Psychiatric Nursing

Psychiatric nursing specializes in the treatment of mental disorders and care for those patients with acute or chronic mental illness, or mental distress, including schizophrenia, bipolar disorder, psychosis or depression.

In ancient Egypt, Greece and Rome, mental disorders were considered to be supernatural in origin. The Roman philosopher Marcus Tullius Cicero (106 to 43 BCE), devised a questionnaire that bears resemblance to modern-day psychiatric techniques in determining treatment plans for mentally ill patients.

Psychiatric hospitals were built in Europe as early as the 13th century, although no treatment was provided due to the prevailing opinion that patients could be cured by religious intervention. The provision of care took only the most basic form, in providing food and shelter. Psychiatric nursing gained greater credibility during the 17th century in France, with a public system of hospitals for those suffering from mental disorders. There was still no formal training for nurses in this field and no treatment plan for patients. Many of these institutions came to be known as "asylums," where patients were treated little more than inmates, and were they were often subject to abuse, rather than care, by the warders. In Regency England of the early 19th century, it was the fashion for the nobility and wealthy to pay a fee for a tour of asylums for their entertainment.

Formal recognition of psychiatric nursing began in the second half of the 19th century. In the United States, Linda Richards opened Boston City College in 1882, the first training academy for psychiatric nursing. German psychiatrist Karl Ludwig Kahlbaum (1828 to 1899) began a study of psychotic patients and introduced a classification system that became the basis for modern clinical practices in mental health. Another German psychiatrist, Emil Kraepelin (1856 to 1926), followed up the work of Kahlbaum by developing the idea that the cause of mental disorder was biological. In the Encyclopedia of Psychology by H. J. Eysenck, Kraepelin is described as the founder of modern scientific psychiatry. Kraepelin described schizophrenia as an organic brain disease, something which was confirmed by the end of the 20th century by the use of technologies such as in vivo imaging.

By 1946, the passing of the National Mental Health Act allowed for the development of psychiatric nursing in the United States. Psychiatric disorders are classified using the Diagnostic and Statistical Manual of Mental Disorders. The main categories include:

- Disorders usually first diagnosed in infancy, childhood or adolescence

- Mental disorders due to a general medical condition

- Substance-related disorders

- Schizophrenia and other psychotic disorders

- Sexual and gender identity disorders.

Treatment is undertaken on a holistic and collaborative basis, with psychiatrists and mental health nurses taking into account a number of factors including background and family history. Patients presenting with a psychiatric disorder are usually seen on an out-patient basis in a more personal setting. Patients may be institutionalized if they are deemed to be an immediate danger to themselves or others, but the emphasis is on short-term care rather than long-term incarceration. By the end of the 20th century, the length of stay of patients had been much reduced from earliest practice.

There are different strands of treatment within psychiatry. Among them are Biological Psychiatry, which deals with physical, chemical and neurological causes and treatment; Social Psychiatry, concerned with the cultural and social factors that engender mental disorders; and Geriatric Psychiatry, which specializes in mental illness in the elderly. Modern psychiatry places emphasis on empowering the patient. Mental health practitioners are trained to gain understanding of the patient, providing individualized care and support through empathy and demonstrating respect.

Care can include psychosocial interventions, such as cognitive behavioral therapy, or medication. Electroconvulsive therapy (ECT) can also be used as a treatment for severe depression where the patient has not responded to other treatments. This was first used in 1938 and commonly used in the 1950s and 1960s. The debate on the efficacy and safety of ECT has been widely debated.

Psychiatric nursing may also play a part in crime prevention. Forensic psychiatry specializes in working with people who have committed crime and have mental health issues. Nurses in this branch of psychiatry work in the community with those who have committed crime as well as visiting prisons, young offenders' institutions and secure hospitals. A common challenge in treating psychiatric disorders is the unwillingness of some patients to receive treatment. It is one of the few branches of medicine in which a patient may not wish to be well.

Psychiatric Nursing: Selected full-text books and articles

The Tidal Model: Developing a Person-Centered Approach to Psychiatric and Mental Health Nursing By Barker, Phil Perspectives in Psychiatric Care, Vol. 37, No. 3, July-September 2001
Peer-reviewed publications on Questia are publications containing articles which were subject to evaluation for accuracy and substance by professional peers of the article's author(s).
A Century of Psychiatry By Hugh Freeman Mosby, 1999
Librarian's tip: "Mental Health Nursing" begins on p. 93
Nurture: The Fundamental Significance of Relationship as a Paradigm for Mental Health Nursing By Raingruber, Bonnie Perspectives in Psychiatric Care, Vol. 39, No. 3, July-September 2003
Peer-reviewed publications on Questia are publications containing articles which were subject to evaluation for accuracy and substance by professional peers of the article's author(s).
Stigma in Psychiatric Nursing By Halter, Margaret Jordan Perspectives in Psychiatric Care, Vol. 38, No. 1, January-March 2002
Peer-reviewed publications on Questia are publications containing articles which were subject to evaluation for accuracy and substance by professional peers of the article's author(s).
Bioethics: A Nursing Perspective By Megan-Jane Johnstone Harcourt Saunders, 1999 (3rd edition)
Librarian's tip: "Practical Ethics in Mental Health" begins on p. 256
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