Varcarolis's Canadian Psychiatric Mental Health Nursing, Canadian Edition, 1st Edition Class Notes
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Varcarolis’s Canadian Psychiatric Mental Health Nursing
Chapter 01: Mental Health and Mental Illness
Thoughts About Teaching the Topic
The instructor will probably devote an hour or less to this material and will probably
emphasize (1) the mental health–mental illness continuum; (2) the mental health assessment,
using both the factors that influence mental health and the five criteria of mental health; and
(3) the importance of becoming conversant with the DSM-5.
The learning activities found on the Evolve Web site will assist students to operationalize
this general knowledge. Activities can be used in class or assigned as independent work.
Key Terms and Concepts
clinical epidemiology
co-morbid condition
Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5)
electronic health care
epidemiology
evidence-informed practice
incidence
mental health
mental illness
Nursing Interventions Classification (NIC)
Nursing Outcomes Classification (NOC)
prevalence
resilience
Objectives
1. Describe the two conceptualizations of mental health and mental illness.
2. Explore the role of resilience in the prevention of and recovery from mental illness, and
consider your own resilience in response to stress.
3. Identify how culture influences our view of mental illnesses and behaviours associated
with them.
4. Define and identify attributes of positive mental health.
5. Discuss the nature/nurture origins of psychiatric disorders.
6. Summarize the social determinants of health in Canada.
7. Explain how findings of epidemiological studies can be used to identify areas for medical
and nursing interventions.
STUDY NOTES
Chapter 01: Mental Health and Mental Illness
Thoughts About Teaching the Topic
The instructor will probably devote an hour or less to this material and will probably
emphasize (1) the mental health–mental illness continuum; (2) the mental health assessment,
using both the factors that influence mental health and the five criteria of mental health; and
(3) the importance of becoming conversant with the DSM-5.
The learning activities found on the Evolve Web site will assist students to operationalize
this general knowledge. Activities can be used in class or assigned as independent work.
Key Terms and Concepts
clinical epidemiology
co-morbid condition
Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5)
electronic health care
epidemiology
evidence-informed practice
incidence
mental health
mental illness
Nursing Interventions Classification (NIC)
Nursing Outcomes Classification (NOC)
prevalence
resilience
Objectives
1. Describe the two conceptualizations of mental health and mental illness.
2. Explore the role of resilience in the prevention of and recovery from mental illness, and
consider your own resilience in response to stress.
3. Identify how culture influences our view of mental illnesses and behaviours associated
with them.
4. Define and identify attributes of positive mental health.
5. Discuss the nature/nurture origins of psychiatric disorders.
6. Summarize the social determinants of health in Canada.
7. Explain how findings of epidemiological studies can be used to identify areas for medical
and nursing interventions.
STUDY NOTES
Varcarolis’s Canadian Psychiatric Mental Health Nursing
Chapter 01: Mental Health and Mental Illness
Thoughts About Teaching the Topic
The instructor will probably devote an hour or less to this material and will probably
emphasize (1) the mental health–mental illness continuum; (2) the mental health assessment,
using both the factors that influence mental health and the five criteria of mental health; and
(3) the importance of becoming conversant with the DSM-5.
The learning activities found on the Evolve Web site will assist students to operationalize
this general knowledge. Activities can be used in class or assigned as independent work.
Key Terms and Concepts
clinical epidemiology
co-morbid condition
Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5)
electronic health care
epidemiology
evidence-informed practice
incidence
mental health
mental illness
Nursing Interventions Classification (NIC)
Nursing Outcomes Classification (NOC)
prevalence
resilience
Objectives
1. Describe the two conceptualizations of mental health and mental illness.
2. Explore the role of resilience in the prevention of and recovery from mental illness, and
consider your own resilience in response to stress.
3. Identify how culture influences our view of mental illnesses and behaviours associated
with them.
4. Define and identify attributes of positive mental health.
5. Discuss the nature/nurture origins of psychiatric disorders.
6. Summarize the social determinants of health in Canada.
7. Explain how findings of epidemiological studies can be used to identify areas for medical
and nursing interventions.
STUDY NOTES
Chapter 01: Mental Health and Mental Illness
Thoughts About Teaching the Topic
The instructor will probably devote an hour or less to this material and will probably
emphasize (1) the mental health–mental illness continuum; (2) the mental health assessment,
using both the factors that influence mental health and the five criteria of mental health; and
(3) the importance of becoming conversant with the DSM-5.
The learning activities found on the Evolve Web site will assist students to operationalize
this general knowledge. Activities can be used in class or assigned as independent work.
Key Terms and Concepts
clinical epidemiology
co-morbid condition
Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5)
electronic health care
epidemiology
evidence-informed practice
incidence
mental health
mental illness
Nursing Interventions Classification (NIC)
Nursing Outcomes Classification (NOC)
prevalence
resilience
Objectives
1. Describe the two conceptualizations of mental health and mental illness.
2. Explore the role of resilience in the prevention of and recovery from mental illness, and
consider your own resilience in response to stress.
3. Identify how culture influences our view of mental illnesses and behaviours associated
with them.
4. Define and identify attributes of positive mental health.
5. Discuss the nature/nurture origins of psychiatric disorders.
6. Summarize the social determinants of health in Canada.
7. Explain how findings of epidemiological studies can be used to identify areas for medical
and nursing interventions.
STUDY NOTES
1-2
8. Identify how the DSM-5 can influence a clinician to consider a broad range of information
before making a diagnosis.
9. Describe the specialty of psychiatric mental health nursing.
10. Compare and contrast a DSM-5 medical diagnosis with a NANDA nursing diagnosis.
Chapter Outline Teaching Strategies
Mental Health and
Mental Illness
The validity of several concepts is explored, beginning
with the idea that mental illness is what a culture regards
as unacceptable and that mentally ill individuals are those
who violate social norms. This is shown to be an
inadequate definition by pointing out that political
dissidents are not necessarily mentally ill. Another
misconception to be discussed is that a healthy person
must be logical and rational, with the point being made
that each of us has irrational dreams and experiences
irrational emotions. All human behaviour lies somewhere
along a continuum of mental health and mental illness.
Mentally healthy persons are those who are in harmony
with themselves and their environment. Such individuals
may possess medical deviation or disease, as long as this
does not impair reasoning, judgement, intellectual
capacity, and the ability to make harmonious personal and
social adaptations. Instead of a definition of mental
health, traits possessed by the mentally healthy are
identified as happiness, control over behaviour, appraisal
of reality, effectiveness in work, and a healthy self-
concept. The misconception that mental illness is
incurable or treatment is unsuccessful is refuted by
contrasting people with cardiovascular disease with
people with mental illness.
Contributing Factors Many factors can affect the severity and progression of a
mental illness, as well as the mental health of a person
who does not have a mental illness (Figure 1-3). If
possible, these influences need to be evaluated and
factored into an individual’s plan of care.
