared to its ○ Regardless of their condition or behavior we
therapeutic effect. still need to treat the patient (e.g. nanakit,
○ The therapeutic effect might remove the suicidal)
signs and symptoms of the disorder but the ○ We cannot reject them
side effects will be various and diverse not ○ Never say “lang” (e.g. depression lang yan)
only affecting the physical activity of the ○ There are people who die from suicide rather
person but also other areas of your
CJP ❃ KDP ❃ DMR ❃ CDV ❃ HEDA ❃ NATL ❃ DMMRY ❃ JDM
, than cancer (e.g. more people are prone to ○ Do not do things at the height of your
depression and commiting suicide this emotions
pandemic becuase majority of people’s ○ Whenever you are angry it's not you that is
coping mechanisms are going outside and talking it is your emotions
interacting with people) ○ Compose yourself
○ Psychiatric manifestation: involuntary rolling ○ It is important to verbalize your feelings
of the eyes, tongue movement, spasm of the rather than to talk it out
face and eyelids (clients taking medications) ● Behaviors are learned
● Limit or reject the inappropriate behavior but not the ○ Behaviors apart from mentation are
individual influenced by culture and environment (even
○ When the patient does not want to take a the process of grieving ?)
medication there are instances when they ○ Habang pinapalaki ka iyon na yung tinatanim
can reject to take the medications but there sa isip mo
are also instances when they can't refuse to ○ What was taught to you affects your growing
take medications up pattern which then affects your behavior
- E.g. if a client is suffering from ○ Society and religion may also affect or
depression and they voluntarily influence behavior
seeked help/ consulted a therapist. ● All behaviors have meaning
If a client voluntarily seeked ○ There is a reason behind every behavior
consultation and is aware of their
condition, they can REFUSE taking Interdisciplinary Team Primary Roles
medications. 1. Psychiatrist
- If a client is mentally unstable they ● The psychiatrist is a physician certified in
can't refuse taking medication psychiatry by the American Board of
under two conditions: Psychiatry and Neurology which requires 3
1. They are already posing year residency, 2 years of clinical practice,
threat to themselves and completion of an examination. The
2. If they are already posing primary function of the psychiatrist is
as a threat to other people diagnosis of mental disorders and
= they will be involuntarily prescription of medical treatments.
admitted ○ In the Philippines: Philippine
- Involuntary admission: tatawag ng Psychiatric Association and
mental health facility, jacket Neurology
restraint, admitted to mental health ○ Medical doctors
facility 2. Psychologist
- E.g. the patient voluntarily admitted ● The clinical psychologist has a doctorate
themselves to a mental health (PhD) in clinical psychology and is prepared
facility, after admission they to practice therapy, conduct research, and
displayed hostility = the client will interpret psychological tests. Psychologists
be shifted under involuntary may also participate in the design of therapy
admission (under the discretion / programs for groups of individuals.
judgment of the psychiatrist) ○ Administer IQ and EQ examination
- Psychiatrist are the ones overall ○ BS Degree
incharge in the diagnosis and ○ Doctorate Degree (Doctor of
treatment of a client Philosophy)
- Kapag nanakit ang client tell them ○ Administer therapy (family, group),
that they are not allowed to do it counseling
(presenting facts and policies of the 3. Psychiatric Nurse
institution) ● The registered nurse gains experience in
- Avoid using the term baliw (not working with clients with psychiatric
appropriate) = instead you can call disorders after graduation from accredited
them as mentally challenged program of nursing and completion of
● Encourage and support expression of feelings in a licensure examination. The nurse has a solid
safe and non judgemental environment. Increase foundation in health promotion, illness
verbalization, decreases anxiety prevention, and rehabilitation in all areas,
CJP ❃ KDP ❃ DMR ❃ CDV ❃ HEDA ❃ NATL ❃ DMMRY ❃ JDM
, allowing him or her to view the client experiencing their condition
holistically. The nurse is also an essential ○ Achieve performing of activities of
team member in evaluating the effectiveness daily living
of medical treatment, particularly ○ Sustain and maintain or achieve the
medications. Registered nurses who obtain a ability of the patient to function
master’s degree in mental health may be normally in terms of their
certified as clinical specialists or licensed as psychomotor function
advanced practitioners, depending on 6. Recreational Therapists
individual state nurse practice acts. ● Many recreation therapists complete a
Advanced practice nurses are certified to baccalaureate degree, but in some instances
prescribe drugs in many states. persons with experience fulfill these roles,
○ Have yourself certified for mental the recreation therapist helps the client to
health and specialist in psychiatric achieve a balance of work and play in his or
ward her life and provides activities that promote
○ Why are nurses the most important constructive use of leisure and instructure
part of the healthcare team? time.
