Psychiatry for Nurses S Nambi
Adjustment disorders 62
aetiology 63
nursing care 63
subtypes 62
Alcohol abuse 91
causes of 92
availability 92
biochemical factors 92
genetic factors 92
high risk groups 93
learned behaviour 92
personality factors 93
poor coping strategies 93
process of development 93
psychiatric disorders 93
social causes 93
physical complications of
blood 94
cardiovascular 94
gastrointestinal 94
joints 95
liver 94
muscle 94
nervous system 95
nutrition 95
pancreas 94
pregnancy 95
reproductive system 95
skin 94
psychiatric complications of 95
alcoholic dementia 96
alcoholic hallucinosis 95
alcoholic psychosis 96
amnestic disorder 96
delirium tremens (DT) 95
morbid jealousy 96
pathological intoxication 95
withdrawal phenomenon 95
management of alcoholism 97
alcoholics anonymous 98
aversion therapy 97
detoxification 97
disulfiram 97
nurses role in the prevention of 100
nursing care 98
delirium tremens 99
during later stage of hospitalisation 99
in the acute stage 98
social complications
drunken driving 96
work problems 96
Alzheimer's dementia 109
anterograde 137
classification of 137
confabulation 138
fugue state 138
organic 137
psychogenic 137
nursing care 139
retrograde 137
Basic psychology 14
defence mechanisms 15
characteristics of 15
dissociation 16
rationalisation 17
regression 17
repression 15
sublimation 16
their usage 15
ego 15
id 15
super ego 15
Bio-feed back treatment 198
brain stem 18
cerebral cortex 18
limbic system 18
characteristics of 19
types of 19
Bulimia 141
Community psychiatry
mental health 163
definition of 164
mentally healthy person 164
characteristics of 164
prevention of mental illness
primary prevention 165
secondary prevention 166
tertiary prevention or rehabilitation 166
Drug abuse 90, 100
addict 101
cannabis 102
psychiatric complications of 102
common drugs abused 101
drug addiction 90
drug dependence 90
types of abused substances 91
factors involved in 101
narcotics 102
psychiatric complications of 103
Eating disorders
anorexia nervosa 139
clinical picture 140
treatment 140
Epilepsy 114
and mental illness 116
causes of 114
diagnosis 117
management of 117
nursing care 117119
psychiatric disorders 116
types of
focal 115
grand mal 115
status epilepticus 116
temporal lobe 115
General hospital psychiatry 239
common mental health problems 239
maladaptive psychological reactions to illness 240
guilt-fear 240
organic mental disorders 240
delirium 240
psychosomatic disorders 240
Healthy person, characteristics of 22
Insomnia 134
causes of
behavioural 134
drug-related 135
endocrine 134
physical 134
psychiatric 135
social 135
treatment of 135
non-drug 136
sleep environment 136
sleep hygiene 136
Mania 74
aetiology of 75
biological factors 75
psychological factors 75
clinical features 75
forms of 76
management of
diet 76
drug treatment 76
emotional needs 77
hospitalisation 76
therapeutic environment 77
primary mania 75
Medical complications
psychiatric drugs leading to 241
Medical set up 4
Memory disorders 136
immediate memory 137
recent memory 137
remote memory 137
Mental disorders 28, 36, 37, 39
abnormality 36
concept of 36
aetiology (causes)
bio-chemical 37
biological factors 37
perpetuating factors 39
precipitating factors 39
predisposing factors 39
psychosocial factors 38
social factors 38
classification of 39
concept 28
mental illness 29
affect of mood 34
characteristics of 29
consciousness 34
disturbance in motor activities 35
disturbance of memory 33
disturbance of perception 32
general behaviour 29
ideas of reference 32
symptoms of 29
treatment, physical methods 168
drug treatment 169183
electro convulsive therapy 183
psychosurgery 187
treatment, psychological methods 188
psychotherapy 188
Mental health, definition 21
Mental health education 22
its programmes 22
overcoming prejudices 23
Mental health problems 142
management of 156
nursing care 157
paranoid disorders 157
causes of 153
diagnostic features of 154
management of 155
in adolescents
management of 146
social factors that affect adolescents 146
in children 142
role of a nurse 145
in old age 151
depression 152
human ageing 151
psychiatric illness 152
in women 147
menopause 150
psychiatric disorders 148
Mental health services
in India 24
facilities available 25
Mental retardation 120
assessment of the need 124
causes of 122
antenatal damage 122
cranial malformations 122
cretinism 123
Downs syndrome 123
genetic 122
gross disease of the brain 122
metabolic disorders 122
perinatal 122
phenylketonuria 123
post-natal damage 122
classification of 120
custodial care 125
education of 124
health education regarding 126
parent's counselling 127
nursing care of 124
prevention of 125
recognition of 121
rehabilitation of 124
training 124
Mentally ill persons 231
criminal responsibility of 231
civil responsibility 231
Milieu therapy 202
Mood disorder 68
classification of 68
depression 69
aetiology of 71
bipolar disorders 70
complications of 72
dysthymic disorder 70
management 72
nursing care 73
Neurotic disorders 48
anxiety disorders 48