Resilience Resilience is associated with adaptation and means that
rather than falling victim to negative emotions, resilient
people recognize their feelings, readily deal with them,
and learn from experience. Accessing and developing
resilience assists people to recover from painful
experiences and difficult events. It is characterized by
optimism and a sense of mastery and competence.
According to the Substance Abuse and Mental Health
Services Administration (SAMHSA) (2011), a recovery
process includes the following components: self-directed,
individual, empowering, holistic, nonlinear, strengths-
based, peer-supported, respect, responsibility, and hope.
8. Identify how the DSM-5 can influence a clinician to consider a broad range of information
before making a diagnosis.
9. Describe the specialty of psychiatric mental health nursing.
10. Compare and contrast a DSM-5 medical diagnosis with a NANDA nursing diagnosis.
Chapter Outline Teaching Strategies
Mental Health and
Mental Illness
The validity of several concepts is explored, beginning
with the idea that mental illness is what a culture regards
as unacceptable and that mentally ill individuals are those
who violate social norms. This is shown to be an
inadequate definition by pointing out that political
dissidents are not necessarily mentally ill. Another
misconception to be discussed is that a healthy person
must be logical and rational, with the point being made
that each of us has irrational dreams and experiences
irrational emotions. All human behaviour lies somewhere
along a continuum of mental health and mental illness.
Mentally healthy persons are those who are in harmony
with themselves and their environment. Such individuals
may possess medical deviation or disease, as long as this
does not impair reasoning, judgement, intellectual
capacity, and the ability to make harmonious personal and
social adaptations. Instead of a definition of mental
health, traits possessed by the mentally healthy are
identified as happiness, control over behaviour, appraisal
of reality, effectiveness in work, and a healthy self-
concept. The misconception that mental illness is
incurable or treatment is unsuccessful is refuted by
contrasting people with cardiovascular disease with
people with mental illness.
Contributing Factors Many factors can affect the severity and progression of a
mental illness, as well as the mental health of a person
who does not have a mental illness (Figure 1-3). If
possible, these influences need to be evaluated and
factored into an individual’s plan of care.
Resilience Resilience is associated with adaptation and means that
rather than falling victim to negative emotions, resilient
people recognize their feelings, readily deal with them,
and learn from experience. Accessing and developing
resilience assists people to recover from painful
experiences and difficult events. It is characterized by
optimism and a sense of mastery and competence.
According to the Substance Abuse and Mental Health
Services Administration (SAMHSA) (2011), a recovery
process includes the following components: self-directed,
individual, empowering, holistic, nonlinear, strengths-
based, peer-supported, respect, responsibility, and hope.
1-3
Culture In determining the mental health or mental illness of an
individual, we must consider the norms and influence of
culture. Cultures differ in their views of mental illness, the
meaning ascribed to experiences of health or illness, and
the behaviour categorized as mental illness. Although
some disorders such as bipolar disorder and schizophrenia
are found throughout the world, other syndromes are
culture bound (e.g., running amok, pibloktoq, and
anorexia nervosa). The DSM-5 provides information
about cultural variations for each of the clinical disorders,
a description of culture-bound syndromes, and an outline
of cultural formulations for evaluating and reporting the
impact of the individual’s cultural context.
Perceptions of Mental
Health and Mental
Illness
Mental Illness Versus
Physical Illness
A distinction between mental and physical illnesses is
often made. It frequently implies that psychiatric
disorders are all “in the head,” whereas the majority of
physical illnesses are considered to be beyond personal
responsibility.
Nature Versus Nurture The most prevalent and disabling mental disorders have
strong biological influences. Examples are schizophrenia,
bipolar disorder, major depression, obsessive-compulsive
and panic disorders, post-traumatic stress disorder, and
autism. Nurses are cautioned to remember that we do not
treat diseases; rather we care holistically for people.
Factors that affect a person’s mental health include
support systems, family influences, developmental events,
cultural or subcultural beliefs and values, health practices,
and negative influences impinging upon one’s life. Each
must be evaluated and factored into a plan of care. Figure
1-3 identifies some influences that can affect a person’s
mental health. Currently, the diathesis–stress model, in
which diathesis represents biological predisposition, and
stress represents the environmental aspect, is the most
accepted explanation for mental illness.
Culture In determining the mental health or mental illness of an
individual, we must consider the norms and influence of
culture. Cultures differ in their views of mental illness, the
meaning ascribed to experiences of health or illness, and
the behaviour categorized as mental illness. Although
some disorders such as bipolar disorder and schizophrenia
are found throughout the world, other syndromes are
culture bound (e.g., running amok, pibloktoq, and
anorexia nervosa). The DSM-5 provides information
about cultural variations for each of the clinical disorders,
a description of culture-bound syndromes, and an outline
of cultural formulations for evaluating and reporting the
impact of the individual’s cultural context.
Perceptions of Mental
Health and Mental
Illness
Mental Illness Versus
Physical Illness
A distinction between mental and physical illnesses is
often made. It frequently implies that psychiatric
disorders are all “in the head,” whereas the majority of
physical illnesses are considered to be beyond personal
responsibility.
Nature Versus Nurture The most prevalent and disabling mental disorders have
strong biological influences. Examples are schizophrenia,
bipolar disorder, major depression, obsessive-compulsive
and panic disorders, post-traumatic stress disorder, and
autism. Nurses are cautioned to remember that we do not
treat diseases; rather we care holistically for people.
Factors that affect a person’s mental health include
support systems, family influences, developmental events,
cultural or subcultural beliefs and values, health practices,
and negative influences impinging upon one’s life. Each
must be evaluated and factored into a plan of care. Figure
1-3 identifies some influences that can affect a person’s
mental health. Currently, the diathesis–stress model, in
which diathesis represents biological predisposition, and
stress represents the environmental aspect, is the most
accepted explanation for mental illness.
1-4
Social Influences on
Mental Health Care
Self-Help Movement Groups of people with mental illnesses began to advocate
for their rights and the rights of others with mental illness;
they fight stigma, discrimination, and forced treatment.
Decade of the Brain The last decade of the 1900s was designated as the
Decade of the Brain” by then U.S. president George H.W.
Bush. The goal was to make legislators and the general
public aware of the advances that had been made in
neuroscience and brain research (Tandon, 2000).
Mental Health for
Canadians: Striking a
Balance
One of the first national reports, Mental Health for
Canadians: Striking a Balance (Epp, 1988), sought to
review mental health–related policies and programs.
Three challenges in mental health were identified at that
time: (1) reducing inequities, (2) increasing prevention,
and (3) enhancing coping. These challenges continue, and
the more recent Mental Health Commission of Canada
strategy (2012) identified similar challenges: (1)
promoting mental health across the lifespan; (2) fostering
recovery and well-being for people while upholding their
rights; (3) providing timely access to treatment and
supports; (4) reducing disparities; (5) recognizing the
distinct circumstances, rights, and cultures in addressing
mental health needs of individuals and communities; and
(6) ensuring effective leadership and collaboration across
sectors, agencies, and communities.
