life responsibilities, function

effectively in daily life, and are

satisfied with their interpersonal
Study Notes – relationships and themselves.​
Introduction to Mental ●​ No single universal definition of
Health & Mental Illness mental health exists.​

●​ Generally, a person’s behavior can

provide clues to his or her mental
Mental Health and Mental Illness health.​
●​ Mental health and mental illness are ●​ Because each person can have a
difficult to define precisely.​ different view or interpretation of
behavior (depending on his or her
●​ People who can carry out their roles values and beliefs), the
in society and whose behavior is determination of mental health may
appropriate and adaptive are viewed be difficult.​
as healthy.​
●​ In most cases, mental health is a
●​ Conversely, those who fail to fulfill state of emotional, psychological,
roles and carry out responsibilities or and social wellness evidenced by
whose behavior is inappropriate are satisfying interpersonal
viewed as ill.​ relationships, effective behavior and
coping, positive self-concept, and
●​ The culture of any society strongly emotional stability.​
influences its values and beliefs, and
this, in turn, affects how that society ●​ Mental health has many
defines health and illness.​ components, and a wide variety of
factors influence it.​
●​ What one society may view as
acceptable and appropriate, another ●​ These factors interact; thus, a
society may see as maladaptive and person’s mental health is a dynamic,
inappropriate.​ or ever-changing, state.​

●​ Factors influencing a person’s

mental health can be categorized as
individual, interpersonal, and
Mental Health
social/cultural.​
●​ The World Health Organization
●​ Individual, or personal, factors
defines health as a state of complete
include a person’s biologic makeup,
physical, mental, and social
autonomy and independence,
wellness, not merely the absence of
self-esteem, capacity for growth,
disease or infirmity.​
vitality, ability to find meaning in life,
emotional resilience or hardiness,
●​ This definition emphasizes health as
sense of belonging, reality
a positive state of well-being.​
orientation, and coping or stress
management abilities.​
●​ People in a state of emotional,
physical, and social well-being fulfill
 ●​ Interpersonal, or relationship, factors loss of meaning in one’s life.​
include effective communication,
ability to help others, intimacy, and a ●​ Interpersonal factors include
balance of separateness and ineffective communication,
connectedness.​ excessive dependency on or
withdrawal from relationships, no
●​ Social/cultural, or environmental, sense of belonging, inadequate
factors include a sense of social support, and loss of emotional
community, access to adequate control.​
resources, intolerance of violence,
support of diversity among people, ●​ Social/cultural factors include lack of
mastery of the environment, and a resources, violence, homelessness,
positive, yet realistic, view of one’s poverty, an unwarranted negative
world.​ view of the world, and discrimination
such as stigma, racism, classism,
ageism, and sexism.​

●​ It is important to note that some of

Mental Illness these social/cultural factors can
result in isolation, feelings of
●​ Mental illness includes disorders that alienation, and maladaptive, violent,
affect mood, behavior, and thinking, or criminal behavior.​
such as depression, schizophrenia,
anxiety disorders, and addictive ●​ This may support a diagnosis of a
disorders.​ personality disorder but not
necessarily a mental illness with
●​ Mental disorders often cause symptoms amenable to treatment
significant distress or impaired with medication.​
functioning or both.​
●​ This is an ongoing debate among
●​ Individuals experience health care professionals; is it illness
dissatisfaction with self, or bad behavior? The answers to
relationships, and ineffective coping.​ these questions are not always
clear.​
●​ Daily life can seem overwhelming or Alright — I’ll continue with the exact
unbearable.​ sentences from page 27 (DSM-5)
through page 48 exactly as in your
●​ Individuals may believe that their file, formatted in note style for clarity
situation is hopeless.​ but without changing the wording.