generalised anxiety disorder 49
panic disorder 51
hypochondriasis 59
hysteria 55
characteristics of 56
conversion hysteria 57
dissociative disorder 57
fugue 57
hysterical amnesia 57
hysterical personality 56
management of 58
multiple meaning of 56
multiple personality 58
obsessive compulsive disorder 54
causes of 55
treatment of 55
phobic disorder 52
agora phobia 53
nursing care of 59
phobia 52
simple phobia 53
social phobia 54
treatment of 54, 194
Neurotic persons 46
environmental stress 47
individual susceptibility 47
interpersonal problems 47
intrapsychic conflict 47
characteristics of 46
Normal sexual behaviour
genital response 128
orgasm 128
sex drive 128
sexual arousal 128
Nurse role in
community mental health services 237
general hospital setting 237
mental hospital 237
psychiatric institutional setting 236
Nursing care of
AIDS patient 225
counselling 226
neuropsychiatric complications 225
deluded patients 224
dying patients 227
mentally ill accident prone 220
suicidal patient 222
violent patient 217
withdrawn patient 218
Organic mental disorders 105
delirium 105
causes of 106
clinical features 106
management of 107
dementia 107, 153
causes of 108, 153
clinical features 109
management 110
head injury 112
psychiatric aspects of 112
parkinsonism 112
psychiatric aspects of 112
Personality disorders 64
aetiology 66
characteristics of 64
main personality disorders 65
psychotherapy 66
management of 67
nursing care of 67
Physical complaints 240
psychiatric conditions presenting with 240
Psychiatric care 5
early asylums 6
psychiatric hospital 7
functions of 7
lunatic asylums 8
therapeutic community 7
Psychiatric complaints 241
medical drugs leading to 241
physical conditions presenting with 241
Psychiatric emergencies 204
approach to 204
types of 204
acute dystonia 214
alcohol and addiction forming drugs 212
attempted suicide 205
delirium 206
epilepsy related emergencies 211
excitement 206
lithium toxicity 215
panic attack 210
refusal of food 215
stupor 206
Psychiatric examination 42
format for examining psychiatric patients 42
basic information 42
complaints 42
family history 43
history of present illness 42
mental status examination 43
personal life history 42
personality 43
previous illnesses 42
writing a relevent case sheet 45
Psychiatric nursing 1, 9, 11, 229
definition 9
qualities of an ideal psychiatric nurse 10
development of 11
future of 13
legal aspects of 229
crime 230
psychiatric disorders 230
need for 1
paramedical personnel 3
psychotherapist 3
rehabilitation programmes 3
surrogate mother 3
Psychiatric set up 4
Psychiatry in India 232
law relating to 232
admission in the psychiatric hospital 232
Psychologically ill 2
Psychophysiological disorders 158
psychosocial theories
biological theory 159
family dynamic theory 159
learning theory 159
personality theory 159
psychosomatic disorders 159
asthma 160
coronary heart disease 160
irritable bowel syndrome 161
nursing care in 161
peptic ulcer 161
Psychotherapy 189
behaviour therapy 194
bio-feed back treatment 198
cognitive therapy 192
crisis intervention 193
family therapy 190
group therapy 189
encounter groups 190
psychodrama 190
T-groups 190
traditional group therapy 190
hypnotherapy 192
individual psychotherapy 189
psychoanalysis 191
relaxation therapy 195
meditation 197
relaxation exercises 195
yoga 197
Rehabilitation 199
half-way home 203
industrial therapy 201
occupation therapy
advantages 200
aim 200
nurses role 201
recreational therapy 201
therapeutic community 202
characteristic of 202
Schizophrenia 78
aetiology of
biochemical factors 79
environmental factors 80
genetic factors 79
psychological factors 80
clinical features of 81
autism 82
behavioural change 83
bizarre mannerisms 83
catatonic excitement 83
emotional disturbance 82
hallucinations 83
sleep disturbances 83
thought disturbance 81
volitional disturbance 82
management of 85
nursing care 8689
treatment methods 86
types of 83
catatonic 84
classification of 84
hebephrenic 83
paranoid 83
residual 84
simple 84
undifferentiated 84
Sexual disorders 128, 131
classification of
parasomnias 133
primary sleep disorders 133
secondary sleep disorders 133
disorders of sexual preference 131
gender identity disorder 130
sexual inadequacies 129
sexual orientation disorder-homo sexuality 131
Chapter Notes

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Introduction to Psychiatric Nursing1

“Health is not merely the absence of disease but a sense of physical, psychological and social well being”. Physical and mental health are like two sides of a coin and both are interdependent. A nurse who is responsible for total health care of a person must take care of the emotional aspect also. The nurse should develop a basic understanding and skill in psychiatric nursing to achieve total health care. She should learn to care for patients with varying degrees of personality deviation and she should understand her role in contributing to positive mental health. This step will enable her to exercise effectively in all areas of nursing.