Human Genome Project This project lasted from 1990 to 2003 and strengthened
biological and genetic explanations for psychiatric
conditions (Cohen, 2000). Although researchers have
begun to identify strong genetic links to mental illness (as
you will see in the chapters on clinical disorders), it will
be some time before we understand the exact nature of
genetic influences on mental illness.
Changing Directions,
Changing Lives: The
Mental Health Strategy
for Canada
The Mental Health Commission of Canada released a
report titled Toward Recovery & Well-Being: A
Framework for a Mental Health Strategy for Canada in
2009. Up to this time, Canada did not have a national plan
for the development of a mental health strategy. This put
forward the vision and broad goals for the strategy that
was released in 2012: Changing Directions, Changing
Lives: The Mental Health Strategy for Canada.
The aim of the strategy is to improve the mental health
and well-being for all Canadians. Six key strategic
directions (see Box 1-2) were outlined in the report.
Epidemiology of Mental
Disorders
The epidemiology of mental disorders may be defined as
the quantitative study of the distribution of mental
disorders in human populations. Epidemiologists can
identify high-risk groups and high-risk factors associated
Social Influences on
Mental Health Care
Self-Help Movement Groups of people with mental illnesses began to advocate
for their rights and the rights of others with mental illness;
they fight stigma, discrimination, and forced treatment.
Decade of the Brain The last decade of the 1900s was designated as the
Decade of the Brain” by then U.S. president George H.W.
Bush. The goal was to make legislators and the general
public aware of the advances that had been made in
neuroscience and brain research (Tandon, 2000).
Mental Health for
Canadians: Striking a
Balance
One of the first national reports, Mental Health for
Canadians: Striking a Balance (Epp, 1988), sought to
review mental health–related policies and programs.
Three challenges in mental health were identified at that
time: (1) reducing inequities, (2) increasing prevention,
and (3) enhancing coping. These challenges continue, and
the more recent Mental Health Commission of Canada
strategy (2012) identified similar challenges: (1)
promoting mental health across the lifespan; (2) fostering
recovery and well-being for people while upholding their
rights; (3) providing timely access to treatment and
supports; (4) reducing disparities; (5) recognizing the
distinct circumstances, rights, and cultures in addressing
mental health needs of individuals and communities; and
(6) ensuring effective leadership and collaboration across
sectors, agencies, and communities.
Human Genome Project This project lasted from 1990 to 2003 and strengthened
biological and genetic explanations for psychiatric
conditions (Cohen, 2000). Although researchers have
begun to identify strong genetic links to mental illness (as
you will see in the chapters on clinical disorders), it will
be some time before we understand the exact nature of
genetic influences on mental illness.
Changing Directions,
Changing Lives: The
Mental Health Strategy
for Canada
The Mental Health Commission of Canada released a
report titled Toward Recovery & Well-Being: A
Framework for a Mental Health Strategy for Canada in
2009. Up to this time, Canada did not have a national plan
for the development of a mental health strategy. This put
forward the vision and broad goals for the strategy that
was released in 2012: Changing Directions, Changing
Lives: The Mental Health Strategy for Canada.
The aim of the strategy is to improve the mental health
and well-being for all Canadians. Six key strategic
directions (see Box 1-2) were outlined in the report.
Epidemiology of Mental
Disorders
The epidemiology of mental disorders may be defined as
the quantitative study of the distribution of mental
disorders in human populations. Epidemiologists can
identify high-risk groups and high-risk factors associated
1-5
with illness onset, duration, and recurrence. The further
study of risk factors for mental illness may then lead to
important clues about the causes of various mental
disorders. Incidence—the number of new cases of mental
disorders in a healthy population within a given
period—and prevalence—the total number of cases, new
and existing, in a given population during a specific
period of time, regardless of when the subjects became
ill—provide information that can be used to improve
clinical practice and plan public-health policies.
Applications of
Epidemiology
Clinical epidemiology is briefly explained as a broad field
that addresses what happens to people with illnesses once
they are seen by providers of clinical care.
Classification of Mental
Disorders
Presently there are two major classification systems for
mental disorders in Canada: the Diagnostic and Statistical
Manual of Mental Disorders (DSM-5) and the
International Statistical Classification of Diseases and
Related Health Problems, tenth revision (ICD-10-CA)
(WHO, 2011).
DSM-5 In the DSM-5, each of the over 350 mental disorders is
conceptualized as a clinically significant behavioural or
psychological syndrome or pattern that occurs in an
individual and is associated with present distress or
disability or with a significantly increased risk of
suffering death, pain, disability, or an important loss of
freedom. DSM-5 supports accurate diagnostic assessment
by providing information about culturally diverse
populations.
ICD-10-CA This document helps to identify epidemiological trends
among populations in an effort to report and manage the
global burden of disease.
What is Psychiatric
Mental Health Nursing?
Psychiatric mental health nurses work with knowledge,
skill and compassion alongside people throughout the
lifespan. They assist healthy people who are in crisis or
who are experiencing life problems, as well as those with
long-term mental illness. Their patients may include
people with concurrent disorders (e.g., a mental disorder
and a coexisting substance disorder), homeless people and
families, people in jail, individuals who have survived
abusive situations, and people in crisis. Psychiatric mental
health nurses work with individuals, couples, families,
and groups in every nursing setting: in hospitals, in
patients’ homes, in halfway houses, in shelters, in clinics,
in storefronts, on the street—virtually everywhere.
Nursing
Classifications/NIC/NOC
The Nursing Interventions Classification (NIC) is a tool
used to standardize, define, and measure nursing care. The
Nursing Outcomes Classification (NOC) is a reference
with illness onset, duration, and recurrence. The further
study of risk factors for mental illness may then lead to
important clues about the causes of various mental
disorders. Incidence—the number of new cases of mental
disorders in a healthy population within a given
period—and prevalence—the total number of cases, new
and existing, in a given population during a specific
period of time, regardless of when the subjects became
ill—provide information that can be used to improve
clinical practice and plan public-health policies.
Applications of
Epidemiology
Clinical epidemiology is briefly explained as a broad field
that addresses what happens to people with illnesses once
they are seen by providers of clinical care.
Classification of Mental
Disorders
Presently there are two major classification systems for
mental disorders in Canada: the Diagnostic and Statistical
Manual of Mental Disorders (DSM-5) and the
International Statistical Classification of Diseases and
Related Health Problems, tenth revision (ICD-10-CA)
(WHO, 2011).
DSM-5 In the DSM-5, each of the over 350 mental disorders is
conceptualized as a clinically significant behavioural or
psychological syndrome or pattern that occurs in an
individual and is associated with present distress or
disability or with a significantly increased risk of
suffering death, pain, disability, or an important loss of
freedom. DSM-5 supports accurate diagnostic assessment
by providing information about culturally diverse
populations.
ICD-10-CA This document helps to identify epidemiological trends
among populations in an effort to report and manage the
global burden of disease.
