history of psychiatric nursing

1. • CHANNABASAPPA .K.M
ASSISTANT PROFESSOR
DEPT OF PSYCHIATRIC NURSING

2. Perspective of mental health and mental
health nursing

3. • PSYCHIATRY
It is branch of medicine that deals
with the diagnosis, treatment and
prevention of mental illness.

4.  Psychiatric Mental Health
Nursing
“Is specialized area of nursing practice that
employs neurological principles and theories of
human behavior as its science and the purposeful use
of self as its art in the diagnosis and treatment of
human responses to actual or potential mental health
problems”
(ANA, 1994).
 Psychiatric nursing is not a newly developed specialty
in nursing. It has got a rich history.

5. • DEVELOPMENT OF PSYCHIATRIC
NURSING IN THE WORLD

6. DEVELOPMENT OF PSYCHIATRIC NURSING IN
THE WORLD
The moral period (1790 to 1900)
Institutionalization (1900 to 1955)
Deinstitutionalization (1955 to 1990)
The" decade of the brain“ (1990 to
present)

7. THE MORAL PERIOD
 In colonial America, colonists believed mental
illness was a punishment from God. The insane
were considered beast like, and the only
treatment was administered by public officials
(e.g. incarceration, whipping etc.).
 cell keepers rather than nurses, cared for those
afflicted with mental disorders.

8.  17th century all abnormal behaviour was
believed to be the act of devil. Mentally ill
were considered evil and described as
witches.

9.  Moral treatment characterized by kind,
compassionate care began with the
quakes.
 The most part, attendants cared for
patients, as there were few trained nurses.
 Treatment involved little more than
maintaining order, preventing escape, and
guarding patients from sharp objects.

10.  Dr. Edward Cowles, director of the
McLean Asylum in Massachusetts, firmly
believed that patients in mental hospitals
should receive nursing care.
 But it was failure because, nurses had
no formal education in mental diseases
and many of them were resistant to
being associated with the asylum
because of the stigma attached to
mental disorders

11. Cowles assisted Linda Richards, the
United States first trained nurse, to open a
training school for psychiatric mental
health nurses that was based on Florence
Nightingale’s principles and training
practices .
The Boston City Hospital Training School
for nurses, which was established in 1882
at McLean Hospital,

12. • It was the first institution in the
United States to provide men the
opportunity to become trained
nurses.

13. INSTITUTIONALISATION
 The training consisted of practical work during
the first year and later included formal
instruction with lectures and classrooms
recitation.
 Early instruction focused more on physical than
on mental care.
 The skills taught included the prevention and
dressing of bedsores, the making of beds,
observation of mental symptoms, and the
principles of fresh air and ventilation as well as
care of the excited patient and temperature
regulation for the sick.

14. • Hydrotherapy, one of the first interventions for
treatment of symptoms related to mental disorders,
was introduced into the curriculum in 1899.
• Only a few textbooks were available for use by the
students, and physicians had written the majority of
them.
• One notable exception was Nightingale’s Notes on
Nursing (Nightingale, 1859).

15.  In 1899, Linda Richards became the
superintendent of Taunton Insane Asylum,
where they began a 2 - year course for nurses.
 In 1913, Euphemia (Effie) Jane Taylor, initiated
the first nurse program of study organized by
nurses for psychiatric training at Johns Hopkins
Phipps Clinic).

16. • The first psychiatric nursing textbook,
Nursing Mental Disease, was published
in 1920.
• It was written by Harriet bailey, a
former Assistant Superintendent of
Nurses at the John Hopkins Hospital
Training School.

17. Early views of Psychiatric Mental
health nursing
 Effie Taylor’s at (Johns Hopkins) like
Nightingale before her, encouraged
nurses to avoid the false dichotomy of
mind and body .
 She believed that the integrated whole
was the focus of nursing.

18.  1914: Mary Adelaide Nutting (1858 - 1948)
(distinguished nursing leader and educator ):
 nursing care should be based on scientific study
and conceptualized in terms of diagnosis, care,
and treatment.

19. early 1900’s
 Management of manic behaviors entailed
packing patients tightly in wet sheets.
 These treatments did not involve any
interaction with patients as individuals..