Psychiatric nursing concepts are an integral part of general nursing. Every nurse who performs the simplest nursing duty gives the patient some psychiatric nursing care whether she is aware of it or not. For example giving medication. What is important in the nursing role includes not only her knowledge of the properties of the drug, and methods of administration correct dosage but also what and how she explains to the patient when giving the drugs and how the patient reacts to it.
  1. Psychiatric nursing makes a nurse aware of what she is doing to a patient psychologically.
  2. It educates her how to observe her patient.
  3. It equips her with appropriate techniques to meet the patients psychological needs and manage the nurse-patient relationship.
Psychiatric training for nurses is essential not only to manage the severely mentally ill or psychotic patients in psychiatric wards or hospitals, which forms only a part or group, but psychiatric nursing concerns itself with the care of the psychiatric patients 2extending beyond the walls of the psychiatric hospital to encompass the needs of the family and of the community. She may also have to work in a general hospital that has a psychiatric department/ward. Apart from major mental illnesses there are many other psychological problems which include depression, anxiety and other neurotic disturbances, psychosomatic disorders, problems due to alcohol and drug abuse, emotional problems of children, adolescents and elderly population.
Apart from these psychiatric disorders, every medical or surgical condition is accompanied by some emotional problem. The nurse who spends her considerable time with the patient cannot afford to ignore this aspect of the illness. Often patients suffer more from their psychological problems than actual physical pain. Because of the intimate relationship of the body and mind, it is difficult for anything to affect the body without affecting the mind.
The broad principles of psychiatric nursing can thus be applied to patients with medical, surgical, obstetric, orthopaedic, paediatric and psychosomatic conditions as well as patients suffering from neurosis, psychosis, personality disorder and drug dependence.
More usually the nurse acts as a part of a therapeutic team, where, in addition to her traditional work, she has the opportunity to take an active part in other aspects of treatment. Her job is to work with the team to enable each patient get better and return back to the community.
The following are some important tasks of a nurse in a psychiatric set-up.
  1. The nurse often has the opportunity to intervene a behaviour problem on the spot which if ignored or allowed to continue would aggravate the patient's psychological condition.
  2. The nurse should conduct brief counselling with patients and their families. Such counselling may be formally structured or may take place in informal situations keeping main focus on helping the patients in communicating more clearly.
  3. The technical aspects of patient-care represent another major role of the nurse. She manages the distribution of drugs, carries out medical treatment and assists in physical methods of treatment.3
  4. Reporting is another main task. The nurse has to record, assess and report to the psychiatrist her observations regarding the patient's behaviour, the interaction between the patient and members of his family, the effects of drugs and other forms of treatment, the patient's physical status etc.
  5. The nurse plays the role of a surrogate mother when she takes care of the activities of daily living. She keeps him clean, helps him in the elimination, exercise his inactive limb, makes sure that he gets sufficient nourishment by well-balanced diet. Exploiting this relationship to the fullest can result in considerable therapeutic benefit to the patient.
  6. Health education is another important role. The nurse helps patients learn physical and mental hygiene.
  7. The nurse motivates the patient to participate actively in rehabilitation programmes like occupational therapy, industrial therapy and recreation therapy.
  8. The nurse in a psychiatric set-up also guides and supervises the functions of other paramedical personnel in the ward. These staff members work closely with the patients and depend on the nurse for directions and guidance.
  9. The nurse as a helping and caring person makes the patient feel supported and reassured. Thus, the nurse acts as a psychotherapist. Nurses also conduct family therapy and group therapy in a cotherapist situation or alone or as part of a team. Nursing role in crisis intervention and suicide prevention is very vital.
  10. A psychiatric nurse has to play different roles according to the setting. Her job may be looking after demented elderly in-patients at one set-up and working in a therapeutic community run for adolescents in another. Other varied situations include the acute admission ward of a large psychiatric hospital, community work where patients are seen in their own homes, attachment to a psychiatric department in a general hospital, administrative work, and work in a day hospital or out-patient clinic.
Thus, in the care of the psychologically ill, the nurse has many roles to play. She is:
  1. an assistant
  2. a caretaker
  3. a well-wisher4
  4. a listener
  5. an observer
  6. a therapist
  7. a motivator
  8. a teacher
  9. a surrogate mother
  10. an administrator, and
  11. a healer
  1. The nurse does more for a patient physically in medical or surgical nursing. But in psychiatric nursing she has to be psychologically active but physically passive much of the time. Listening to an emotionally disturbed patient with pain in his mind may be profoundly touching.
  2. In taking care of physical illnesses the signs and symptoms are generalised and mostly uniform in all patients.
  3. However in psychiatric patients, for the same disease, the symptoms may vary from individual to individual depending on the nature of the disease, the individual's personality and complex psychobiosocial implications.
  4. Physically ill patients respond to the reassurance given by the nurse they are satisfied with the care they are getting and co-operate during the treatment programme.
Emotional disturbance make many psychiatric patients fail to respond to ordinary reassurance in the beginning. Because of impaired human relationships these patients often show reactions like mistrust, suspicion and hostility. Patients suffering from major mental illnesses lack insight. They are not aware that they are ill. Hence, they may not co-operate fully during the treatment programme. It requires special skills and experience for a nurse to work with such patient.