What is Psychiatric
Mental Health Nursing?
Psychiatric mental health nurses work with knowledge,
skill and compassion alongside people throughout the
lifespan. They assist healthy people who are in crisis or
who are experiencing life problems, as well as those with
long-term mental illness. Their patients may include
people with concurrent disorders (e.g., a mental disorder
and a coexisting substance disorder), homeless people and
families, people in jail, individuals who have survived
abusive situations, and people in crisis. Psychiatric mental
health nurses work with individuals, couples, families,
and groups in every nursing setting: in hospitals, in
patients’ homes, in halfway houses, in shelters, in clinics,
in storefronts, on the street—virtually everywhere.
Nursing
Classifications/NIC/NOC
The Nursing Interventions Classification (NIC) is a tool
used to standardize, define, and measure nursing care. The
Nursing Outcomes Classification (NOC) is a reference
Loading page 6...
1-6
that provides standardized outcomes, definitions, and
measures to describe patient outcomes influenced by
nursing practice (Moorhead, 2008, p. 15).
Evidence-Informed
Practice
The nursing diagnosis classification systems form a
foundation for the novice or experienced nurse to
participate in evidence-informed practice— that is, care
based on the collection, interpretation, and integration of
valid, important, and applicable patient-reported,
clinician-observed, and research-derived evidence.
Levels of Psychiatric
Mental Health Clinical
Nursing Practice
Levels of psychiatric mental health nursing clinical
practice are differentiated by educational preparation,
professional experience, and certification.
Basic Level A psychiatric mental health registered nurse holds a
diploma or baccalaureate degree in nursing or psychiatric
nursing and may become certified. Certification
demonstrates that the nurse has met the profession’s
standards of knowledge and experience in the specialty.
Advanced Practice An advanced-practice registered nurse–psychiatric mental
health (APRN-PMH) will have preparation at the master’s
degree or higher level in psychiatric nursing and will have
the designation clinical nurse specialist or nurse
practitioner.
Future Challenges and
Roles for Psychiatric
Mental Health Nurses
Future trends for psychiatric nursing indicate the need to
strengthen current roles and develop novel approaches to
patient care. Key trends will affect the future of
psychiatric nursing: the aging of the population,
increasing cultural diversity, ever-expanding technology,
and advocacy for broader social determinants of mental
health.
The growing number of older Canadians with
Alzheimer’s disease and other dementias will require
increased skilled nursing care in institutions. Healthier
older adults will need services at home, in retirement
communities, or in assisted-living facilities.
Cultural diversity is steadily increasing in Canada. Recent
immigrants represent about 16% of Canada’s population
(Ali, 2002).
These new Canadians add to and form an important part
of our social, cultural, and economic institutions. Going
forward, psychiatric mental health nurses will need to
increase their cultural competence—that is, their
relational practice and awareness of the unique
experiences and views of their patients regarding mental
health, illness, and response to treatment.
that provides standardized outcomes, definitions, and
measures to describe patient outcomes influenced by
nursing practice (Moorhead, 2008, p. 15).
Evidence-Informed
Practice
The nursing diagnosis classification systems form a
foundation for the novice or experienced nurse to
participate in evidence-informed practice— that is, care
based on the collection, interpretation, and integration of
valid, important, and applicable patient-reported,
clinician-observed, and research-derived evidence.
Levels of Psychiatric
Mental Health Clinical
Nursing Practice
Levels of psychiatric mental health nursing clinical
practice are differentiated by educational preparation,
professional experience, and certification.
Basic Level A psychiatric mental health registered nurse holds a
diploma or baccalaureate degree in nursing or psychiatric
nursing and may become certified. Certification
demonstrates that the nurse has met the profession’s
standards of knowledge and experience in the specialty.
Advanced Practice An advanced-practice registered nurse–psychiatric mental
health (APRN-PMH) will have preparation at the master’s
degree or higher level in psychiatric nursing and will have
the designation clinical nurse specialist or nurse
practitioner.
Future Challenges and
Roles for Psychiatric
Mental Health Nurses
Future trends for psychiatric nursing indicate the need to
strengthen current roles and develop novel approaches to
patient care. Key trends will affect the future of
psychiatric nursing: the aging of the population,
increasing cultural diversity, ever-expanding technology,
and advocacy for broader social determinants of mental
health.
The growing number of older Canadians with
Alzheimer’s disease and other dementias will require
increased skilled nursing care in institutions. Healthier
older adults will need services at home, in retirement
communities, or in assisted-living facilities.
Cultural diversity is steadily increasing in Canada. Recent
immigrants represent about 16% of Canada’s population
(Ali, 2002).
These new Canadians add to and form an important part
of our social, cultural, and economic institutions. Going
forward, psychiatric mental health nurses will need to
increase their cultural competence—that is, their
relational practice and awareness of the unique
experiences and views of their patients regarding mental
health, illness, and response to treatment.
Loading page 7...
1-7
Technology is also important in areas of the nurse’s
communication, patient care, and patient teaching. The
Internet and telehealth can provide individuals with health
lines to care from a totally new perspective. This will
mean that psychiatric nurses must remain current and
become more active in providing patient care in new and
innovative ways.
Psychiatric nurses will also need to remain current with
technological advances that can shape their practice.
There will be an increased need for nurses to understand
research and help promote and propose research areas that
addresses prevention of mental illness and early treatment
and intervention, as new methodologies become available.
Finally, the psychiatric nurse will have an advocacy role
in protecting the rights of patients with psychiatric
disabilities, particularly those rights that concern the
broader social determinants of health and mental health.
This role needs to continue to evolve. The nurse must be
vigilant about provincial or territorial and national
legislation affecting health care to identify potential
detrimental effects on the mentally ill.
We know that mental health care looks much different
today from how it looked a half century ago. We have
more and better services for more individuals, but we also
know that we still have individuals who do not receive
decent mental health care. As concerned professionals, we
need to continue to make required improvements toward
the goal of serving those who are in need of mental health
care in local, rural, and remote geographical areas.
Technology is also important in areas of the nurse’s
communication, patient care, and patient teaching. The
Internet and telehealth can provide individuals with health
lines to care from a totally new perspective. This will
mean that psychiatric nurses must remain current and
become more active in providing patient care in new and
innovative ways.
Psychiatric nurses will also need to remain current with
technological advances that can shape their practice.
There will be an increased need for nurses to understand
research and help promote and propose research areas that
addresses prevention of mental illness and early treatment
and intervention, as new methodologies become available.
Finally, the psychiatric nurse will have an advocacy role
in protecting the rights of patients with psychiatric
disabilities, particularly those rights that concern the
broader social determinants of health and mental health.
This role needs to continue to evolve. The nurse must be
vigilant about provincial or territorial and national
legislation affecting health care to identify potential
detrimental effects on the mentally ill.
