STANDARDS OF MENTAL HEALTH NURSING

PRACTICE

INTRODUCTIONTo provide qualitative care of psychiatric

patients and to fulfill professional obligation towards psychiatric care, in 1973, the Division of Psychiatric and Mental Health Nursing.

If the nurse is able to follow the standards of Mental Health Nursing by maintaining accurate records based on observation and they can be able to avoid intelligently in getting involved in personal issues.

For e.g., Client’s will related to property, giving wrong information related to client to his family or to other welfare/situational agency or to any type of assaults (physical or sexual assault).

If the nurse fails to follow the standards perfectly in her practice it will be referred to as, ‘NEGLIGENCE’.

DEFINITIONS1. Advanced practice registered nurse in

psychiatric-mental health (APRN-PMH) - A licensed registered nurse (RN), educationally prepared at least at the master's degree level in the specialty, whose graduate level preparation is distinguished by a depth of knowledge of advanced clinical nursing skills.

2. Brief therapy - Treatment that focuses on the resolution of a specific problem or behavior in a limited number of sessions.

3. Case management - An intervention in which health care is integrated, coordinated, and advocated for individuals, families, and groups who require services.

4. Crisis intervention – A short-term therapeutic process that focuses on the rapid resolution of an immediate crisis or emergency using available personnel, family, and/or environmental factors.

5. National Council of State Boards of Nursing -

A membership organization comprised of states’ boards of nursing that recommends practice guidelines and addresses practice issues.

6. Nurse Practice Act – State statute that defines the legal limits of practice for registered nurses.

7. Milieu therapy/therapeutic environment – A type of psychotherapy using the total environment to provide a therapeutic community.

8. Clinical Nurse Specialist(Nurse practitioner) – An advanced practice nurse (APRN) with Master’s degree in a specialty area of practice with specific competencies outlined in the scope and standards of practice for each specialty.

9. Autonomy- It implies self-determination, independence, and shared power. For psychiatric nursing, attaining autonomy means being able to exercise control over psychiatric nursing practice.

10. Accountability – It means to be answerable to someone for something. It focuses responsibility on the individual nurse for personal actions, or perhaps lack of actions.

11.Nursing practice standards – Authoritative statements that describe a level of care or performance, common to the profession of nursing, by which the quality of nursing can be judged. They include activities related to assessment, diagnosis, outcomes, planning, intervention, evaluation, ethics etc.

CATEGORIES OF STANDARDS OF MENTAL HEALTH NURSING

There are mainly two categories or types of mental health nursing standards: I. Professional Practice

StandardsII. Professional Performance

Standards

I. PROFESSIONAL PRACTICE

STANDARDS

1. THEORY

Theories were formulated based on scientific phenomena of concern to nurse and to provide basis for nursing interventions.

Hence nurse must apply appropriate theory which is scientifically based to take necessary decisions related to nursing practice.

2. ASSESSMENT/DATA COLLECTION

To adopt nursing process in a systemic way, assessment is the first step to carry out systematically to enable the nurse to draw sound conclusions in order to diagnose the client’s condition and to plan unnecessary interventions to improve clients condition by promoting their mental health.

The data will be gathered in a systemic manner factual, realistic, accurate, and relevant information related to psychology, psychiatry, psychological and biophysical sciences and essential for professional psychiatric nurses to assess the client’s condition.

Scientific techniques and various resources will be used to collect the data, e.g., clinical observation, interview, physical examination, health assessment and mental status examination etc.

2. ASSESSMENT

Nursing conditions

Self awarenessAccurate observationTherapeutic

communicationResponsive dimensions

of care

Nursing Behaviors→Establish nursing

contact→Obtain information

from patient and family→Validate date with

patient→Organize data

3. DIAGNOSIS Nurse will utilize the standard classification

of mental disorders to infer the conclusions supported by analyzing the recorded data, which has been assessed to determine the nursing diagnosis by following scientific investigation.

Nurse will identify the actual and potential health problems of the specified client within the scope of nursing practice, which will promote the nurse to plan for required nursing interventions on logical basis.

3. DIAGNOSIS

Nursing conditions Logical decision making Knowledge of normal

parameters Inductive and deductive

reasoning Socio-cultural sensitivity

Nursing behaviors→ Identify patterns in data→ Compare data with norms → Analyze and synthesize

data→ Problem and strengths

identified→ Validate problems with

patient→ Formulate nursing

diagnosis

4. OUTCOME IDENTIFICATION The clinical nurse has to plan individualized

holistic interventions by identifying expected outcomes through implementing nursing care activities to attain the fullest extent of their capabilities.