Because a psychiatric nurse is the ○ E.g. music, art therapy
one always monitoring the clients ○ Classical music is ideally used for
status, most in contact with the mentally challenged individuals
client (as compared to the ○ Be vigilant that these activities are
psychiatrist and psychologist) appropriate to the client
○ Psychiatric nurses are the most 7. Vocational Rehabilitation Specialist
essential part of the mental ● Vocational rehabilitation includes
healthcare team determining client's interest and abilities and
○ After giving medications to the matching them with vocational choices.
client we have to document the Clients are also assisted in job seeking and
changes of behavior (if there is) to job retention skills, as well as pursuit of
the client, note improvement seen further education if that is needed and
in patients desired. Vocational rehabilitation specialists
○ We come in contact with the patient can be prepared at the baccalaureate or
24 hours a day masters level and may have different levels
4. Psychiatric Social Worker of autonomy and program supervision based
● Most psychiatric social workers are prepared on their education.
at the master’s level and they are licensed in ○ Match areas that you can apply for
some states. Social workers may practice ○ Psychological examination should
therapy and often have the primary be a standard for all practices
responsibility for working with families,
community support, and referral.
○ E.g. family therapy
CRITERIA OF MENTAL HEALTH
5. Occupational Therapists
(Jahoda, 1953; Staurt and Sundeen, 1995)
● Occupational therapists may have an
associate degree (certified occupational
therapy assistant) or a baccalaureate degree Personality Integration
(certified occupational therapist). ● Ability of the individual to adjust
Occupational therapy focuses on the ● Kubler Ross all of us undergo grieving after we lose
functional abilities of the client and ways to people or things
improve client functioning such as working ● We get sad but we don't necessarily get depressed
with arts and crafts and focusing on ● Follows the grieving process (DABDA)
psychomotor skills. 1. Denial
○ E.g. client suffers from stroke and - First to manifest
has limitations in performing 2. Anger
previous activities prior to having - manifest as impulsive or reckless behavior
stroke. Occupational therapists ○ Do not react right away when we are angry
work to help clients resume their because not all situations require reactions
normal activities prior to ○ Avoiding conflict is different from evading it
CJP ❃ KDP ❃ DMR ❃ CDV ❃ HEDA ❃ NATL ❃ DMMRY ❃ JDM
, ○ Avoiding is preventive, evading is ignoring suffering or case before going to
3. Bargaining your client; be vigilant all the time
- It's hard to change if you can't accept that because of their behavior
you have a problem ● Integration - ability of the person to adjustment - not
- A person will not change if they do not only external but also internal
realize that they have a problem ● self - awareness - being able to know strengths and
- You cannot force someone to change weakness
- Try to undo things
4. Depression Autonomy
- Loss of drive ● Involves self determination, self responsible for
- Loss of ability to do activities of daily living decisions, balance between dependence and
- Some individuals suffer from depression for independence, and acceptance of the consequences
a long time but they are not able to cope of one's action.
5. Acceptance ○ pertains to the person have the ability to
- Forgiving is different from forgetting decide from yourself- decision making -
impulsivity leads to harming the individual
Reality Perception (discern what’s real from not; includes and also yourself, that’s why need to
senses) understand the situation first and have a plan
● Ability to test assumptions about the world by of action in dealing a client - promote
empirical thought (things observed); includes social continuity of care and spontaneity of our
sensitivity (empathy) action
○ Empathy - ability of the person to relate to - We should compose ourselves on
other individual (putting yourself in the what happened and how to react;
condition of the individual) think before you act
○ Sympathy - means naawa (pity). If you over - What you really want in life
sympathize with your client, you can easily - Decision making
attach with your client that’s why nurse have - Do not be dependent on other
limits and boundaries to follow people
○ Empathy is more therapeutic than - Excessive autonomy is a bad thing
sympathy (This will be ability of the person along with deficiency
gauge what is real and what is actually part - Low confidence = inferiority
of their disorder (manifestation perceptual) complex
different of what is real from what is not - You are still in control
- Do things for yourself because after
Growth, Development, and Self Actualization you help yourself that is when you
● (by Maslow) which includes fully functioning person extend your help to other people
(by Rogers) Self Awareness
○ Maslow’s Hierarchy of needs is included in ● Not only knowing about your strengths and
self-actualization but growth and achievements but also your weaknesses
development is a different thing (because
during growth and development years, the Positive Attitudes
most important individuals that help nurture ● Toward self; includes self identity, self acceptance,
your persona are parents or surrogate self awareness, belongingness, security and
mother) (nurse, auntie) wholeness
○ What you could see from your parents could
also be your behavior
○ Environmental mastery
● Core concept of psychiatrist is self awareness -
pertaining to self-actualization
○ need to be aware with your self and
environment
- understand the situation of the
client first
- it is very important to have
knowledge about what is the client’s
CJP ❃ KDP ❃ DMR ❃ CDV ❃ HEDA ❃ NATL ❃ DMMRY ❃ JDM
antidepressants)
● Most important thing to remember: it’s the study of
PRELIMS
human behavior.