We know that mental health care looks much different
today from how it looked a half century ago. We have
more and better services for more individuals, but we also
know that we still have individuals who do not receive
decent mental health care. As concerned professionals, we
need to continue to make required improvements toward
the goal of serving those who are in need of mental health
care in local, rural, and remote geographical areas.
Loading page 8...
Varcarolis’s Canadian Psychiatric Mental Health Nursing
Chapter 02: Historical Overview of Psychiatric Mental Health Nursing
Thoughts About Teaching the Topic
The instructor will incorporate this historical overview in an introduction to a course as a
prereading and to set the context for topics to follow (e.g., ethics, therapeutic relationships,
care in acute and community settings, and so on). The learning activities found on the Evolve
Web site will assist students to operationalize this general knowledge. Activities can be used
in class or assigned as independent work.
Key Terms and Concepts
advanced-practice nursing (APN)
asylums
Canadian Federation of Mental Health Nurses
custodial care
deinstitutionalization
Dorothea Dix
moral treatment
Philippe Pinel
Registered Psychiatric Nurses of Canada
Weir Report
William Tuke
Objectives
1. Identify the sociopolitical, economic, cultural, and religious factors that influenced the
development of psychiatric mental health nursing.
2. Summarize the influence of psychiatric treatment trends on the role of the nurse.
3. Identify the factors that led to the separate designations of registered nurse and registered
psychiatric nurse.
4. Analyze the factors that have enhanced and delayed the professionalization of psychiatric
mental health nursing.
5. Consider the future potentials and challenges for psychiatric mental health nursing in
Canada.
Chapter Outline Teaching Strategies
Trends in approaches to the treatment of mental illness
have contributed to the emergence and evolution of the
role of psychiatric nursing. These trends stem largely
from societal values, politics, culture, and economics.
Early Mental Illness Care Early asylums were eighth-century Middle Eastern
Chapter 02: Historical Overview of Psychiatric Mental Health Nursing
Thoughts About Teaching the Topic
The instructor will incorporate this historical overview in an introduction to a course as a
prereading and to set the context for topics to follow (e.g., ethics, therapeutic relationships,
care in acute and community settings, and so on). The learning activities found on the Evolve
Web site will assist students to operationalize this general knowledge. Activities can be used
in class or assigned as independent work.
Key Terms and Concepts
advanced-practice nursing (APN)
asylums
Canadian Federation of Mental Health Nurses
custodial care
deinstitutionalization
Dorothea Dix
moral treatment
Philippe Pinel
Registered Psychiatric Nurses of Canada
Weir Report
William Tuke
Objectives
1. Identify the sociopolitical, economic, cultural, and religious factors that influenced the
development of psychiatric mental health nursing.
2. Summarize the influence of psychiatric treatment trends on the role of the nurse.
3. Identify the factors that led to the separate designations of registered nurse and registered
psychiatric nurse.
4. Analyze the factors that have enhanced and delayed the professionalization of psychiatric
mental health nursing.
5. Consider the future potentials and challenges for psychiatric mental health nursing in
Canada.
Chapter Outline Teaching Strategies
Trends in approaches to the treatment of mental illness
have contributed to the emergence and evolution of the
role of psychiatric nursing. These trends stem largely
from societal values, politics, culture, and economics.
Early Mental Illness Care Early asylums were eighth-century Middle Eastern
Loading page 9...
2-2
retreats from society, with the view that after several
months of rest, people with mental illness could be cured
(Weir, 1932). These early treatment centres, guided by
Islamic beliefs, provided a compassionate and peaceful
environment in which to care for people with mental
illnesses.
In medieval Western Europe, strong religious influences
inspired the belief that mental illness was the cause of
spiritual failings or sin, resulting in treatments that were
punitive. By the fifteenth century, several asylums had
been built across Europe, and patients were often chained
or caged, and cruelty or neglect was the norm (Digby,
1983).
In late-1700s France, more humane treatments were
developed—literally removing the chains of the patients,
talking to them, and providing a calmer, soothing
environment.
In England, similarly, the use of social and psychological
approaches emerged as “moral treatment” (Digby, 1983).
This revolutionary way of treating people with mental
illness swept across Europe and influenced the design of
early asylums in North America.
Early Canadian Mental
Health Care
Canada’s context draws on this history but is uniquely
influenced by the history, immigration patterns and the
land itself. Canada’s Aboriginal peoples had a variety of
holistic approaches to treating mental illness—treating
mind, body, and soul—and included sweat lodges, ani-
mistic charms, potlatch, and Sundance (Kirkmayer, Brass,
& Tait, 2000).
Sixteenth-century colonial settlers from France and
England brought their own approach, with responsibility
for care falling upon the family and religious orders, such
as the Grey Nuns, who provided early care in Canada
(Hardill, 2006).
By the 1800s, migration to Canada increased alongside
urbanization, and the European model of asylums was
established.
Early Canadian Asylums Asylums were built in country-like settings, providing
occupational therapies such as farming. Toward the end of
the nineteenth century, asylum care became more
acceptable, with family support systems becoming diluted
due to rapid urbanization (Cellard & Thifault, 2006). The
lack of success in treating mental illnesses, combined with
overcrowding in many asylums, meant that minimal—or
custodial—care was the norm.
retreats from society, with the view that after several
months of rest, people with mental illness could be cured
(Weir, 1932). These early treatment centres, guided by
Islamic beliefs, provided a compassionate and peaceful
environment in which to care for people with mental
illnesses.
In medieval Western Europe, strong religious influences
inspired the belief that mental illness was the cause of
spiritual failings or sin, resulting in treatments that were
punitive. By the fifteenth century, several asylums had
been built across Europe, and patients were often chained
or caged, and cruelty or neglect was the norm (Digby,
1983).
In late-1700s France, more humane treatments were
developed—literally removing the chains of the patients,
talking to them, and providing a calmer, soothing
environment.
In England, similarly, the use of social and psychological
approaches emerged as “moral treatment” (Digby, 1983).
This revolutionary way of treating people with mental
illness swept across Europe and influenced the design of
early asylums in North America.
Early Canadian Mental
Health Care
Canada’s context draws on this history but is uniquely
influenced by the history, immigration patterns and the
land itself. Canada’s Aboriginal peoples had a variety of
holistic approaches to treating mental illness—treating
mind, body, and soul—and included sweat lodges, ani-
mistic charms, potlatch, and Sundance (Kirkmayer, Brass,
& Tait, 2000).
Sixteenth-century colonial settlers from France and
England brought their own approach, with responsibility
for care falling upon the family and religious orders, such
as the Grey Nuns, who provided early care in Canada
(Hardill, 2006).
By the 1800s, migration to Canada increased alongside
urbanization, and the European model of asylums was
established.
Early Canadian Asylums Asylums were built in country-like settings, providing
occupational therapies such as farming. Toward the end of
the nineteenth century, asylum care became more
acceptable, with family support systems becoming diluted
due to rapid urbanization (Cellard & Thifault, 2006). The
lack of success in treating mental illnesses, combined with
overcrowding in many asylums, meant that minimal—or
custodial—care was the norm.
