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The U.S. Census Bureau (2010) reports that increasing numbers of U.S. residents trace their ancestry to African, Asian, Arab, or Hispanic origins. Nurses must be prepared to care for this culturally diverse population; preparation includes being aware of cultural differences that influence mental health and the treatment of mental illness. See Chapter 7 for a discussion on cultural differences.

Diversity is not limited to culture; the structure of families has changed as well. With a divorce rate of 50% in the United States, single parents head many families, and many blended families are created when divorced persons remarry. Twenty-five percent of households consist of a single person (U.S. Census Bureau, 2010), and many people live together without being married. Gay men and lesbians form partnerships, can marry in some states, and sometimes adopt children. The face of the family in the United States is varied, providing a challenge to nurses to provide sensitive, competent care.

PSYCHIATRIC NURSING PRACTICE In 1873, Linda Richards graduated from the New England Hospital for Women and Children in Boston. She went on to improve nursing care in psychiatric hospitals and organized educational programs in state mental hospitals in Illinois. Richards is called the first American psychiatric nurse; she believed that “the mentally sick should be at least as well cared for as the physically sick” (Doona, 1984).

The first training of nurses to work with persons with mental illness was in 1882 at McLean Hospital in Belmont, Massachusetts. The care was primarily custodial and focused on nutrition, hygiene, and activity. Nurses


adapted medical–surgical principles to the care of clients with psychiatric disorders and treated them with tolerance and kindness. The role of psychiatric nurses expanded as somatic therapies for the treatment of mental disorders were developed. Treatments, such as insulin shock therapy (1935), psychosurgery (1936), and electroconvulsive therapy (1937), required nurses to use their medical–surgical skills more extensively.

The first psychiatric nursing textbook, Nursing Mental Diseases by Harriet Bailey, was published in 1920. In 1913, Johns Hopkins was the first school of nursing to include a course in psychiatric nursing in its curriculum. It was not until 1950 that the National League for Nursing, which accredits nursing programs, required schools to include an experience in psychiatric nursing.

Two early nursing theorists shaped psychiatric nursing practice: Hildegard Peplau and June Mellow. Peplau published Interpersonal Relations in Nursing in 1952 and Interpersonal Techniques: The Crux of Psychiatric Nursing in 1962. She described the therapeutic nurse–client relationship with its phases and tasks and wrote extensively about anxiety (see Chapter 14). The interpersonal dimension that was crucial to her beliefs forms the foundations of practice today.

Mellow’s 1968 work, Nursing Therapy, described her approach of focusing on clients’ psychosocial needs and strengths. Mellow (1986) contended that the nurse as therapist is particularly suited to working with those with severe mental illness in the context of daily activities, focusing on the here and now to meet each person’s psychosocial needs. Both Peplau and Mellow substantially contributed to the practice of psychiatric nursing.

The American Nurses Association (ANA) develops standards of care, which are revised as needed. Standards of care are authoritative statements by professional organizations that describe the responsibilities for which nurses are accountable. They are not legally binding unless they are incorporated into the state nurse practice act or state board rules and regulations. When legal problems or lawsuits arise, these professional standards are used to determine safe and acceptable practice and to assess the quality of care. The standards form the basis for specialty areas to write standards for practice.

The American Psychiatric Nurses Association (APNA) has Standards of practice and standards of professional performance. This document also outlines the areas of practice and phenomena of concern for today’s psychiatric–mental health nurse. The phenomena of concern describe the 13 areas of concern that mental health nurses focus on when caring for


clients (Box 1.2). The standards of care incorporate the phases of the nursing process, including specific types of interventions for nurses in psychiatric settings. They also outline standards for professional performance, quality of care, performance appraisal, education, collegiality, ethics, collaboration, research, and resource utilization (ANA, 2014). Box 1.3 summarizes specific areas of practice and specific interventions for both basic and advanced nursing practice.

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