○ Apart from the cognition and affect, generally
what we deal with in psychiatry is the
Lesson 1:
PSYCHIATRIC NURSING behavior of the client
○ Your knowledge could also affect your
behavior
● A specialized area of nursing practice employing ○ With knowledge, we will not be alarmed
theories of human behavior as its science and when dealing with these disorders because
purposely use of self as its art we know how to prevent it which is also
○ One of the theories responsible for this reflected on the behavior
definitions is Joyce Travelbee ○ We are not being lax but we just know how
○ The person to actually note that psychiatric to prevent or control the behavior from
nursing is the usage or the science of happening
helping other individuals by using self is
noted by Joyce Travelbee Basic Principles of Psychiatric Nursing
- Also responsible for the theory ● We have to be vigilant all the time in the
Therapeutic use of self mental facility
- There are no other individual that ○ Because in just a second the client
can actually correct the problem but may change their mood
yourself ○ We always have to be self aware
- Simple concept: I can't help you if and conscious of what we are doing
you are not going to help yourself ○ Know where your clients are
- To achieve the goal of having an ○ Some clients are not hostile but
adapted behavior in the society you some are, hence, we always have
have to be adjusted in the to be conscious
environment and you have to use ○ E.g. when a patient hides their
yourself (you have to compose, toothbrush and stabs themselves
organize yourself) because they are suicidal = we
- Usage of yourself in order to adjust need to take note of the things our
and adapt clients are doing because we could
● Includes the continuous and comprehensive services be liable if they are hurt (even by
necessary for the promotion of optimal mental health, themselves) while you are on duty
prevention of mental illness, health maintenance, ○ We cannot go alone with a patient =
management and referral of mental and physical always buddy system or by pair
health problems, the diagnosis and treatment of ○ If there is an invite coming from the
mental disorders and their sequelae, and client we do not have to reject them
rehabilitation. right away we just need to tell them
○ Common stigma in dealing with the rules (e.g. we are not allowed to
psychiatrically challenged individuals is that go inside your rooms) = not
they are hostile right away rejection but just presenting facts
○ Right after the disorder it is not just the (these are the things that we can do
disorder that we have to focus on, it includes and what we are not allowed to do)
the acceptance and the side effects ○ We have to be aware of the
promoted by the treatment or medications protocols imposed by the institution
○ Medications in psychiatry are considered as ● Accept and respect the client regardless of his
“dirty medications”. These are medications behavior
that have more side effects compared to its ○ Regardless of their condition or behavior we
therapeutic effect. still need to treat the patient (e.g. nanakit,
○ The therapeutic effect might remove the suicidal)
signs and symptoms of the disorder but the ○ We cannot reject them
side effects will be various and diverse not ○ Never say “lang” (e.g. depression lang yan)
only affecting the physical activity of the ○ There are people who die from suicide rather
person but also other areas of your
CJP ❃ KDP ❃ DMR ❃ CDV ❃ HEDA ❃ NATL ❃ DMMRY ❃ JDM
, than cancer (e.g. more people are prone to ○ Do not do things at the height of your
depression and commiting suicide this emotions
pandemic becuase majority of people’s ○ Whenever you are angry it's not you that is
coping mechanisms are going outside and talking it is your emotions
interacting with people) ○ Compose yourself
○ Psychiatric manifestation: involuntary rolling ○ It is important to verbalize your feelings
of the eyes, tongue movement, spasm of the rather than to talk it out
face and eyelids (clients taking medications) ● Behaviors are learned
● Limit or reject the inappropriate behavior but not the ○ Behaviors apart from mentation are
individual influenced by culture and environment (even
○ When the patient does not want to take a the process of grieving ?)