Loading page 10...
2-3
Many sought to reform these approaches, among them
Dorothea Dix, a retired school teacher from New England
who was the superintendent of nurses during the
American Civil War. Dix was educated in the asylum
reform movements in England while she was there
recuperating from tuberculosis. Passionate about social
reform, she began advocating for the improved treatment
and public care of people with mental illness.
Early Psychiatric
Treatments
By the end of the nineteenth century, the new field of
psychiatry sought medical cures for mental illness. With
few medications available other than heavily alcohol-
based sedatives, doctors used many experimental
treatments—for example, leeching (using bloodsucking
worms), spinning (tying the patient to a chair and
spinning it for hours), hydrotherapy (forced baths), and
insulin shock treatment (injections of large doses of
insulin to produce daily comas over several weeks).
By the mid-twentieth century, treatment choices expanded
to include electroconvulsive therapy (see Chapter 14) and
lobotomies, through which nerve fibres in the frontal lobe
were severed. With these more invasive treatments, more
patient monitoring beyond custodial care led to the
recruitment of nurses to work in these experimental
medical institutions.
Bringing Nurses to
Asylums
No nurses were working in Canadian psychiatric settings
prior to the late 1800s. Asylums used predominantly male
attendants to provide custodial care for patients. The
increased medicalization of psychiatry prompted a need
for more specially trained providers, especially for female
patients (Connor, 1996).
The first psychiatric institution in Canada offered a 2-year
diploma (to women only) in Kingston, Ontario, in 1888
(Kerrigan, 2011). The curriculum, which was taught by
physicians, included courses in physiology, anatomy,
nursing care of the sick, and nursing care of the insane
(Legislature of the Province of Ontario, 1889).
Shifts in Control Over
Nursing
In the early 1900s, the Canadian Nurses Association’s
(CNA) desires to professionalize nursing were
contentious, mostly because physicians wanted control
over nursing education; patriarchal society structures
devalued nursing knowledge; nursing skills were seen as
natural women’s work; and hospitals relied on the
economical service hours of nursing students (Anthony &
Landeen, 2009).
In 1932, a joint Canadian Medical Association and CNA
report—the “Weir Report ”—concluded that drastic
Many sought to reform these approaches, among them
Dorothea Dix, a retired school teacher from New England
who was the superintendent of nurses during the
American Civil War. Dix was educated in the asylum
reform movements in England while she was there
recuperating from tuberculosis. Passionate about social
reform, she began advocating for the improved treatment
and public care of people with mental illness.
Early Psychiatric
Treatments
By the end of the nineteenth century, the new field of
psychiatry sought medical cures for mental illness. With
few medications available other than heavily alcohol-
based sedatives, doctors used many experimental
treatments—for example, leeching (using bloodsucking
worms), spinning (tying the patient to a chair and
spinning it for hours), hydrotherapy (forced baths), and
insulin shock treatment (injections of large doses of
insulin to produce daily comas over several weeks).
By the mid-twentieth century, treatment choices expanded
to include electroconvulsive therapy (see Chapter 14) and
lobotomies, through which nerve fibres in the frontal lobe
were severed. With these more invasive treatments, more
patient monitoring beyond custodial care led to the
recruitment of nurses to work in these experimental
medical institutions.
Bringing Nurses to
Asylums
No nurses were working in Canadian psychiatric settings
prior to the late 1800s. Asylums used predominantly male
attendants to provide custodial care for patients. The
increased medicalization of psychiatry prompted a need
for more specially trained providers, especially for female
patients (Connor, 1996).
The first psychiatric institution in Canada offered a 2-year
diploma (to women only) in Kingston, Ontario, in 1888
(Kerrigan, 2011). The curriculum, which was taught by
physicians, included courses in physiology, anatomy,
nursing care of the sick, and nursing care of the insane
(Legislature of the Province of Ontario, 1889).
Shifts in Control Over
Nursing
In the early 1900s, the Canadian Nurses Association’s
(CNA) desires to professionalize nursing were
contentious, mostly because physicians wanted control
over nursing education; patriarchal society structures
devalued nursing knowledge; nursing skills were seen as
natural women’s work; and hospitals relied on the
economical service hours of nursing students (Anthony &
Landeen, 2009).
In 1932, a joint Canadian Medical Association and CNA
report—the “Weir Report ”—concluded that drastic
Loading page 11...
2-4
changes were needed in nursing education programs,
including standardization of curriculum, work hours,
instructor training, and that care of people with mental
illnesses needed to be integrated into all generalist
programs (Fleming, 1932). A split between Western and
Eastern Canada in training programs occurred, with the
western provinces creating the specialty-focused
psychiatric nursing training programs and the registered
psychiatric nurse designation separately, and the eastern
and Atlantic provinces offering a generalist training.
Deinstitutionalization
and the Role of
Psychiatric Nursing
Psychiatric nursing continued to take place predominantly
in hospital settings until the 1960s, when
deinstitutionalization shifted care into communities. Since
then, a wide range of community-based mental health
services eventually developed (e.g., crisis management,
consultation-liaison, primary care psychiatry), creating
new settings and skill requirements for psychiatric mental
health nurses.
University Education The first shift from hospital to university education
occurred in the 1930s, with the first degree offered at the
University of Toronto in 1942.
In Western Canada, the shift to the role of registered
psychiatric nurse, and the increased range of practice
settings into community settings brought about radical
changes in educational programs over the past 20 years.
Psychiatric nurse diploma training continued until 1995,
when Brandon University began its baccalaureate
program in psychiatric mental health nursing. Registered
Psychiatric Nurses of Canada (RPNC) issued a position
statement in 2008 advocating for baccalaureate degree
entry to practice for RPNs due to the increasingly
complex needs and roles of the registered psychiatric
nurse (Registered Psychiatric Nurses of Canada, 2008a).
Further, the first graduate program in psychiatric nursing
for registered psychiatric nurses began at Brandon
University in January 2011.
National Certification Since 1995, the Canadian Nurses Association has offered
registered nurses certification in psychiatric mental health
nursing; this certification exam is one of the most
commonly written (CNA, 2011b)
Advanced Practice Advanced-practice nursing (APN) includes the roles of
nurse practitioner and clinical nurse specialist (CNA,
2008). Each province has its own regulations guiding the
licensing and scope of practice for APN. The clinical
nurse specialist (CNS) role has been well established in
psychiatry since the 1970s. CNSs can provide
psychotherapy and have worked as consultants, educators,
and clinicians in inpatient and outpatient psychiatry
changes were needed in nursing education programs,
including standardization of curriculum, work hours,
instructor training, and that care of people with mental
illnesses needed to be integrated into all generalist
programs (Fleming, 1932). A split between Western and
Eastern Canada in training programs occurred, with the
western provinces creating the specialty-focused
psychiatric nursing training programs and the registered
psychiatric nurse designation separately, and the eastern
and Atlantic provinces offering a generalist training.
