Psychiatric Mental Health Nursing by Videbeck

As you begin the study of psychiatric-mental health

nursing, you may be excited, uncertain, and even a

little anxious. The field of mental health often seems

a little unfamiliar or mysterious, making it hard to

imagine “What is this experience going to be like?” or

“What does a nurse do in this area?” This chapter ad-

dresses these and other questions by providing an

overview of the history of mental illness, advances in

treatment, current issues in mental health, and the

role of the psychiatric nurse.

MENTAL HEALTH

AND MENTAL ILLNESS

Mental health and mental illness are difficult to de-

fine precisely. People who can carry out their roles in

society and whose behavior is appropriate and adap-

tive are viewed as healthy. Conversely those who fail

to fulfill roles and carry out responsibilities or whose

behavior is inappropriate are viewed as ill. The cul-

ture of any society strongly influences its values and

beliefs, and this in turn affects how that society de-

fines health and illness. What one society may view

as acceptable and appropriate, another society may

see as maladaptive or inappropriate.

Mental Health
The World Health Organization (WHO) defines
health as a state of complete physical, mental, and
social wellness, not merely the absence of disease or
infirmity. This definition emphasizes health as a pos-
itive state of well-being, not just absence of disease.
People in a state of emotional, physical, and social
well-being fulfill life responsibilities, function effec-
tively in daily life, and are satisfied with their inter-
personal relationships and themselves.
No single, universal definition of mental health
exists. Generally a person’s behavior can provide clues
to his or her mental health. Because each person can
have a different view or interpretation of behavior
(depending on his or her values and beliefs), the de-
termination of mental health may be difficult. In most
cases, mental healthis a state of emotional, psycho-
logical, and social wellness evidenced by satisfying
interpersonal relationships, effective behavior and
coping, positive self-concept, and emotional stabil-
ity. Mental health has many components, and a wide
variety of factors influence it (Mohr, 2003):

• Autonomy and independence:The person
  can look within for guiding values and rules
  by which to live. He or she considers the
  opinions and wishes of others but does
  not allow them to dictate decisions and
  behavior. The person who is autonomous
  and independent can work interdependently

or cooperatively with others without losing

his or her autonomy.

• Maximization of one’s potential:The person is
  oriented toward growth and self-actualization.
  He or she is not content with the status quo
  and continually strives to grow as a person.


• Tolerance of life’s uncertainties:The person
  can face the challenges of day-to-day living
  with hope and a positive outlook despite not
  knowing what lies ahead.


• Self-esteem:The person has a realistic aware-
  ness of his or her abilities and limitations.


• Mastery of the environment:The person can
  deal with and influence the environment in a
  capable, competent, and creative manner.


• Reality orientation:The person can distin-
  guish the real world from a dream, fact from
  fantasy, and act accordingly.


• Stress management:The person can tolerate
  life stresses, appropriately handle anxiety or
  grief, and experience failure without devas-
  tation. He or she uses support from family
  and friends to cope with crises, knowing that
  the stress will not last forever.
  These factors constantly interact; thus, a person’s
  mental health is a dynamic or ever-changing state.
  Factors influencing a person’s mental health can
  be categorized as individual, interpersonal, and so-
  cial/cultural. Individual factorsinclude a person’s
  biologic makeup, sense of harmony in life, vitality,
  ability to find meaning in life, emotional resilience
  or hardiness, spirituality, and positive identity
  (Seaward, 1997). Interpersonal factorsinclude effec-
  tive communication, ability to help others, intimacy,
  and a balance of separateness and connection. Social/
  cultural factorsinclude a sense of community, access
  to adequate resources, intolerance of violence, and
  support of diversity among people. Individual, inter-
  personal, and social/cultural factors are discussed in
  Chapter 7.

Mental Illness

The American Psychiatric Association (APA, 2000)

defines a mental disorderas “a clinically significant

behavioral or psychological syndrome or pattern that

occurs in an individual and that is associated with

present distress (e.g., a painful symptom) or disabil-

ity (i.e., impairment in one or more important areas

of functioning) or with a significantly increased risk

of suffering death, pain, disability, or an important

loss of freedom” (p. xxxi). General criteria to diagnose

mental disorders include dissatisfaction with one’s

characteristics, abilities, and accomplishments; in-

effective or nonsatisfying relationships; dissatisfac-

tion with one’s place in the world; ineffective coping

1 FOUNDATIONS OFPSYCHIATRIC-MENTALHEALTHNURSING 3