●​ Factors contributing to mental illness

can also be viewed within individual,
interpersonal, and social/cultural Diagnostic and Statistical
categories.​
Manual of Mental Disorders
●​ Individual factors include biologic
●​ The Diagnostic and Statistical
makeup, intolerable or unrealistic
Manual of Mental Disorders, fifth
worries or fears, inability to
edition (DSM-5), is a taxonomy
distinguish reality from fantasy,
published by the American
intolerance of life’s uncertainties, a
Psychiatric Association and revised
sense of disharmony in life, and a
 as needed.​ understand the reason for the
admission and to begin building
●​ The current edition made some knowledge about the nature of
major revisions and was released in psychiatric illnesses.​
2013.​

●​ The DSM-5 describes all mental

disorders, outlining specific
diagnostic criteria for each based on Historical Perspectives of the
clinical experience and research.​ Treatment of Mental Illness
●​ All mental health clinicians who Ancient Times
diagnose psychiatric disorders use
this diagnostic taxonomy.​ ●​ People of ancient times believed that
any sickness indicated displeasure
●​ The DSM-5 has three purposes:​ of the gods and, in fact, was a
• To provide a standardized punishment for sins and wrongdoing.​
nomenclature and language for all
mental health professionals​ ●​ Those with mental disorders were
• To present defining characteristics viewed as either divine or demonic,
or symptoms that differentiate depending on their behavior.​
specific diagnoses​
• To assist in identifying the ●​ Individuals seen as divine were
underlying causes of disorders​ worshipped and adored; those seen
as demonic were ostracized,
●​ The classification system allows the punished, and sometimes burned at
practitioner to identify all the factors the stake.​
that relate to a person’s condition:​
• All major psychiatric disorders ●​ Later, Aristotle (382–322 BC)
such as depression, schizophrenia, attempted to relate mental disorders
anxiety, and substance-related to physical disorders and developed
disorders​ his theory that the amounts of blood,
• Medical conditions that are water, and yellow and black bile in
potentially relevant to understanding the body controlled the emotions.​
or managing the person’s mental
disorder as well as medical ●​ These four substances, or humors,
conditions that might contribute to corresponded with happiness,
understanding the person​ calmness, anger, and sadness.​
• Psychosocial and environmental
problems that may affect the ●​ Imbalances of the four humors were
diagnosis, treatment, and prognosis believed to cause mental disorders;
of mental disorders. Included are therefore, treatment was aimed at
problems with the primary support restoring balance through
group, the social environment, bloodletting, starving, and purging.​
education, occupation, housing,
economics, access to health care, ●​ Such “treatments” persisted well into
and the legal system.​ the 19th century (Baly, 1982).​
●​ Although student nurses do not use
the DSM-5 to diagnose clients, they
will find it a helpful resource to
Possessed by Demons Period of Enlightenment and Creation
of Mental Institutions
●​ In early Christian times (1–1000
AD), primitive beliefs and ●​ In the 1790s, a period of
superstitions were strong.​ enlightenment concerning persons
with mental illness began.​
●​ All diseases were again blamed on
demons, and the mentally ill were ●​ Philippe Pinel in France and William
viewed as possessed.​ Tuke in England formulated the
concept of asylum as a safe refuge
●​ Priests performed exorcisms to rid or haven offering protection at
sufferers of evil spirits.​ institutions where people had been
whipped, beaten, and starved
●​ When that failed, they used more because they were mentally ill
severe and brutal measures, such (Gollaher, 1995).​
as incarceration in dungeons,
flogging, and starving.​ ●​ With this movement began the moral
treatment of the mentally ill.​
●​ In England during the Renaissance
(1300–1600), people with mental ●​ In the United States, Dorothea Dix
illness were distinguished from (1802–1887) began a crusade to
criminals.​ reform the treatment of mental
illness after a visit to Tuke’s
●​ Those considered harmless were institution in England.​
allowed to wander the countryside or
live in rural communities, but the ●​ She was instrumental in opening 32
more “dangerous lunatics” were state hospitals that offered asylum to
thrown in prison, chained, and the suffering.​
starved (Rosenblatt, 1984).​
●​ Dix believed that society was
●​ In 1547, the Hospital of St. Mary of obligated to those who were
Bethlehem was officially declared a mentally ill; she advocated adequate
hospital for the insane, the first of its shelter, nutritious food, and warm
kind.​ clothing (Gollaher, 1995).​