Deinstitutionalization
and the Role of
Psychiatric Nursing
Psychiatric nursing continued to take place predominantly
in hospital settings until the 1960s, when
deinstitutionalization shifted care into communities. Since
then, a wide range of community-based mental health
services eventually developed (e.g., crisis management,
consultation-liaison, primary care psychiatry), creating
new settings and skill requirements for psychiatric mental
health nurses.
University Education The first shift from hospital to university education
occurred in the 1930s, with the first degree offered at the
University of Toronto in 1942.
In Western Canada, the shift to the role of registered
psychiatric nurse, and the increased range of practice
settings into community settings brought about radical
changes in educational programs over the past 20 years.
Psychiatric nurse diploma training continued until 1995,
when Brandon University began its baccalaureate
program in psychiatric mental health nursing. Registered
Psychiatric Nurses of Canada (RPNC) issued a position
statement in 2008 advocating for baccalaureate degree
entry to practice for RPNs due to the increasingly
complex needs and roles of the registered psychiatric
nurse (Registered Psychiatric Nurses of Canada, 2008a).
Further, the first graduate program in psychiatric nursing
for registered psychiatric nurses began at Brandon
University in January 2011.
National Certification Since 1995, the Canadian Nurses Association has offered
registered nurses certification in psychiatric mental health
nursing; this certification exam is one of the most
commonly written (CNA, 2011b)
Advanced Practice Advanced-practice nursing (APN) includes the roles of
nurse practitioner and clinical nurse specialist (CNA,
2008). Each province has its own regulations guiding the
licensing and scope of practice for APN. The clinical
nurse specialist (CNS) role has been well established in
psychiatry since the 1970s. CNSs can provide
psychotherapy and have worked as consultants, educators,
and clinicians in inpatient and outpatient psychiatry
Loading page 12...
2-5
throughout Canada.
Nurse practitioners, on the other hand, work as
consultants or collaborative team members and can
diagnose, prescribe and manage medications, and can also
provide psychotherapy. While the role of psychiatric
nurse practitioner has been well established in the United
States, the role has remained virtually nonexistent in
Canada.
Future Directions Based on its success in the United States, the role of
advanced-practice nurse in psychiatric mental health care
is another one that is certain to develop in Canada in the
future. The changes in public perception of mental illness
and decreases in stigma are beginning to increase the role
of mental health promotion and illness prevention in
schools and workplace settings.
Evidence-informed approaches to treatment have led to
the creation of related nursing roles, education, and
research.
throughout Canada.
Nurse practitioners, on the other hand, work as
consultants or collaborative team members and can
diagnose, prescribe and manage medications, and can also
provide psychotherapy. While the role of psychiatric
nurse practitioner has been well established in the United
States, the role has remained virtually nonexistent in
Canada.
Future Directions Based on its success in the United States, the role of
advanced-practice nurse in psychiatric mental health care
is another one that is certain to develop in Canada in the
future. The changes in public perception of mental illness
and decreases in stigma are beginning to increase the role
of mental health promotion and illness prevention in
schools and workplace settings.
Evidence-informed approaches to treatment have led to
the creation of related nursing roles, education, and
research.
Loading page 13...
Varcarolis’s Canadian Psychiatric Mental Health Nursing
Chapter 03: Relevant Theories and Therapies for Nursing Practice
Thoughts About Teaching the Topic
When students have completed a growth and development course prior to the psychiatric
nursing course, a review of personality theories by reading may be sufficient. It’s wise,
however, to offer a self-paced activity or a match exercise and remind students that they are
responsible for the content, whether or not it is included in a lecture. The chapter’s
explanation of therapies is succinct, yet it is sufficient in detail to permit learners to grasp the
material. However, because learners have a limited frame of reference for therapies, most
would rather explore what those in the field think rather than discuss or debate among
themselves. Use of a film, followed by a discussion, may help learners grasp the basic
principles and concepts of therapy.
Key Terms and Concepts
automatic thoughts
behavioural therapy
biofeedback
classical conditioning
cognitive-behavioural therapy (CBT)
cognitive distortions
conditioning
conscious
counter-transference
defence mechanisms
ego
extinction
id
interpersonal psychotherapy
milieu therapy
negative reinforcement
operant conditioning
positive reinforcement
preconscious
psychodynamic therapy
punishment
reinforcement
superego
transference
Chapter 03: Relevant Theories and Therapies for Nursing Practice
Thoughts About Teaching the Topic
When students have completed a growth and development course prior to the psychiatric
nursing course, a review of personality theories by reading may be sufficient. It’s wise,
however, to offer a self-paced activity or a match exercise and remind students that they are
responsible for the content, whether or not it is included in a lecture. The chapter’s
explanation of therapies is succinct, yet it is sufficient in detail to permit learners to grasp the
material. However, because learners have a limited frame of reference for therapies, most
would rather explore what those in the field think rather than discuss or debate among
themselves. Use of a film, followed by a discussion, may help learners grasp the basic
principles and concepts of therapy.
Key Terms and Concepts
automatic thoughts
behavioural therapy
biofeedback
classical conditioning
cognitive-behavioural therapy (CBT)
cognitive distortions
conditioning
conscious
counter-transference
defence mechanisms
ego
extinction
id
interpersonal psychotherapy
milieu therapy
negative reinforcement
operant conditioning
positive reinforcement
preconscious
psychodynamic therapy
punishment
reinforcement
superego
transference
Loading page 14...
3-2
unconscious
Objectives
1. Evaluate the premises behind the various therapeutic models discussed in this chapter.
2. Describe the evolution of therapies for psychiatric disorders.
3. Identify ways each theorist has contributed to the nurse’s ability to assess a patient’s
behaviours.
4. Drawing on clinical experience, provide the following:
a. An example of how a patient’s irrational beliefs influenced behaviour
b. An example of counter-transference in your relationship with a patient
c. An example of the use of behaviour modification with a patient
5. Identify Peplau’s framework for the nurse–patient relationship.
6. Choose the therapeutic model that would be most useful for a particular patient or patient
problem.
Chapter Outline Teaching Strategies
Major Theories of
Personality
The contributions of Freud, Erikson, Sullivan, Peplau, and
Maslow are summarized.
Sigmund Freud’s
Psychoanalytic Theory
Through the use of talk therapy and free association, Freud
came to believe that there were three levels of psychological
awareness. He used the image of an iceberg to describe these
levels of awareness.
1. Conscious—the part of the mind he compared to the tip
of the iceberg. It contains all the material a person is
aware of at any one time, including perceptions,
memories, thoughts, fantasies, and feelings.
2. Preconscious—just below the surface of awareness
which contains material that can be retrieved rather
easily through conscious effort.
3. Unconscious—this includes all repressed memories,
passions, and unacceptable urges lying deep below the
surface. Emotions associated with trauma are often
“placed” in the unconscious because the individual
finds it too painful to deal with them. It is usually too
difficult to retrieve unconscious material without the
assistance of a trained therapist.
