Sabtu, 19 Desember 2009

"An illness with psychological or behavioral impairment or Manifestations and infunctioning due to a social, psychologic, generic, physical/chemical, or biologic disturbance". (Stuard & Sundeen 1998)
Psychiatric Nursing is a interpersonal process that promotes and maintains behaviors that contribute to integrated functioning. The patient my be an individual, family, group, organization, or community. The three domains of psychiatric nursing practice are direct care, communication and management. (Stuart Sundeen’s & Laraia, Psyhiatric Nursing, 1998: 15)
Nursing the soul is the interpersonal process that seeks to improve and maintain the integrated function. Nursing the soul is a specialized field of nursing practice is to apply the theory of human behavior as their knowledge and use of therapeutic self as tricks (ANA).
According to WHO, mental health is not just a state does not occur problem soul, but contains many positive characteristics that describe spiritual harmony and balance that reflects the personality of the respective maturity. According to the Mental Health Act No. 3 In 1996, a mental health condition allows physical, intellectual, emotional optimally from someone and this development in harmony with others. Meanwhile, according to Yahoda, mental health is a dynamic touch-containing positive sense, which can be seen from the normality of behavior, the integrity of personality, a true recognition of the reality and not just an absence of disease and disorders and mental apartness.

1920-1945: Care focus on disease (Curative Care model)

1. Focus on clients, family members are not considered as part of the treatment team.
2. Restrains and Psychotropic replace Seclusion.
3. Deinstitutionalization started, they were not active participants in care and treatment of their own health.
4. Focus on the therapeutic relationship.
5. Focus on primary preventive.
6. Care provided in a psychiatric hospital is a large (private or government) that are usually located away from dense residential areas.
7. Old nurse a client is usually long enough.

Movement of Civil Rights (The Civil Rights) in the 1960’s was the catalyst to focus on the rights of people with mental disorders.
1. The Community Mental Health Centers Act (1963) dramatically affect mental health service delivery.
2. Law is what causes the focus and funding of care shifted from mental hospitals to large health centers community spirit that began many established and includes the following services:
a. Emergency care : assessment and provision of appropriate care and quick.
b. 24-hour inpatient care: hospital-based care for stabilitation symptoms (eg, short-term treatment).
c. Partial Hospitalitation: treatment programs for individuals who require daily care, but not the 24-hour care. Clients come for 6 to 8 hours every day and participated in various therapies (eg, group or individual therapy, social skills training).
d. Outpatient: assessment, psychotherapy, and medication management, clients come 1 to 2 hours every week.
e. Consultation and education: outreach programs to community groups that discuss topics of mental health, such as training for employers in helping their employees with alcohol problems.

1773: Custodial Care (not by health workers) is isolation.

1. Maintenance shifted from hospital care to the old long-term care that is shorter.
2. Focus on community-based care/service (community-based treatment).
3. Research & Technology.
4. The population of clients in a mental hospital a large decrease, and many hospitals are closed.
5. Center-community mental health centers are often not able to provide services due to the growing number of clients.
6. Homeless become a problem for people with chronic mental illness who experience persistent shortage of family resources and adequate social support.

1980 to 1990:
Health care costs are high and the cost limitations need to be a national focus.
1. Managed care systems, manage the relationship between payers, providers, and consumers of health services.
a. These systems monitor the distribution of services, provider actions, and results of treatment.
b. The purpose of this system is to reduce costs while still improving the quality of service.
c. The relationship between service providers and service users no longer be primary. Managers and health insurers to monitor the relationship between service providers and consumers of health services.

2. The types of managed care systems include:
a. Health maintenance organizations (HMOs), offering funds previously set for the client in a particular population as a payment for health care providers for a given period of time.
b. Independent practice organizations, where groups of health care providers to contract with HMOs.
c. Selected Provider Organization (Preferred Provider Organizations [PPOI]), groups of service providers who have been approved certain HMOs to provide services to clients pupolation.

1882: Primary Consistend of Custodial Care

: Focus on preventive/community based services, using various primary preventive approaches; such as mental health centers, partical, hospital service, day care centers, home health and Hospice Care.