●​ By 1775, visitors at the institution ●​ The period of enlightenment was

were charged a fee for the privilege short-lived.​
of viewing and ridiculing the inmates,
who were seen as less than human ●​ Within 100 years after the
animals (McMillan, 1997).​ establishment of the first asylum,
state hospitals were in trouble.​
●​ During this same period in the
colonies (later the United States), ●​ Attendants were accused of abusing
the mentally ill were considered evil the residents, the rural locations of
or possessed and were punished.​ hospitals were viewed as isolating
patients from their families and
●​ Witch hunts were conducted, and homes, and the phrase insane
offenders were burned at the stake.​ asylum took on a negative
connotation.​
 antimanic agent, were the first drugs
to be developed.​
Sigmund Freud and Treatment of
Mental Disorders ●​ Over the following 10 years,
monoamine oxidase inhibitor
●​ The period of scientific study and antidepressants; haloperidol
treatment of mental disorders began (Haldol), an antipsychotic; tricyclic
with Sigmund Freud (1856–1939) antidepressants; and antianxiety
and others, such as Emil Kraepelin agents, called benzodiazepines,
(1856–1926) and Eugen Bleuler were introduced.​
(1857–1939).​
●​ For the first time, drugs actually
●​ With these men, the study of reduced agitation, psychotic
psychiatry and the diagnosis and thinking, and depression.​
treatment of mental illness started in
earnest.​ ●​ Hospital stays were shortened, and
many people became well enough to
●​ Freud challenged society to view go home.​
human beings objectively.​
●​ The level of noise, chaos, and
●​ He studied the mind, its disorders, violence greatly diminished in the
and their treatment as no one had hospital setting.​
done before.​