Personality structure is described as three categories of
experience:
1. Id—source of drives and instincts; includes genetic
inheritance; reflexes, wishes that motivate us; uses pleasure
principle, is not logical, and lacks the ability to problem
solve.
2. Ego—develops because the needs, wishes, and demands of
the id cannot be satisfactorily met through primary
processes and reflex action. The ego emerges in the fourth
or fifth month of life and follows the reality principle,
which says to the id, “You have to delay gratification for
unconscious
Objectives
1. Evaluate the premises behind the various therapeutic models discussed in this chapter.
2. Describe the evolution of therapies for psychiatric disorders.
3. Identify ways each theorist has contributed to the nurse’s ability to assess a patient’s
behaviours.
4. Drawing on clinical experience, provide the following:
a. An example of how a patient’s irrational beliefs influenced behaviour
b. An example of counter-transference in your relationship with a patient
c. An example of the use of behaviour modification with a patient
5. Identify Peplau’s framework for the nurse–patient relationship.
6. Choose the therapeutic model that would be most useful for a particular patient or patient
problem.
Chapter Outline Teaching Strategies
Major Theories of
Personality
The contributions of Freud, Erikson, Sullivan, Peplau, and
Maslow are summarized.
Sigmund Freud’s
Psychoanalytic Theory
Through the use of talk therapy and free association, Freud
came to believe that there were three levels of psychological
awareness. He used the image of an iceberg to describe these
levels of awareness.
1. Conscious—the part of the mind he compared to the tip
of the iceberg. It contains all the material a person is
aware of at any one time, including perceptions,
memories, thoughts, fantasies, and feelings.
2. Preconscious—just below the surface of awareness
which contains material that can be retrieved rather
easily through conscious effort.
3. Unconscious—this includes all repressed memories,
passions, and unacceptable urges lying deep below the
surface. Emotions associated with trauma are often
“placed” in the unconscious because the individual
finds it too painful to deal with them. It is usually too
difficult to retrieve unconscious material without the
assistance of a trained therapist.
Personality structure is described as three categories of
experience:
1. Id—source of drives and instincts; includes genetic
inheritance; reflexes, wishes that motivate us; uses pleasure
principle, is not logical, and lacks the ability to problem
solve.
2. Ego—develops because the needs, wishes, and demands of
the id cannot be satisfactorily met through primary
processes and reflex action. The ego emerges in the fourth
or fifth month of life and follows the reality principle,
which says to the id, “You have to delay gratification for
Loading page 15...
3-3
right now” and sets a course of action.
3. Superego—internal representative of values, ideals, and
moral standards of society; strives for perfection as
opposed to seeking pleasure or engaging reason. The
superego consists of the conscience (all the “should nots”
internalized from parents) and the ego ideal (all the
“shoulds” internalized from parents).
In a mature and well-adjusted individual, the three systems of
the personality work together as a team under the leadership of
the ego.
Freud suggested that ego defence mechanisms are developed
to reduce anxiety by denying, falsifying, or distorting reality to
prevent conscious awareness of threatening feelings. These
mechanisms operate unconsciously.
He further wrote that the individual proceeds through a series
of psychosexual stages of development from infancy to
adulthood. Each stage (except latency) refers to the bodily
zone that produces the main source of gratification during the
stage. Each stage has its own conflict to be resolved:
1. Oral—0 to 1 year: weaning
2. Anal—1 to 3 years: toilet training
3. Phallic—3 to 6 years: oedipal conflict
4. Latency—6 to 12 years: hides sexuality from disapproving
adults
5. Genital—12 to 20 years: genital sexuality
Classical Psychoanalysis Classical psychoanalysis, among the least practised therapies
and the most expensive, calls for protracted one-on-one
therapy with an analyst. It makes use of free association and
working through transference to uncover unconscious feelings
and thoughts that interfere with the patient’s life. The patient is
more active than the therapist.
Psychodynamic Therapy The psychodynamic approach to therapy “understands that
unconscious dynamics exist within normal human conscious-
ness and that it is possible in therapy to engage many aspects
of the human psyche in ways that are useful, creative, and
healing” (Canadian Association for Psychodynamic Therapy,
n.d., para. 2).
The best candidates for brief psychotherapy are relatively
healthy and well-functioning individuals, sometimes referred
to as the “worried well,” who have a clearly circumscribed
area of difficulty and are intelligent, psychologically minded,
and well motivated for change. Patients with psychosis, severe
depression, borderline personality disorders, and severe
character disorders often are not appropriate candidates for this
type of treatment. Supportive therapies, which are within the
scope of practice of the basic-level psychiatric nurse, are
useful for these patients. A variety of supportive therapies are
right now” and sets a course of action.
3. Superego—internal representative of values, ideals, and
moral standards of society; strives for perfection as
opposed to seeking pleasure or engaging reason. The
superego consists of the conscience (all the “should nots”
internalized from parents) and the ego ideal (all the
“shoulds” internalized from parents).
In a mature and well-adjusted individual, the three systems of
the personality work together as a team under the leadership of
the ego.
Freud suggested that ego defence mechanisms are developed
to reduce anxiety by denying, falsifying, or distorting reality to
prevent conscious awareness of threatening feelings. These
mechanisms operate unconsciously.
He further wrote that the individual proceeds through a series
of psychosexual stages of development from infancy to
adulthood. Each stage (except latency) refers to the bodily
zone that produces the main source of gratification during the
stage. Each stage has its own conflict to be resolved:
1. Oral—0 to 1 year: weaning
2. Anal—1 to 3 years: toilet training
3. Phallic—3 to 6 years: oedipal conflict
4. Latency—6 to 12 years: hides sexuality from disapproving
adults
5. Genital—12 to 20 years: genital sexuality
Classical Psychoanalysis Classical psychoanalysis, among the least practised therapies
and the most expensive, calls for protracted one-on-one
therapy with an analyst. It makes use of free association and
working through transference to uncover unconscious feelings
and thoughts that interfere with the patient’s life. The patient is
more active than the therapist.
Psychodynamic Therapy The psychodynamic approach to therapy “understands that
unconscious dynamics exist within normal human conscious-
ness and that it is possible in therapy to engage many aspects
of the human psyche in ways that are useful, creative, and
healing” (Canadian Association for Psychodynamic Therapy,
n.d., para. 2).
The best candidates for brief psychotherapy are relatively
healthy and well-functioning individuals, sometimes referred
to as the “worried well,” who have a clearly circumscribed
area of difficulty and are intelligent, psychologically minded,
and well motivated for change. Patients with psychosis, severe
depression, borderline personality disorders, and severe
character disorders often are not appropriate candidates for this
type of treatment. Supportive therapies, which are within the
scope of practice of the basic-level psychiatric nurse, are
useful for these patients. A variety of supportive therapies are
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Nursing