20.  Nurses were allowed to perform these procedures
only with an order from the physician.
 Other treatments performed by physicians but aided
by nurses were ;
:lobotomies and
: malaria fever therapy

21. • Hildegard Peplau first encountered lobotomy
patients.
• she found them blind in one eye and
unreachable.
• These patients required extensive monitoring
and direction for even basic needs, such as
eating and toileting.

22.  1937, habit training became part of psychiatric
nurses skills.
 The goal of habit training was to rid patients of
undesirable habits, such as spitting, hoarding
and stealing.
 Nurses’ knowledge of medications was
discouraged.

23.  World war II dramatically changed psychiatric
nursing.
 the war abolished mental disorders as illness
that could happen to anyone.
 need for trained nurses, psychiatrists, and
psychologists to care for he many soldiers
suffering from the consequences of the war.

24.  Peplau (in 1952), published Interpersonal
Relations in Nursing, a landmark work in
psychiatric nursing.
 Peplau established the first graduate program in
psychiatric nursing in 1954 at Rutgers University
New Brunswick, New Jersey.

25. DEINSTITUTIONALISATION
1955 to 1990,
 shorter stays and community based efforts
Psychiatric nursing changed its
name to reflect its new role and
became psychiatric mental
health nursing
“Patient” designation, which
signifies and illness
perspective, changed to “client”
signifying one who seeks
health services.

26.  the focus shifted to the family system.
 Psychiatric nursing education had two levels:
generalists and specialists.
 Generalist :a bachelor’s degree
specialist: a master’s degree
1970s, various doctoral degrees in nursing
became available.

27. In 1963, the first nursing journals exclusively
covering psychiatric nursing were published -
: Perspectives in Psychiatric care and the
journal of Psychiatric nursing.
In 1973, the American Nurses Association
(ANA) published the standards of psychiatric
- Mental Health Nursing Practice
In 1979, another psychiatric nursing journal-
Issues in Mental health Nursing, began
publication.

28.  In 1973, the ANA initiated the certification
of specialists in psychiatric mental health
nursing.
 1987 :2 new journals: Archives of
Psychiatric Nursing and Child and
Adolescent Psychiatric and Mental Health
Nursing.
 formation of the Society for Education and
Research in Psychiatric Nursing (SERPN)
in 1984.

29. DECADE OF THE BRAIN
 A shift from the behavioral sciences to
neuroscience led former American
president George H.W Bush to proclaim the
1990s the “decade of the brain”
 Purpose: to enhance public awareness of
the benefits to derived from brain
research.

30.  In 1994, the standards of psychiatric mental
health clinical nursing practice was written by
the ANA, APNA and Association of Child and
Adolescent Psychiatric Nurses (ACAPN).
 The statement was to identify recent trends,
issues, and developments in psychiatric
nursing practice to provide guidance of the
responsibilities within the specialty, especially
clinical practice.

31.  1994 - Psychopharmacology guidelines for
psychiatric mental health nurses published by
the ANA in psychiatric mental health nursing
psychopharmacology project.
 1996 - Guidelines specifying course content
and competencies published by SERPN.
 1999 -ISPN formed.

32. DEVELOPMENT OF
PSYCHIATRIC NURSING
IN INDIA

33. • The history of Indian Psychiatry is as old as
that of the world
• In ancient India there was provision for
treating mentally ill.
• Charaka, Susrutha and other pioneers had
mentioned about various mental diseases and
their treatment.

34. Charaka

35. BEFORE INDEPENDENCE
In 1912 The Indian Lunacy Act was
passed as law.
First Mental Hospital in India -In 1918
British constructed a European Mental
Hospital at Ranchi.
In 1925 the Indian Mental Hospital was
built at Ranchi.
Thereafter hospitals were made in
Calcutta and Bombay.

36.  First Course in Psychiatric Nursing –
 2 British nurses along with one matron were brought
from England to work in the Indian Mental Hospital
at Ranchi.
 Later on they arranged 3-6months courses in
psychiatric nursing for the English-speaking nurses.
 The certificates were given to the trainees and the
Royal Medical Psychological Association
recognized these.