●​ Many other theorists built on Freud’s

pioneering work (see Chapter 3).​
Move toward Community Mental
●​ Kraepelin began classifying mental Health
disorders according to their
symptoms, and Bleuler coined the ●​ The movement toward treating those
term schizophrenia.​ with mental illness in less restrictive
environments gained momentum in
1963 with the enactment of the
Alright — I’ll continue with the exact Community Mental Health Centers
sentences from your file, keeping them in Construction Act.​
the same note format until we reach page
48. ●​ Deinstitutionalization, a deliberate
shift from institutional care in state
hospitals to community facilities,
began.​
Development of
Psychopharmacology ●​ Community mental health centers
served smaller geographic
●​ A great leap in the treatment of catchment, or service, areas that
mental illness began in about 1950 provided less restrictive treatment
with the development of located closer to individuals’ homes,
psychotropic drugs, or drugs used to families, and friends.​
treat mental illness.​
●​ These centers provided emergency
●​ Chlorpromazine (Thorazine), an care, inpatient care, outpatient
antipsychotic drug, and lithium, an services, partial hospitalization,
 screening services, and education.​ received treatment within the past
year.​
●​ Thus, deinstitutionalization
accomplished the release of ●​ The 18 to 25 age group had the
individuals from long-term stays in highest prevalence of mental illness
state institutions, the decrease in as well as the lowest percent of
admissions to hospitals, and the people receiving treatment.​
development of community-based
services as an alternative to hospital ●​ Furthermore, mental illness or
care.​ serious emotional disturbances
impair daily activities for an
●​ In addition to deinstitutionalization, estimated 15 million adults and 4
federal legislation was passed to million children and adolescents.​
provide an income for disabled
persons: supplemental security ●​ For example,
income (SSI) and Social Security attention-deficit/hyperactivity
disability income (SSDI).​ disorder affects 3% to 5% of
school-aged children.​
●​ This allowed people with severe and
persistent mental illness to be more ●​ More than 10 million children
independent financially and to not younger than 7 years grow up in
rely on family for money.​ homes where at least one parent
suffers from significant mental illness
●​ States were able to spend less or substance abuse, a situation that
money on care of the mentally ill hinders the readiness of these
than they had spent when these children to start school.​
individuals were in state hospitals
because this program was federally ●​ The economic burden of mental
funded.​ illness in the United States, including
both health care costs and lost
●​ Also, commitment laws changed in productivity, exceeds the economic
the early 1970s, making it more burden caused by all kinds of
difficult to commit people for mental cancer.​
health treatment against their will.​
●​ Mental disorders are the leading
●​ This further decreased the state cause of disability in the United
hospital populations and, States and Canada for persons 15 to
consequently, the money that states 44 years of age.​
spent on them.​
●​ Yet, only one in four adults and one
in five children and adolescents
requiring mental health services get
the care they need.​
Mental Illness in the 21st
Century
●​ According to the National Institutes
Revolving Door
of Health (2018), 44.7 million people
in the United States have a mental
●​ Some believe that
illness, though only 19.2 million
deinstitutionalization has had
 negative as well as positive effects.​ ●​ Shorter unplanned hospital stays
further complicate frequent repeated
●​ Although deinstitutionalization hospital admissions.​
reduced the number of public
hospital beds by 80%, the number of ●​ People with severe and persistent
admissions to those beds mental illness may show signs of
correspondingly increased by 90%.​ improvement in a few days but are
not stabilized.​
●​ Such findings have led to the term
revolving door effect.​ ●​ Thus, they are discharged into the
community without being able to
●​ Although people with severe and cope with community living.​
persistent mental illness have
shorter hospital stays, they are ●​ However, planned or scheduled
admitted to hospitals more short hospital stays do not contribute
frequently.​ to the revolving door phenomenon
and may show promise in dealing
●​ The continuous flow of clients being with this issue (see Chapter 4).​
admitted and discharged quickly
overwhelms general hospital ●​ The result frequently is
psychiatric units.​ decompensation and
rehospitalization.​
●​ In some cities, emergency
department (ED) visits for acutely ●​ In addition, many people have a dual
disturbed persons have increased by problem of both severe mental
400% to 500%.​ illness and substance abuse.​

●​ Patients are often boarded or kept in ●​ Use of alcohol and drugs

the ED while waiting to see if the exacerbates symptoms of mental
crisis deescalates or until an illness, again making
inpatient bed can be located or rehospitalization more likely.​
becomes available.​
●​ Substance abuse issues cannot be
●​ The practice of boarding leads to dealt with in the 3 to 5 days typical
frustration of health care personnel, for admissions in the current
dissatisfaction with care for clients managed care environment.​
and their families, and some believe
an increase in suicide.​

●​ Provision of an adequate number of

psychiatric inpatient beds could Homelessness
better meet the needs of clients and
might even decrease homelessness, ●​ Homelessness is a major problem in
incarceration, and violence (Allison the United States today with 610,000
et al., 2018).​ people, including 140,000 children,
homeless on any given night.​

●​ Approximately 257,300 of the

homeless population (33%) have a
Shorter Unplanned Hospital Stays severe mental illness or a chronic
 substance use disorder.​ has never been given the financial
base it needs to be effective.​
●​ The segment of the homeless
population considered to be ●​ In addition, mental health services
chronically homeless numbers provided in the community must be
110,000, and 30% of this group has individualized, available, and
a psychiatric illness and two-thirds culturally relevant to be effective.​
have a primary substance abuse
disorder or other chronic health
condition (Treatment Advocacy
Center, 2019).​
Objectives for the Future
●​ Those who are homeless and
mentally ill are found in parks, airport ●​ More people are being treated for
and bus terminals, alleys and mental illness than in the past.​
stairwells, jails, and other public
places.​ ●​ But large numbers of people go
untreated, particularly among the
●​ Some use shelters, halfway houses, homeless population, persons who
or board-and-care rooms; others are incarcerated, and people who
rent cheap hotel rooms when they experience both mental illness and
can afford it.​ substance abuse.​

