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Mental disorders are recognized as one of the major burdens to society These disorders contribute to high morbidity and mortality rates, as well as lost economic productivity. One in five persons will suffer a mental disorder in a lifetime. Suicide rates for middle-aged men are climbing. Substance use disorders are common in our adolescents Mental disorders affect the health and well-being of individuals, families, and communities Mental healthisintegraltoanindividual’swell-being
Mental health care, once viewed as separate from mainstream medical treatment, is now integrated into primary health care. Depression and anxiety are more likely treated in a primary care setting than a mental health center The person with a mental disorder often has challenging medical problems that are complicated by the treatmentofcoexistingpsychiatricproblems Wenowrecognizethatmentalandphysicalhealthgohandinhand
The nurse is a primary health professional who integrates physical and mental health issues into a holistic approach and collaborates with the person who is moving toward recovery and wellness. This nurse practices in a variety of settings including mental health and primary care This text prepares nursing leaders who identify the effect of mental health problems on their patients’ well-being, partner with their patients in the delivery of care, andusethelatestevidenceintheirnursingpractice.
TEXT ORGANIZATION
Early chapters of Psychiatric Nursing: Contemporary Practice, Sixth Edition, introduce students to mental health care in contemporary society Recovery and its 10 components are presented in Chapter 2 and set the stage for recovery-oriented nursing practice. As the building blocks for the future chapters, the first three units present the conceptual underpinnings and principles of psychiatric–mental health nursing Units IV and V present mental health promotion and prevention content, including very comprehensive chapters on stress and mental health and suicide prevention Unit VI presents the care of persons with mental disorders, including an explanation of the effect of the DSM-5. The last three units focus on the care of children, older adults, and special populations includingthosewhoarehomelessormedicallycompromised
The text presents complex concepts in easy-to-understand language with multiple examples and explanations Students find the text easy to comprehend, filled with meaningful information, and applicable to all areas of nursingpractice.
PEDAGOGICAL FEATURES
The sixth edition of PsychiatricNursing:ContemporaryPractice incorporates a multitude of pedagogical features to focusanddirectstudentlearning,including:
Expanded Table of Contents allowsreaderstofindandrefertoconceptsfromonelocation
New! Integration with Primary Care alsothreadedindisorderchaptersandutilizingcasestudycontent, addressesintegrationofpsychiatricdisorderswithbasichealthneedsblended NCLEX Notes helpstudentsfocusonimportantapplicationareastopreparefortheNCLEX
Emergency Care Alerts highlightimportantsituationsinpsychiatricnursingcarethatthenurseshould recognizeasemergencies
Research for Best Practice boxeshighlighttoday’sfocusonevidence-basedpracticeforbestpractice,presenting findingsandimplicationsofstudiesthatareapplicabletopsychiatricnursingpractice
AnImage Bank letsyouusethephotographsandillustrationsfromthistextbookinyourPowerPointslidesor asyouseefitinyourcourse
Case Studies withrelatedquestions(andsuggestedanswers)givestudentsanopportunitytoapplytheir knowledgetoaclientcasesimilartoonetheymightencounterinpractice
An exciting set of free resources is available to help students review material and become even more familiar with vital concepts Students can access all these resources at http://thePointlwwcom/Boyd6e using the codes printed inthefrontoftheirtextbooks
PlusLearning Objectives, Drug Monographs, Carrington Professional Guide, Dosage Calculation Quizzes, andanAudio Glossary
A FULLY INTEGRATED COURSE EXPERIENCE
We are pleased to offer an expanded suite of digital solutions and ancillaries to support instructors and students usingPsychiatricNursing: Contemporary Practice, Sixth Edition To learn more about any solution, please contact yourlocalWoltersKluwerrepresentative.
LippincottCoursePoint+ is an integrated digital learning solution designed for the way students learn It is the only nursingeducationsolutionthatintegrates:
Leading content in context: Contentprovidedinthecontextofthestudentlearningpathengagesstudents andencouragesinteractionandlearningonadeeperlevel
Powerful tools to maximize class performance: Course-specifictools,suchasadaptivelearningpoweredby prepU,provideapersonalizedlearningexperienceforeverystudent
Real-time data to measure students’ progress: Studentperformancedataprovidedinanintuitivedisplaylet youquicklyspotwhichstudentsarehavingdifficultyorwhichconceptstheclassasawholeisstrugglingto grasp.
