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 Waverly, Mass. 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 further.
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 Chap. 13). 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 the client’s
psychosocial needs and strengths. Mellow contends
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-andnow
to meet each person’s psychosocial needs (1986).
Both Peplau and Mellow substantially contributed to
the practice of psychiatric nursing.
In 1973, the division of psychiatric and mental
health practice of the American Nurses Association
developed standards of care, which it revised in 1982,
1994, and 2000. 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 what is safe and acceptable
practice and to assess the quality of care.
A two-part document, Statement on Psychiatric-
Mental Health Clinical Nursing Practice and Standards
of Psychiatric-Mental Health Clinical Nursing
Practice, was jointly published in 1994 and revised in
2000 by the American Nurses Association, the American
Psychiatric Nurses Association, the Association
of Child and Adolescent Nurses Association, and the
Society for Education and Research in Psychiatric-
Mental Health Nursing. This document outlines the
areas of concern and standards of care for today’s
psychiatric-mental health nurse. The phenomena
of concern describe the 12 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
and outline standards for professional performance:
quality of care, performance appraisal, education, collegiality,
ethics, collaboration, research, and resource
utilization (Box 1-3). Box 1-4 summarizes specific
areas of practice and specific interventions for both
basic and advanced nursing practice.