●​ Homelessness worsens psychiatric ●​ Statistics like these underlie the

problems for many people with Healthy People 2020 objectives for
mental illness who end up on the mental health proposed by the U.S.
streets, contributing to a vicious Department of Health and Human
cycle.​ Services (Box 1.1).​

●​ These objectives, originally

developed as Healthy People 2000,
were revised in January 2000 and
Community Resources and again in January 2010 to increase
Funding Issues the number of people who are
identified, diagnosed, treated, and
●​ Many of the problems of the helped to live healthier lives.​
homeless mentally ill, as well as of
those who pass through the ●​ The objectives also strive to
revolving door of psychiatric care, decrease rates of suicide and
stem from the lack of adequate homelessness, to increase
community resources.​ employment among those with
serious mental illnesses, and to
●​ Money saved by states when state provide more services both for
hospitals were closed has not been juveniles and for adults who are
transferred to community programs incarcerated and have mental health
and support.​ problems.​

●​ Inpatient psychiatric treatment still ●​ A framework has been developed for

accounts for most of the spending Healthy People 2030, which will be
for mental health in the United available in 2020.​
States, so community mental health
 institution.​

Community-Based Care ●​ These programs focus on

rehabilitation, vocational needs,
●​ After deinstitutionalization, the 2,000 education, and socialization as well
community mental health centers as on management of symptoms
that were supposed to be built by and medication.​
1980 had not materialized.​
●​ These services are funded by states
●​ By 1990, only 1,300 programs or counties and some private
provided various types of agencies.​
psychosocial rehabilitation services.​
●​ Therefore, the availability and quality
●​ Persons with severe and persistent of services vary in different areas of
mental illness were either ignored or the country.​
underserved by community mental
health centers.​ ●​ For example, rural areas may have
limited funds to provide mental
●​ This meant that many people health services and smaller numbers
needing services were and still are of people needing them.​
in the general population with their
needs unmet.​ ●​ Large metropolitan areas, though
having larger budgets, also have
●​ The Treatment Advocacy Center thousands of people in need of
(2018) reports that about one-half of service; rarely is there enough
all persons with severe mental money to provide all the services
illness have received no treatment of needed by the population.​
any kind in the previous 12 months.​
●​ The community-based system did
●​ Persons with minor or mild cases not accurately anticipate the extent
are more likely to receive treatment, of the needs of people with severe
while those with severe and and persistent mental illness.​
persistent mental illness are least
likely to be treated.​ ●​ Many clients do not have the skills
needed to live independently in the
●​ Consequences of nontreatment are community, and teaching these skills
cited by the Treatment Advocacy is often time-consuming and
Center (2018) as:​ labor-intensive, requiring a 1:1
• Homelessness​ staff-to-client ratio.​
• Psychiatric boarding​
• Arrest​ ●​ In addition, the nature of some
• Incarceration​ mental illnesses makes learning
• Victimization​ these skills more difficult.​
• Suicidality​
• Familial violence​ ●​ For example, a client who is
• Danger to other​ hallucinating or “hearing voices” can
have difficulty listening to or
●​ Community support service comprehending instructions.​
programs were developed to meet
the needs of persons with mental ●​ Other clients experience drastic
illness outside the walls of an shifts in mood, unable to get out of
 bed one day, and then unable to were successful in some areas with
concentrate or pay attention a few healthier populations of people.​
days later.​
●​ In the 1990s, a new form of
●​ Despite the flaws in the system, managed care was developed by
community-based programs have utilization review firms or managed
positive aspects that make them care organizations to control the
preferable for treating many people expenditure of insurance funds by
with mental illnesses.​ requiring providers to seek approval
before the delivery of care.​
●​ Clients can remain in their
communities, maintain contact with ●​ Case management, or management
family and friends, and enjoy of care on a case-by-case basis,
personal freedom that is not possible represented an effort to provide
in an institution.​ necessary services while containing
cost.​
●​ People in institutions often lose
motivation and hope as well as ●​ The client is assigned to a case
functional daily living skills, such as manager, a person who coordinates
shopping and cooking.​ all types of care needed by the
client.​
●​ Therefore, treatment in the
community is a trend that will ●​ In theory, this approach is designed
continue.​ to decrease fragmented care from a
variety of sources, eliminate
unneeded overlap of services,
provide care in the least restrictive
environment, and decrease costs for
Cost Containment and Managed the insurers.​
Care
●​ In reality, expenditures are often
●​ Health care costs spiraled upward reduced by withholding services
throughout the 1970s and 1980s in deemed unnecessary or by
the United States.​ substituting less expensive
treatment alternatives for more
●​ Managed care is a concept designed expensive care, such as hospital
to purposely control the balance admission.​
between the quality of care provided
and the cost of that care.​ ●​ Psychiatric care is costly because of
the long-term nature of the
●​ In a managed care system, people disorders.​
receive care based on need rather
than on request.​ ●​ A relatively short, single hospital
stay can cost $20,000 to $30,000.​
●​ Those who work for the organization
providing the care assess the need ●​ Also, there are fewer objective
for care.​ measures of health or illness.​

