accomplishments; ineffective or nonsatisfy-
ing interpersonal relationships; dissatisfac-
tion with one’s place in the world; ineffective
coping with life events; and lack of personal
growth.- Factors contributing to mental illness are bi-
ologic factors and anxiety, worries, and fears;
ineffective communication; excessive depen-
dence or withdrawal from relationships and
loss of emotional control; and lack of re-
sources, exposure to violence, homelessness,
poverty, and discrimination. - The DSM-IV-TR is a taxonomy used to pro-
vide a standard nomenclature of mental dis-
orders, 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 admis-
sion 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. - The Department of Health and Human Ser-
vices estimates that 56 million Americans
have a diagnosable mental illness, but only
one in four adults and one in five children
and adolescents receive treatment. - 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 ap-
proval of less expensive alternatives for men-
tal health care. - Mental health care is limited by days of
service or dollar amounts; in contrast, in-
surance for medical illnesses rarely has
such limitations. - The population in the United States is be-
coming increasingly diverse in terms of cul-
ture, race, ethnicity, and family structure. - Psychiatric nursing was recognized in the
late 1800s although it was not required in
nursing education programs until 1950. - Psychiatric nursing practice has been pro-
foundly influenced by Hildegard Peplau and
June Mellow, who wrote about the
nurse–client relationship, anxiety, nurse
therapy, and interpersonal nursing theory.- The American Nurses Association 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 threatened physically, recog-
nizing someone they know as a client, and
sharing similar problems or backgrounds
with clients. - Awareness of one’s feelings, beliefs, atti-
tudes, 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 be-
liefs unless one desires to do so.
For further learning, visit http://connection.lww.com.
REFERENCES
American Nurses Association. (2000). Scope and Stan-
dards of Psychiatric-Mental Health Nursing Practice.
Washington, DC: American Nurses Publishing,
American Nurses Foundation/American Nurses
Association.
American Psychiatric Association. (2000). Diagnostic and
statistical manual of mental disorders(4th ed., text
revision). Washington DC: Author.
Appleby, L., & Desai, P. N. (1993). Length of stay and
recidivism in schizophrenia: A study of public psy-
chiatric hospital patients. American Journal of
Psychiatry, 150(1), 72–76.
Baly, M. (1982). A leading light. Nursing Mirror, 155(19),
49–51.
Department of Health and Human Services. (2002). The
Department of Health and Human Services on men-
tal health issues. http://www.dhhs.gov/
Department of Health and Human Services. (2000).
Healthy People 2010.Washington, DC: Author.
Doona, M. (1984). At least well cared for... Linda
Richards and the mentally ill. Image, 16(2), 51–56.
Gollaher, D. (1995). Voice for the mad: The life of
Dorothea Dix.New York: The Free Press.
Haugland, G., Siegel, C., Hopper, K., & Alexander, M. J.
(1997). Mental illness among homeless individuals
in a suburban county. Psychiatric Services, 48(4),
504–509.
International Association of Psychosocial Rehabilitation
Services (IAPRS). (1990). A national directory: Orga-
nizations providing psychosocial rehabilitation and
related community support services in the United
States.Boston: Center for Psychiatric Rehabilitation,
Boston University.1 FOUNDATIONS OFPSYCHIATRIC-MENTALHEALTHNURSING 15