medication there are instances when they ○ Habang pinapalaki ka iyon na yung tinatanim
can reject to take the medications but there sa isip mo
are also instances when they can't refuse to ○ What was taught to you affects your growing
take medications up pattern which then affects your behavior
- E.g. if a client is suffering from ○ Society and religion may also affect or
depression and they voluntarily influence behavior
seeked help/ consulted a therapist. ● All behaviors have meaning
If a client voluntarily seeked ○ There is a reason behind every behavior
consultation and is aware of their
condition, they can REFUSE taking Interdisciplinary Team Primary Roles
medications. 1. Psychiatrist
- If a client is mentally unstable they ● The psychiatrist is a physician certified in
can't refuse taking medication psychiatry by the American Board of
under two conditions: Psychiatry and Neurology which requires 3
1. They are already posing year residency, 2 years of clinical practice,
threat to themselves and completion of an examination. The
2. If they are already posing primary function of the psychiatrist is
as a threat to other people diagnosis of mental disorders and
= they will be involuntarily prescription of medical treatments.
admitted ○ In the Philippines: Philippine
- Involuntary admission: tatawag ng Psychiatric Association and
mental health facility, jacket Neurology
restraint, admitted to mental health ○ Medical doctors
facility 2. Psychologist
- E.g. the patient voluntarily admitted ● The clinical psychologist has a doctorate
themselves to a mental health (PhD) in clinical psychology and is prepared
facility, after admission they to practice therapy, conduct research, and
displayed hostility = the client will interpret psychological tests. Psychologists
be shifted under involuntary may also participate in the design of therapy
admission (under the discretion / programs for groups of individuals.
judgment of the psychiatrist) ○ Administer IQ and EQ examination
- Psychiatrist are the ones overall ○ BS Degree
incharge in the diagnosis and ○ Doctorate Degree (Doctor of
treatment of a client Philosophy)
- Kapag nanakit ang client tell them ○ Administer therapy (family, group),
that they are not allowed to do it counseling
(presenting facts and policies of the 3. Psychiatric Nurse
institution) ● The registered nurse gains experience in
- Avoid using the term baliw (not working with clients with psychiatric
appropriate) = instead you can call disorders after graduation from accredited
them as mentally challenged program of nursing and completion of
● Encourage and support expression of feelings in a licensure examination. The nurse has a solid
safe and non judgemental environment. Increase foundation in health promotion, illness
verbalization, decreases anxiety prevention, and rehabilitation in all areas,
CJP ❃ KDP ❃ DMR ❃ CDV ❃ HEDA ❃ NATL ❃ DMMRY ❃ JDM
, allowing him or her to view the client experiencing their condition
holistically. The nurse is also an essential ○ Achieve performing of activities of
team member in evaluating the effectiveness daily living
of medical treatment, particularly ○ Sustain and maintain or achieve the
medications. Registered nurses who obtain a ability of the patient to function
master’s degree in mental health may be normally in terms of their
certified as clinical specialists or licensed as psychomotor function
advanced practitioners, depending on 6. Recreational Therapists
individual state nurse practice acts. ● Many recreation therapists complete a
Advanced practice nurses are certified to baccalaureate degree, but in some instances
prescribe drugs in many states. persons with experience fulfill these roles,
○ Have yourself certified for mental the recreation therapist helps the client to
health and specialist in psychiatric achieve a balance of work and play in his or
ward her life and provides activities that promote
○ Why are nurses the most important constructive use of leisure and instructure
part of the healthcare team? time.
Because a psychiatric nurse is the ○ E.g. music, art therapy
one always monitoring the clients ○ Classical music is ideally used for
status, most in contact with the mentally challenged individuals
client (as compared to the ○ Be vigilant that these activities are
psychiatrist and psychologist) appropriate to the client
○ Psychiatric nurses are the most 7. Vocational Rehabilitation Specialist
essential part of the mental ● Vocational rehabilitation includes
healthcare team determining client's interest and abilities and
○ After giving medications to the matching them with vocational choices.
client we have to document the Clients are also assisted in job seeking and
changes of behavior (if there is) to job retention skills, as well as pursuit of
the client, note improvement seen further education if that is needed and
in patients desired. Vocational rehabilitation specialists
○ We come in contact with the patient can be prepared at the baccalaureate or
24 hours a day masters level and may have different levels
4. Psychiatric Social Worker of autonomy and program supervision based
● Most psychiatric social workers are prepared on their education.
at the master’s level and they are licensed in ○ Match areas that you can apply for
some states. Social workers may practice ○ Psychological examination should
therapy and often have the primary be a standard for all practices
responsibility for working with families,
community support, and referral.