●​ Managed care began in the early ●​ For example, when a person is

1970s in the form of health suicidal, the clinician must rely on
maintenance organizations, which the person’s report of suicidality; no
 laboratory tests or other diagnostic ●​ Funding for mental illness treatment
studies can identify suicidal ideas.​ came from two main sources,
Medicare and Medicaid, both of
●​ Mental health care is separated from which were instituted in 1965.​
physical health care in terms of
insurance coverage; there are often ●​ Medicare is a federal program, and
specific dollar limits or permitted Medicaid is a joint federal-state
numbers of hospital days in a program.​
calendar year.​
●​ Medicare covers persons age 65
●​ When private insurance limits are and older, people with permanent
met, public funds through the state kidney failure, and people with
are used to provide care.​ certain disabilities.​

●​ As states experience economic ●​ Medicaid covers low-income

difficulties, the availability of state individuals and families.​
funds for mental health care
decreases as well.​ ●​ Each state establishes its own
eligibility criteria for Medicaid, and
●​ Mental health care is managed each state’s Medicaid program is
through privately owned behavioral unique.​
health care firms that often provide
the services and manage their costs.​ ●​ States may choose to expand
Medicaid under the Patient
●​ Persons without private insurance Protection and Affordable Care Act
must rely on their counties of (ACA).​
residence to provide funding through
tax dollars.​ ●​ Medicaid is the largest payer for
state-financed mental health care.​
●​ These services and the money to
fund them often lag far behind the ●​ Access to mental health care for
need that exists.​ people covered by Medicaid is often
limited because few providers
●​ In addition, many persons with accept Medicaid payment.​
mental illness do not seek care and
in fact avoid treatment.​

●​ These persons are often homeless

or in jail.​ Mental Health Parity

●​ Two of the greatest challenges for ●​ In 1996, the U.S. Congress passed
the future are to provide effective the Mental Health Parity Act, which
treatment to all who need it and to eliminated annual and lifetime dollar
find the resources to pay for this amounts for mental health care for
care.​ companies with more than 50
employees.​