37.  In 1930 :The nurses were asked to engage
psychiatric patients in various skill-oriented
activities.
 In 1943 : 3 months psychiatric nursing course at the
Mental Hospital Madras, and was subsequently
stopped during 1964.
 1946, a collegiate programme of nursing was
started at R.A.K College of Nursing, Delhi.
 Indian Nursing Council included the subject
psychiatric nursing in 1964.
 In 1946,.Bhore committee reported an urgent need
to look after the mentally ill like any other illness

38. AFTER INDEPENDENCE
 Based on Bhore Committee recommendations,
4 more mental hospitals were constructed in
the 1950s.
 In 1950 Indian Psychiatric Society gave a draft
of the ‘Indian mental health act’
 The lunatic asylum established by the
Government of India was renamed as the
Mental Hospital in 1925
 In 1974, the All India Institute of Mental
Health became NIMHANS(National Institute
of Mental Heath and Neuro-Sciences).

39. • First Indian Book in Psychiatric
Nursing-In 1992 and in 1994
published by Mrs. Bimla
Kapoor,Faculty R A K College of
Nursing .
• Thus she became the first
Psychiatric Nurse Author in India.

40.  In 1980 :The National Mental Health Policy’
for India .
 In 1982, the Central Council of Health
accepted the National Mental Health Policy.
 Based on that the National Mental Health
Programme (NMHP) was brought out by the
psychiatric experts.
 In1989 most of the schools of nursing started
a separate psychiatric nursing examination
paper in GNM course

41.  1991, the International Council of Nurses
declared the year for Mental Health
Nursing.
 TNAI welcomed the theme of the year
and published articles on mental health
nursing in Nursing Journal of India
 In February 1991: “Indian Society of
Psychiatric Nurses.”

42.  Kuthiravattom Mental Hospital was
founded in the year 1982.It started functioning
in 1984-85.
 In the beginning it was only meant for
prisoners.
 First Master's programme in Psychiatric Nursing
was started at College of Nursing Kottayam and
Calicut in the year 2003 with 2 and 4 seats
respectively which was increased to 4 and 6 in
2006

43. TRENDS AND ISSUES IN PSYCHIATRIC
NURSING

44. IN THE WORLD
• Use Of Various Diagnostic And
Treatment Modalities
• Emphasis on Importance of Psychiatric
Nurses
• New Concepts
1952, Dr. Hildegard Peplau, defined nursing as a
“significant therapeutic process`
1953 'Therapeutic Community’ as new treatment
method in Psychiatry by Maxwell Jones

45.  Definite Functions
 Shift of Focus to Prevention
 Psychiatric Nursing Process and Related
Developments
- ln 1986 American Psychiatric Nurses Association
(A P N A) established.
- In 1995, Journal of the American Psychiatric Nurses
Association (J A P N A) published.
- Multidisciplinary approach-

46. Changes in Role of Psychiatric Mental Health
Nurse
Staff Nurse
Clinical Nurse Specialist
Nurse Psychotherapist
Psychiatric Nurse Educators
Psychiatric Nurse Leader
Psychiatric Mental Health Advanced
Practice Registered Nurse
Case Manager
Sub-specialisation

47.  Cost-Effective Nursing Care
 Focus of Care
 Psychiatric Nursing Education
 Role of Nurse in Psychiatric Mental Health &
Research

48.  Present Trends
 The Decade of Brain
 Psychopharmacological Treatment
 Nursing Informatics
 Computer Assisted Instruction Programme-
 Nurses On-line
 Psychotherapy
 Occupational therapy
 Community mental health nursing
 Forensic Nursing

49. Future Trends
White (1991) identified 3 areas of further
expansion.
• (1)Client Advocate
• (2) Supporting people with HIV and AIDS
• (3) Creating Mental Health Units

50. Other trends in function of
psychiatric nurses
 Health promotion and maintenance,
 Screening and evaluation,
 Case management,
 Milieu therapy,
 Self-care activities,
 Psychological Instructions
 Health Teaching
 Crisis Intervention
 Counseling
 Home visit
 Advocacy
 Relaxation training

51. • Standards for Psychiatric Mental
Health Nursing
• Challenges for the Nurse
A. Demographic Changes
B. Social Changes
C. Economic Changes
D. Technological Changes
E. Gap in Mental and Physical
Health Care

52. OTHERS
– No clear diagnosis
– Side effects of drugs-huge amount
– Slow and less cure of mental illness
– Social Stigma
– New technologies like……. hypnosis,
– Child Psychiatry
– Stigma in Staff and Students
– Crisis Intervention
– De addiction Centre
– No Policy on Diagnosis &Treatment
– Drug Compliance
– Suicide