Psychiatric and mental health nursing: theory and practice

Abstract

Contemporary psychiatric nursing has its recent history in the custodial model of care which caused the mentally ill to be isolated, frequently under lock and key, from the rest of the population. Such people were housed in psychiatric institutions, and provided with clothing, heat, food and other physical requirements. The main purpose of medical intervention was to separate patients from the rest of the community, to keep them in reasonably good physical health, and to provide physically based psychiatric treatment. Medical intervention was, for the most part, confined to making psychiatric diagnoses, the prescription of a small range of tranquillizers, and to other forms of physical treatment. For the most part, psychiatric nurses functioned in support of this isolate and tranquillize philosophy. Up until the 1940s and 1950s, one of the main attributes of a psychiatric nurse was adequate physical stature and strength. The main purpose of psychiatric nursing was to contain patients, keep them in reasonable physical health, and prevent patients from harming themselves, other patients, and staff. The custodial role of the nurse in these areas was of paramount importance, with the psychiatrist being the sole source of decision making, determining the type and focus of nursing care, and generally being responsible for all aspects of patient treatment. This relationship between doctor and nurse, with the former being responsible for and directing the activities of nursing staff, was little changed from that existing 100 years earlier when Connelly (1856, p. 37) wrote: ‘...all his [the physician’s] plans, all his care, all his personal labour, must be counteracted, if he has attendants [nurses] who will not observe his rules, when he is not in the ward, as conscientiously as when he is present.’