○ E.g. family therapy
CRITERIA OF MENTAL HEALTH
5. Occupational Therapists
(Jahoda, 1953; Staurt and Sundeen, 1995)
● Occupational therapists may have an
associate degree (certified occupational
therapy assistant) or a baccalaureate degree Personality Integration
(certified occupational therapist). ● Ability of the individual to adjust
Occupational therapy focuses on the ● Kubler Ross all of us undergo grieving after we lose
functional abilities of the client and ways to people or things
improve client functioning such as working ● We get sad but we don't necessarily get depressed
with arts and crafts and focusing on ● Follows the grieving process (DABDA)
psychomotor skills. 1. Denial
○ E.g. client suffers from stroke and - First to manifest
has limitations in performing 2. Anger
previous activities prior to having - manifest as impulsive or reckless behavior
stroke. Occupational therapists ○ Do not react right away when we are angry
work to help clients resume their because not all situations require reactions
normal activities prior to ○ Avoiding conflict is different from evading it
CJP ❃ KDP ❃ DMR ❃ CDV ❃ HEDA ❃ NATL ❃ DMMRY ❃ JDM
, ○ Avoiding is preventive, evading is ignoring suffering or case before going to
3. Bargaining your client; be vigilant all the time
- It's hard to change if you can't accept that because of their behavior
you have a problem ● Integration - ability of the person to adjustment - not
- A person will not change if they do not only external but also internal
realize that they have a problem ● self - awareness - being able to know strengths and
- You cannot force someone to change weakness
- Try to undo things
4. Depression Autonomy
- Loss of drive ● Involves self determination, self responsible for
- Loss of ability to do activities of daily living decisions, balance between dependence and
- Some individuals suffer from depression for independence, and acceptance of the consequences
a long time but they are not able to cope of one's action.
5. Acceptance ○ pertains to the person have the ability to
- Forgiving is different from forgetting decide from yourself- decision making -
impulsivity leads to harming the individual
Reality Perception (discern what’s real from not; includes and also yourself, that’s why need to
senses) understand the situation first and have a plan
● Ability to test assumptions about the world by of action in dealing a client - promote
empirical thought (things observed); includes social continuity of care and spontaneity of our
sensitivity (empathy) action
○ Empathy - ability of the person to relate to - We should compose ourselves on
other individual (putting yourself in the what happened and how to react;
condition of the individual) think before you act
○ Sympathy - means naawa (pity). If you over - What you really want in life
sympathize with your client, you can easily - Decision making
attach with your client that’s why nurse have - Do not be dependent on other
limits and boundaries to follow people
○ Empathy is more therapeutic than - Excessive autonomy is a bad thing
sympathy (This will be ability of the person along with deficiency
gauge what is real and what is actually part - Low confidence = inferiority
of their disorder (manifestation perceptual) complex
different of what is real from what is not - You are still in control
- Do things for yourself because after
Growth, Development, and Self Actualization you help yourself that is when you
● (by Maslow) which includes fully functioning person extend your help to other people
(by Rogers) Self Awareness
○ Maslow’s Hierarchy of needs is included in ● Not only knowing about your strengths and
self-actualization but growth and achievements but also your weaknesses
development is a different thing (because
during growth and development years, the Positive Attitudes
most important individuals that help nurture ● Toward self; includes self identity, self acceptance,
your persona are parents or surrogate self awareness, belongingness, security and
mother) (nurse, auntie) wholeness
○ What you could see from your parents could
also be your behavior
○ Environmental mastery
● Core concept of psychiatrist is self awareness -
pertaining to self-actualization
○ need to be aware with your self and
environment
- understand the situation of the
client first
- it is very important to have
knowledge about what is the client’s
CJP ❃ KDP ❃ DMR ❃ CDV ❃ HEDA ❃ NATL ❃ DMMRY ❃ JDM