●​ This legislation was a first step in

making mental health coverage
Funding Through Medicare and equal to medical coverage.​
Medicaid
●​ However, annual limits remained for same-sex parents are common.​
number of inpatient days and
outpatient visits.​ ●​ These changes affect the support
systems available to clients with
●​ Mental health parity legislation mental illness.​
continues to evolve, and the goal is
to eliminate differences in coverage
for mental and physical illness so
that people can get the care they
need for mental disorders in the Psychiatric Nursing Practice
same way they can for physical
disorders.​ ●​ Psychiatric–mental health nursing is
an area of nursing practice
committed to promoting mental
health through the assessment,
diagnosis, and treatment of human
Cultural Considerations responses to mental health
problems and psychiatric disorders
●​ The United States is becoming (ANA, 2014).​
increasingly diverse in terms of race,
ethnicity, and culture.​ ●​ Linda Richards, the first American
psychiatric nurse, believed that “the
●​ Health care providers, including mentally sick should be at least as
nurses, must be sensitive to the well cared for as the physically sick”
cultural differences of all clients.​ (Richards, 1915, p. 301).​

●​ Culture has a profound effect on ●​ She organized educational programs

how clients view mental illness, the in state mental hospitals in Illinois
behaviors associated with it, and and Michigan, and she established
how it should be treated.​ the first school of psychiatric nursing
at the McLean Hospital in Waverly,
●​ Some cultures view mental illness as Massachusetts, in 1882.​
a disgrace or a family burden, and
some view it as a spiritual concern.​ ●​ The care provided by nurses was
primarily custodial.​
●​ These beliefs influence whether
people seek treatment, follow ●​ In the early 20th century, nurses
treatment recommendations, or often worked as attendants and
continue with treatment after they were expected to follow the orders of
have started.​ physicians without question.​

●​ In the 1940s, the development of

somatic therapies such as insulin
shock therapy, psychosurgery, and
Changes in Family Structure electroconvulsive therapy provided
new treatments for patients with
●​ Family structure in the United States mental illness.​
is also changing.​
●​ Nursing practice slowly expanded to
●​ Single-parent families, blended include these therapies, but the
families, and families headed by focus remained on the physical
 needs of the patient and the • Being rejected by the client​
administration of medications.​ • Asking personal questions​
• Handling bizarre or inappropriate
●​ Hildegard Peplau, considered the behavior​
mother of psychiatric nursing, • Safety concerns​
introduced the concept of the • Encountering someone they know​
therapeutic nurse–patient • Sharing similar problems or
relationship and the importance of backgrounds with the client​
interpersonal techniques in nursing
practice.​

●​ She emphasized that the

nurse–patient relationship was the Self-Awareness Issues
foundation of psychiatric nursing and
that nurses must engage with clients ●​ Self-awareness means recognizing
as human beings rather than treating one’s own values, beliefs, thoughts,
them as tasks to be completed.​ and feelings, and understanding how
these can affect others.​
●​ June Mellow emphasized the
importance of focusing on the ●​ Self-awareness allows the nurse to
patient’s psychosocial needs and accept differences in others and to
strengths as well as the patient’s build therapeutic relationships that
physical condition.​ are based on the client’s needs
rather than the nurse’s personal
●​ The American Nurses Association agenda.​
(ANA) has published standards of
care that outline the professional ●​ Developing self-awareness is a
performance level expected of all process that requires ongoing
nurses and define the reflection and a willingness to
responsibilities for which nurses are change learned behaviors.​
accountable.​
●​ Strategies for developing
●​ The American Psychiatric Nurses self-awareness include:​
Association (APNA) has identified 13 • Keeping a journal of thoughts,
standard areas of concern for feelings, and behaviors​
psychiatric–mental health nurses • Engaging in clinical supervision​
(Box 1.2).​ • Participating in therapy or
counseling​
• Seeking feedback from trusted
colleagues and friends​

Student Concerns in Psychiatric

Nursing

●​ Nursing students often have

concerns about working with clients
in psychiatric settings.​

●​ Common concerns include:​

• Saying the wrong thing​
• Not knowing what to do​