Preparation for practice: Integratedvirtualsimulationandevidence-basedresourcesimprovestudent competence,confidence,andsuccessintransitioningtopractice
LippincottAdvisorforEducation: Withover8500entriescoveringthelatestevidence-basedcontentand druginformation,LippincottAdvisorforEducationprovidesstudentswiththemostup-to-dateinformation possible,whilegivingthemvaluableexperiencewiththesamepoint-of-carecontenttheywillencounterin practice
Training services and personalized support: Toensureyoursuccess,ourdedicatededucationalconsultants andtrainingcoacheswillprovideexpertguidanceeverystepoftheway
Acknowledgments
This text is a result of many long hours of diligent work by the contributors, editors, and assistants Psychiatric nurses are constantly writing about and discussing new strategies for caring for persons with mental disorders. Consumers of mental health services provided directions for nursing care and validated the importance of nursing interventions Iwishtoacknowledgeandthanktheseindividuals
Natasha McIntyre, Helen Kogut, and Greg Nicholl of Wolters Kluwer and Beverly Tscheschlog were extraordinary partners in this project. I want to especially acknowledge their attention to detail and their commitment to excellence. They provided direction, support, and valuable input throughout this project. They were extraordinary partners during revision of this update They brought a broad knowledge base and extreme patience during the whole update process I want to thank Tim Rinehart and Dan Reilly for the organizational skills that kept the project on target. This text would not be possible without Indu Jawwad and the highly committedteamofAptara,Inc.
UNIT I MENTAL HEALTH CARE IN CONTEMPORARY SOCIETY
1 Psychiatric–Mental Health Nursing and Evidence-Based Practice ThePastandPresent EvolutionofMentalHealthRecovery ContemporaryMentalHealthCare
2 Mental Health and Mental Disorders: Fighting Stigma & Promoting Recovery MentalHealthandWellness OverviewofMentalHealthDisorders RecoveryfromMentalIllness
3 Cultural and Spiritual Issues Related to Mental Health Care CulturalandLinguisticCompetence CulturalandSocialFactorsandBeliefsAboutMentalIllness
Spirituality,Religion,andMentalIllness
4 Patient Rights and Legal Issues Self-Determinism:AFundamentalRightandNeed ProtectionofPatientRights TreatmentandPatientRights PrivacyandConfidentiality AccountabilityforNursesandOtherMentalHealthCareProfessionals
5 Mental Health Care in the Community DefiningtheContinuumofCare MentalHealthServicesinaContinuumofCare IntegratedCare IntegratedPrimaryCareandMentalHealth NursingPracticeintheContinuumofCare
27 Trauma- and Stressor-Related Disorders: Management of Posttraumatic Stress TraumaandResilience
OverviewofTrauma-andStressor-RelatedDisorders
Recovery-OrientedCareforPersonsWithPTSD
Evidence-BasedNursingCareofthePersonWithPTSD
OtherTrauma-andStressor-RelatedDisorders
28 Personality and Borderline Personality Disorder: Management of Emotional Dysregulation and Self-Harm OverviewofPersonalityDisorders BorderlinePersonalityDisorder
Everyone experiences emotional and mental health issues at some time in their lives During periods of illness and stress, mental health issues often become overwhelming to individuals and their families. Every nurse provides mental health interventions, no matter the practice site Nurses in acute care settings are likely to care for persons in mental health crises because medical problems are treated before any mental health issues (eg, physical injuries from a suicide attempt are treated before the underlying depression). Like anyone else, people with psychiatric disordersseekhealthcarefortheirmedicalillnesses.Thestressofthemedicalillnesscanalsoexacerbatepsychiatric symptoms
Psychiatric nurses care for patients with a wide range of emotional problems and mental disorders (Box 11) These nurses, specializing in mental health nursing, are not only experts in caring for persons with a primary diagnosisofamentaldisorderbutalsoforthosewithself-conceptandbodyimageissues,developmentalcrises,cooccurring disorders, end-of-life changes, and emotional stress related to illness, disability, or loss It is a psychiatric nurse who is called when violence, suicide, or a disaster erupts In this text, the terms psychiatric nursing and psychiatric–mentalhealthnursingareusedinterchangeably.ThestandardsofpracticearediscussedinChapter6.
