Introduction to Psychiatric Nursing

  • "A specialty nursing practice focusing on the identification of mental health issues, prevention of mental health problems, and the care and treatment of persons with psychiatric disorders." - The American Psychiatric Nurses Association
  • The scope of psychiatric nurses may be in general psychiatry care and specialised areas like child-adolescent mental health nursing, geriatric-psychiatric nursing, forensics, or substance-abuse.
History of Psychiatric Nursing
  • In the 1840s, Florence Nightingale made an attempt to meet the needs of psychiatric patients with proper hygiene, better food, light and ventilation and the use of drugs to chemically restrain violent and aggressive patients. ( (Reddemma K & Nagarajaiah, 2004))
  •  Linda Richards, the first psychiatric nurse graduated in the United States in 1882 from Boston City College.
  • In 1913 Johns Hopkins University was the first college of nursing in the United States to offer psychiatric nursing as part of its general curriculum.
  • The first psychiatric nursing textbook,Nursing Mental Diseases was authored  by Harriet Bailey, in 1920.
  • The registration of psychiatric nurses was done by 1920 in the UK and degree courses in psychiatric nursing began in the USA.
  • Psychiatric nursing was included in the basic nursing curriculum by the International Council of Nurses in 1961.
  • In 1963, President John F. Kennedy in United States passed the Community Mental Health Act which proposed the deinstitutionalization of mentally ill persons.
History of Psychiatric Nursing
  • In fourth century AD, during the period of Emperor Ashoka, hospitals with 15 beds for mentally ill with two male and two female nurses. In1964-65 Psychiatric nursing was included in curriculum. (Reddemma K & Nagarajaiah, 2004)
  • For the first time in India, 11 British nurses along with one matron were brought from the UK to work in the mental hospital at Ranchi in the 1930s.
  • Short training courses of three to six months were conducted in Ranchi in 1921, which were recognized by the Royal Medical Psychological Association.
  • During 1948-50 four nurses were sent to the Govt. of India for mental health nursing diploma.
  • From 1943, the Chennai Government organised a three months’ psychiatric nursing course (subsequently stopped in 1964), for male nursing students at
    the Mental Hospital, Chennai (in lieu of midwifery).
  • During 1954 Manzil Medical Health centre, Lucknow gave psychiatric nursing orientation course of 4 - 6weeks duration.
  • Govt. of India decided to start training psychiatric nurses during 1953-54 and started the first organized course at All India Institute of Mental Health (presently NIMHANS).
  • In 1964–1965, the Indian Nursing Council (INC) made it a requirement to integrate psychiatric nursing in the nursing diploma and degree courses.
  • In 1967, a separate Psychiatric Nursing Committee was formed in the Trained Nurses Association of India.
  • Diploma in Psychiatric Nursing is conducted in three institutions in India.
  • Master of Psychiatric Nursing (MPN) programme is conducted in many institutions.
  • Doctoral programme in psychiatric nursing (Ph.D.) at NIMHANS, Bangalore.
Principles of Psychiatric Nursing
  • Allow client opportunity to set own pace in working with problems.
  • Nursing interventions should center on the client as a person, not on control of the symptoms. Symptoms are important, but not as important as the person having them.
  • Recognize your own feelings toward clients and deal with them.
  • Go to the client who needs help the most.
  • Do not allow a situation to develop or continue in which a client becomes the focus of attention in a negative manner.
  • If client behavior is bizarre, base your decision to intervene on whether the client is endangering self or others.
  • Ask for help—do not try to be a hero when dealing with a client who is out of control!
  • Avoid highly competitive activities, that is, having one winner and a room full of losers.
  • Make frequent contact with clients—it lets them know they are worth your time and effort.
  • Remember to assess the physical needs of your client.
  • Have patience! Move at the client’s pace and ability.
  • Suggesting, requesting, or asking works better than commanding.
  • Therapeutic thinking is not thinking about or for, but with the client.
  • Be honest so the client can rely on you.
  • Make reality interesting enough that the client prefers it to his or her fantasy.
  • Compliment, reassure, and model appropriate behavior.
Theories Applied in Psychiatric Nursing
  • Psychiatric nursing uses theories of human behavior as its scientific framework and requires the use of the self as its art or expression in nursing practice.
  • Some of the theories applied in psychiatric nursing are
    • Hildegard Peplau - Theory of interpersoanal relations
    • Psychoanalytic theory
    • Behaviorism
    • Jean Piaget: Theory of Cognitive Stages of Development
    • Humanistic Theories - Abraham Maslow, Carl Rogers
    • Existential Theories
    • Tidal model by Dr Phil Barker and Poppy Buchanan-Barker
Role of a Psychiatric Nurse
  • Providing a safe therapeutic milieu
  • Working with patients or clients on the real day-to-day problems they face
  • Identifying and caring for the physical aspects of the patient's problems
  • Assuming the role of social agent or parent for the patient in various recreational, occupational, and social situations
  • Conducting psychotherapy
  • Providing leadership and clinical assistance for other nurses and health care workers. 

Psychiatric Nursing Associations
  1. International Society of Psychiatric-Mental Health Nurses -
  2. Indian Society Of Psychiatric Nurses -
  3. Association of Child and Adolescent Psychiatric Nursing 
  4. Registered Psychiatric Nurses Association of Saskatchewan
Mental Health Laws
  1. India - The Mental Health Act
  2. Mental health law in England & Wales, including Mental Health Act 1983
  3. Tarasoff v. Regents of the University of California
  4. Mc 'Naghten Rules
  1. Reddemma K, Nagarajaiah. Psychiatric Nursing: The Perpetual Cinderella. In Mental Health: An Indian Perspective. Edited by S. P. Agarwal. Directorate General of Health Services Ministry of Health and Family Welfare New Delhi, 2004.
  2. Mosby's Medical Dictionary, 8th edition, 2009, Elsevier.


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