Chapter 1: Psy & Mental Health Nurse from Past to Present Flashcards
Early forms of institutional care
Around the 15th century some towns in Europe established small scale asylums as charitable enterprises each hosting about 10 people. The church nor doctors were involved.
Religious orders remerged in 17th century France. They involve themselves in small scale pre-modern hospitals. The sisters of Mercy congregation produced early models for nursing work as a socially respected endeavor.
In the US son he pulled you in New Mexico opened in 1589 as a hospital for the insane under the Roman catholic church.
Popular causes of mental illness included spiritual biologic and social explanations such as evil spirits sin demonic possession fears contagious environments or brain disturbances.
The industrialization and urbanization during the 18th and 19th century made middle class become concerned about a growing number of poor and deviant people.
Later people began to believe that mentally ill people or rational beings with a human nature.
A revolutionary idea: Humane care
By 1792 moral treatment became an influencial idea. Philippe pineal influenced by enlightenment ideas believed that the insane were sick patients who needed humane treatment and ordered the removal of the chains and abuse of drugging and bloodletting. Purposefully designed asylums were Stabley Sh t to provide sympathetic care in quite pleasant surroundings with some form of useful occupation such as weaving or farming.
19th & Early 20th centuries: An era of asylum building
New Brunswick was the first to open a mental institution in 1835. Or that the poor laws system was used to confined insane families in local jails or poor houses. Involuntary confinement and institutional care became. Gender differences were reflected of the social situations of the time. Aboriginal patients died soon after being admitted due to tuberculosis.
A legal basis for mental health care
After the British North America act of 1867 mental health organization care in Canada became provincially-based. In the late 19th century all provinces passed legislation called the insanity act to provide legal basis to public glee can find a mentally ill person’s. In the 20th century this was updated and renamed the mental health act.
In the beginning all patients admitted were certified patients today people are admitted on a voluntary or certified basis.
A social reformer: Dorothea Lynde Dix
. She was a firm advocate for this new form of state supported public care. Her crusade for more humane treatment generated much of the reforms in mental health care systems. She was a teacher and asked to prepare a Sunday school class for women inmates and was shocked by the treatment. There was no heat in the dead of winter. This was due to the myth that the insane were in sensible to extremes of temperature. She investigated the conditions of jails and promoted the building of mental hospitals.
Life Within Early institutions
The focus was on custodial care and practical management of a large number of people. Treatment rarely occurred. Often could only provide food clothing pleasant surroundings and maybe employment. Overcrowding and resource shortages created rowdy dangerous and often unbearable situations. Quiet patients often formed self-contained communities producing their own food and clothing. Clifford beers published an autobiography depicting his three year experience in three types of hospitals. He reported being beaten choked and imprisoned for long periods in dark padded cells. This was in 1908. Adolf Meyer supported beers and suggested the term mental hygiene for bringing about improvements of people’s mental health. They developed prison clinics and mental health approaches. They founded the Canadian national committee for mental hygiene in 1918. The polling conditions triggered particular political concern after World War I when shellshocked veterans returned. A class based concern about an alleged week mindedness among lower class social classes and the need for betterment of the human race prevailed. This expanded professions such as psychiatrists psychologists and nurses.
Development of psychiatric and mental health nursing
Early Debelopmeng:
The CNCMH promoted the introduction of train schools for mental nurses. Well educated woman with a sense of order and compassion had been essential in the introduction of training schools in general hospitals. To model psychiatric hospitals after general hospitals they took the idea and gear training nurses towards woMen.
Regional influences
Western Canada had a stronger orientation to Pritish traditions so mental nurse training schools didn’t occur until 1930s by which time men were also trained. In Alberta Charles Barger Have a strong belief in the ability of female compassion. Initiated training for nurses in attendance where there was arrangements with general hospitals so that after two years of training in the mental hospital female nurse students could do an additional 18 months of training at a general hospital and take licensing exams for registered nurses then return to the mental hospital.
Evolution of scientific thought
In 1990 there was two views on mental illness. One the belief that mental disorders had biological origins and could be treated by physical interventions (biological views) and two the belief that the problems were attributed to environmental and social stressors (Psycho socially oriented ideas).
Meyer and Psychiatruc Pluralism
Psychiatric pluralism is an integration of human biologic functions in the environment. He focussed on investigating how organic functions related to the person and how the person
related to the environment. Unfortunately his disciples thought this included surgical treatment. They removed sites of sepsis such as teeth tonsils and colons.
Freud and Paychoanalytiv Theory
Free developed a personality theory based on unconscious motivations for behaviours or drives. He delved into patients feelings and emotions regarding past experiences. According to Freud normal development occurred in stages such as oral anal and genital. Interference in this development such as psychological trauma would give rise to neurosis or psychosis. Primary causes of mental illness were now viewed as primarily psychological. Psycho analysis was costly and time-consuming and required lengthy training as a result thousands of patients with severe mental illnesses were essentially ignored.
Integration of Biologicsk Theories into Psychodocial Treatment
Until 1940 the boat all logic review did not result in effective treatment. There was a lack of understanding about the biologic basis of mental disorders. Hydrotherapy or baths was an established procedure in mental institutions these were thought to provide common affects for patients. In the 1940s new treatments such as insulin, therapy and electroconvulsive therapy begin. These were normally inappropriately or indiscriminately applied. In the 1940s the lobotomy a psycho surgical treatment again. By the 1970s the lobotomy was controversial. Modified versions of ECT is still used today for the treatment of depression however now it is applied under anesthesia. In the 1950s successful symptom management with psychopharmacology agents became more widespread. Focus on the brain became a key to understanding psychiatric disorders. Chlorpromazine was an early drug that became widely used. However There side effects soon became serious drawbacks. In the 1970s the introduction of lithium for the treatment of bipolar disorder and antidepressants in the treatment of mood disorders came about.