BOX 1 1
Psychiatric–Mental Health Nursing’s Phenomena of Concern
KEYCONCEPTS Groundedinnursingtheories,psychiatric–mental health nursingisdefinedasthe“nursingpracticespecialtycommittedto promotingmentalhealththroughtheassessment,diagnosis,andtreatmentofbehavioralproblems,mentaldisorders,andcomorbidconditions acrossthelifespan Psychiatric–mentalhealthnursinginterventionisanartandascience,employingpurposefuluseofselfandawiderangeof nursing,psychosocial,andneurobiologicevidencetoproduceeffectiveoutcomes”(AmericanNursesAssociation,AmericanPsychiatricNurses Association,&InternationalSocietyofPsychiatric–MentalHealthNurses,2014,p 1)
THE PAST AND PRESENT
Psychiatric nursing has a history that can be traced back to the early days of nursing practice. Today the specialty hasdevelopedintooneofthecorementalhealthprofessionswithanemphasisonevidence-basedpractice
Early Founders
The roots of contemporary psychiatric–mental health nursing can be traced to Florence Nightingale’s holistic view of a patient who lives within a family and community She was especially sensitive to human emotions and recommended interactions that today would be classified as therapeutic communication (see Chapter 9) For example, this early nursing leader’s intervention for reducing anxiety about an illness was to encourage independenceandself-care(Nightingale,1859)
Linda Richards, the first trained nurse in the United States, opened the Boston City Hospital Training School for Nurses in 1882 at McLean Hospital, a mental health facility (Box12) (Cowles, 1887) Employees of McLean were recruited into the nursing program to learn to provide physical care for patients with mental disorders who developed medical illnesses In 1913, Effie Taylor integrated psychiatric nursing content into the curriculum at Johns Hopkins’ Phipps Clinic Taylor, like Nightingale before her, encouraged nurses to avoid the dichotomy of mind and body (Church, 1987) The first psychiatric nursing textbook, Nursing Mental Disease, was written by Harriet Bailey in 1920 (Bailey, 1920). Gradually, nursing education programs in psychiatric hospitals were phased intomainstreamnursingeducationprograms(Peplau,1989)
Emergence of Modern Nursing Perspectives
Aspsychiatric–mentalhealthnursingdevelopedasaprofessioninthe20thcentury,modernperspectivesofmental illness emerged, and these new theories profoundly shaped mental health care (see Units II and III) In 1952, Hildegard E Peplau published the landmark work Interpersonal Relations in Nursing (Peplau, 1952) This publication introduced psychiatric–mental health nursing practice to the concepts of interpersonal relations and the therapeutic relationship Peplau conceptualized nursing practice as independent of physicians The use of self asanursingtoolwasoutsidethedominanceofbothhospitaladministratorsandphysicians
Peplau also contributed to educational programs for psychiatric nursing, developing a specialty training program in psychiatric nursing the first graduate nursing program in 1954 at Rutgers University. Subspecialtiesbegantoemerge,focusingonchildren,adolescents,andolderadults
In 1967, the Division of Psychiatric and Mental Health Nursing Practice of the American Nurses Association (ANA) published the first StatementonPsychiatricNursingPractice This publication was the first official sanction ofa holisticapproach ofpsychiatric–mental healthnurses practicingin avariety ofsettings witha diverse clientele, emphasizing health promotion as well as health restoration Since 1967, there have been several updates of the official practice statement that reflect the expansion of the role of psychiatric nurses with a delineation of functions
Over the past century, psychiatric nursing practice expanded from the hospital to the community Today in the United States, many nursing graduate degree programs offer specializations in psychiatric–mental Psychiatric nurses sit on corporate boards; serve in the armed forces; lead major health care initiatives; teach in major universities; and care for young and old people, families, and disadvantaged and homeless individuals Psychiatric nursingistrulyaversatileandrewardingfieldofnursingpractice(Fig 11)