The changes are significant in mental health care.
1. Managed care and the structure connecting the new service.
a. Case management. A case manager assigned to coordinate services for individual clients and work with multidisciplinary teams.
b. Critical path and map maintenance. Management tools that show clinical organization, sequence and time of intervention provided by the treatment team to a disturbance is identified on the client.
c. Population-based community treatment. Giving and focusing primary prevention services (not just disease-based care); include identification of high-risk groups and counseling to prevent lifestyle to prevent disease.

2. Provide an alternative place of treatment within the least restrictive. Treatment and community-based treatment aimed at tertiary prevention, which is designed to reduce the severity of mental health problems and help someone to live with the highest possible capacity function.
Place for alternative medicine is as follows:
a. Mental health centers and community crisis center.
b. Psychiatric units of short-term inpatient care in community hospitals.
c. Hospitalitation partial and day-care programs.
d. Residential treatment program at the Halfway House, board-and-care homes, and nursing.
e. Mobile crisis units and halfway house for homeless.
f. Clubhouse programs provide transition services to improve community life independence.
g. Prison and care homes.

3. Americans with Disabilities Act (1990) help to ensure that people with disabilities, including people with mental disorders, may participate fully in economic activities and social communities.

4. Growth of the consumer movement
a. Organizations such as the National Alliance of Mentally III, remove the stigma of mental disorders and member of local community support for sufferers and their families disorder soul.
b. Organizations to lobby for increased research funding and treatment of mental disorders.

5. Knowledge of the structure and function of the brain
a. 1990s considered a "Decade of Brain" because of the rapid growth of knowledge about how the brain works.
b. Along with the progress of genetics, the knowledge has result reshape understanding of the causes and treatment of mental disorders.


1. Once considered a mental disorder at the time of possession.
Treatment: remove evil spirits.
2. Colonial Period before any hospital in Indonesia, housed mental patients in the Hospital Civil or Military Hospital in Jakarta, Semarang, and Surabaya, which is accommodated in general people with severe mental disorders.
3. July 1:
- 1882: The first hospital in Indonesia (Bogor)
- 1902: RSJ Lawang
- 1923: RSJ Magelang
- 1927: RSJ Sabang. This asylum is far from city. Nurse-patients are isolation & custody (Custodial care).
Stigma: the family distanced themselves from the patient
4. In this time only one type of psychiatric hospital, psychiatric ospital had a government.
5. In 1910 - began to try to avoid costodial care (guard) & restraints (binding).
6. In 1930 - began working on therapies such as working farms for people with mental disorders.
7. During World War II and Japanese occupation - Efforts to mental health not development.
8. Independent’s day - development in October 1947 the government established the Bureau of Affairs Mental Illness (not work properly).
In 1950 the government warned Mental Illness Affairs Bureau to promote the implementation of service.
9. In 1966 - PUPJ Directorate of Mental Health-Mental Health Act No. 3 years set by the government in 1966-The National Coordinating Patient Rehabilitation Mental Illness (BKR-RPM) with agencies outside the health sector.
10. In 1973 - PPDGJ I published in 1975 is integration with the Centers.
11. In 1970's: the private sector started to think about mental health issues.
12. Medicine knowlegde evolved soul-existence of sub-specialties such as medicine community spirit, Psychiatric Clinic, Medical Soul of Usila and Medical Soul of Justice -Every Sub-Directorate is led by 4 heads of national mental health Program divided into 3 sub-programs with the community decide on priorities for the Health Promotion
1. Sub Service Improvement Program:
- Focus Psychiatric
- Medical
- Care
- The emphasis on curative services (treatment) and rehabilitation

2. Sub-System Development Program, focuses on improving science and technology, continuing education, research administration and management, mental health information.

3. Sub-Program for Community Mental Health Establishment:
- Dissemination of knowledge
- Facilitation of private psychiatric hospital
- Licensing
- Stimulation of private hospital construction
- Work with overseas: ASEAN, ASOD, COD, WHO, AUSAID, etc..


Yosep, IYUS. 2007. Mental nursing. Bandung: PT Refika Aditama.

Padjadjaran University

Nursing Faculty of Padjadjaran