New trends in post-war II mental health care
By the end of the 1940s patients in overcrowded psychiatric hospitals outnumbered the number of patients in other healthcare facilities including general hospitals. Inflammation of universal health insurance for hospital care and medical services generated funding for the Stabley Schmidt of psychiatric departments in general hospitals. The Canadian mental health Association renamed from CNCMH Had a role in policy development for integrating services in general hospitals in the community. Argued that mental illness had to be dealt with similar to physical illness. In the 20th century D installation de institutionalization the downsizing of the large provincial psychiatric hospitals began with a new orientation and community based services. Services and treatments diversified. Group therapy and psychotherapy‘s prevailed. In the 1950s mental hospitals began to reduce their size and over the next decade many closed or changed their focus. In the late 1970s the federal government reduced its share in the cost of funding for healthcare. Provinces developed different models to fund specialized programs such as alcohol and substance abuse treatment which after World War II were pressing issues. Subspecialties also emerged such as child psychiatry forensics and geriatric services.
Continued evolution of psychiatric and mental health nursing
A diverse pattern of PMH nurse education was seen due to efforts of hospital admin to continue staffing psych hospitals through hospital-based nurse training programs. In 1950 Canada entertained to models of education for PMH nursing. General-based hospital schools begin to integrate psychiatric nursing into the curriculum. Student nurses attended the provincial psychiatric hospitals for a brief period of training called an affiliation program. Mental nurse trainees opted for an affiliation to the general hospital resulting in both groups attaining the title of a registered nurse. After world war two Ontario formalized this pattern into a permanent structure. The registered nurse became the main nursing care provider in mental health services. In Western Canada the bulk of nursing care in provincial hospitals continue to be provided by nurses graduated from psychiatric hospital-based nurse training programs. Some western provinces established affiliation programs but limited size. In British Columbia a training school for mental nurses was established in 1930. In western provinces the government had less control Over nurse training. They failed to support affiliation for training. In Saskatchewan registered nurses had never successfully integrated into the mental hospitals. Dissatisfied with the exclusion from any professionally recognized nursing title provincial hospital attendees became instrumental in supporting legislation of a separate psychiatric nurses act which passed in 1948. In 1950 the psychiatric nurse association of Canada was formed. All four Western Canadian provinces passed acts that Entitled graduates to the title of psychiatric nurse.
Expansion of holistic nursing care
The nurse patient relationship was defined as the very essence of PMH nursing and supported a holistic perspective on patient care. Two nursing journals focussed on psychiatric nursing. During the 1980s the CFMH in formed as an interest group of the Canadian nurses association to promote mental health.
The CFMHN wrote standards.
The holistic perspective had PMH nurses practising in a variety of settings with a variety of clientele. The emphasis was on activities ranging from health promotion to health restoration. Nurses should be research driven always incorporating new findings into practice.
Contemporary issues
Due to the various extent and timing of deinstitutionalized policies through provinces, people with mental disorders were discharged into communities that were ill prepared to offer support housing or drop opportunities. Communities were hesitant in excepting people and stigma remained. Revolving door patients signified that long-term severe mental illness remained a persistent problem. Severe mental illness substance dependency and in adequate community resources have increased the homeless population with mental illness or increased those winding up in the criminal justice system. The mental health needs of women remain poorly addressed and suicide is also a huge Issue for both genders.
Awareness is growing that diverse cultural populations have distinct mental health needs. Aboriginal communities experience disproportionate rates of both physical and mental illness. For instants addressing and acknowledging the detrimental impact of residential schools upon families. Canada’s Indian hospitals for treating tuberculosis among aboriginal people also had a severe affect
The new era of healthcare reform
Financial and social barriers continue to affect the overall funding for mental health services. The state remains the major decision maker for resource allocation. Emphasis on reducing expensive institutional care and increasing community-based resources.
In 2000 to the CAMIMH published its first report. 86% of hospitalizations for mental illness occurred in general hospitals. This under scored the need for additional and improved community-based services. The report highlighted the need to counter fragmentation and to address the disparate services provided across the provinces and between rule and urban regions. Critics of the report noted a lack of emphasis is on preventative determinants. Or on the disparities for mental health and addiction services for men and women.
Developing a national mental health strategy
To address the gaps health Canada funded the mental health commission of Canada for a 10 year initiative. They were assigned three primary objectives one to develop a mental health strategy for Canada to begin an anti-stigma campaign and three create a knowledge exchange centre to promote research and build capacity and opportunities in evidence-based mental health strategies.
In 2012 they issued a comprehensive national mental health strategy with six strategic directions. (promote mental health across the lifespan in homes and prevent mental illness and suicide. Foster recovery and well-being for people and uphold the rights. Provide access to the appropriate combination of services and treatments. Reduce disparities in risk factors and respond to the needs of diverse communities. Work with first Nations Inuit and métis to address their needs and their distinct circumstances. Mobilize leader ship improve knowledge and foster collaboration at all levels.)
It also initiated the at home initiative to examine housing for mentally ill individuals and a mental health first aid project involving training to the public on how to identify signs and symptoms of mental illness. Affordable low cost housing remains a key health issue.
The MH cc 2017 to 2022 plan included three key strategies (Objective one leadership partnership and capacity building objective to promotion and advancing of the mental health strategy for Canada. Objective three knowledge mobilization.)
The mental health of immigrants and refugees has moved up in the agenda in recent years.
The world health assembly has four major objectives in the comprehensive mental health action plan (Strengthen effective leader ship and governance for mental health. Provide comprehensive integrated and responsive mental health and social care services in community based settings. Implement strategies for promotion and prevention in mental health. Strengthen information systems, evidence and research for mental health.)