There are mainly 3 types of goals: Short term goal Long term goal Immediate goal

4. OUTCOME IDENTIFICATION

Nursing conditionsCritical thinking skillsPartnership with patient

and family

Nursing behaviors→Hypothesizing→Specific expected

outcomes →Validate goals with

patients

5. PLANNING The solving approach will be utilized in

developing nursing care plans. Nurse develops a plan of care with specific goals that prescribes interventions to attain expected outcomes, delineating nursing actions unique to each client’s needs. Nursing care plans is used to guide the therapeutic interventions which effectively achieves the described outcome.

5. PLANNING

Nursing conditionsApplication of theoryRespect for patient and

family

Nursing behaviors→Prioritize goals→Identify nursing

activities→Validate plan with

patient

6. IMPLEMENTATION OF THERAPEUTIC INTERVENTIONS

Nurse will assist the client in meeting their Activities of Daily Living (ADL) in a goal directed way, to promote self-care activities in order to achieve physical and psychological adequate well being of the individuals.

A combination of treatment modalities e.g., Psychotherapy along with drug therapy and comprehensive health services will be planned to relieve the clinical manifestations of mental illness.

Rehabilitative and Restorative services will be planned to achieve independence and to attain to normalcy. Consultation services are aimed to influence the client’s care plans and to bring effective change in the systems. Nurse are accountable for their services and practices, which has to be prepared adequately.

6. IMPLEMENTATION OF THERAPEUTIC INTERVENTIONS

Standard 6A. COORDINATION OF CARE• The psychiatric mental health registered nurse

coordinates care delivery.Standard 6B.HEALTH TEACHING AND HEALTH

PROMOTION • The psychiatric mental health registered nurse

employs strategies to promote health and a safe environment.

6. IMPLEMENTATION OF THERAPEUTIC INTERVENTIONS

Standard 6C. MILIEU THERAPY • The psychiatric mental health registered nurse

provides, structures, and maintains a safe and therapeutic environment in collaboration with the patients, families and other health care clinicians.

6. IMPLEMENTATION OF THERAPEUTIC INTERVENTIONS

Standard 6D. PHARMACOLOGICAL, BIOLOGICAL AND COMPLEMENTARY INTERVENTIONS

• The psychiatric-mental registered nurse uses knowledge of pharmacological, biological and complementary interventions and applies clinical skills to restore the patient’s health and prevent further disability.

6. IMPLEMENTATION OF THERAPEUTIC INTERVENTIONS

Standard 6E. PRESCRIPTIVE AUTHORITY AND TREATMENT

• The APRN-PMH prescribes or recommends, pharmacological agents for patients with mental health problems and psychiatric disorders based on individual characteristics, such as culture, ethnicity, gender, religious beliefs, age and physical health problems.

6. IMPLEMENTATION OF THERAPEUTIC INTERVENTIONS

Standard 6F. PSYCHOTHERAPY• The Psychiatric Mental Health Advanced

Practice Registered Nurse conducts individual, couples, group, and/or family psychotherapy using evidence-based psychotherapeutic frameworks, interpersonal transactions and nurse-patient therapeutic relationship.

6. IMPLEMENTATION OF THERAPEUTIC INTERVENTIONS

Standard 6G. CONSULTATION• The psychiatric mental health advanced

practice nurse provides consultation to influence the identified plan, enhance the abilities of other clinicians to provide services for patients and effect change.

6. IMPLEMENTATION

Nursing conditionsPast clinical experiencesKnowledge of researchResponsive and action

dimension of care

Nursing behaviors→Consider available

resources→Implement nursing

activities →Generate alternatives→Co-ordinate with other

team members

7. EVALUATION

Nurse has to evaluate their Nursing Activities by assessing the client’s responses and progress in attaining expected outcomes, revise the data bases, Nursing Diagnosis and the modified strategies in the form of Nursing Interventions.

Evaluation is a continuous, active process that begins early in the relationship and continues throughout.

7. EVALUATION

Nursing conditionsSupervisionSelf-analysisPeer reviewPatient and family

participation

Nursing behaviors→Compare patient’s

responses and expected outcome

→Review nursing process→Participate in quality

improvement activities

II. PROFESSIONAL PERFORMANCE

STANDARDS

1. QUALITY ASSURANCE BY PEER REVIEW

To evaluate quality of nursing care provided to the clients, nurses will participate in peer review discussions staff evaluation programmes and assurance process etc. to ensure the client’s prognosis and who receives qualitative care.

1. QUALITY ASSURANCE BY PEER REVIEW

Nursing conditionsPersonal and

professional integrityOpenness to inquiryCritical thinking skills

Nursing behaviors→Identify improvement

opportunities→Collect and analyze

relevant data→Formulate a planned

approach for improvement

→Implement suggested changes

2. EDUCATION

Nurse assumes the responsibility for professional development by updating their knowledge and contributes for professional growth by participating and organizing continuing and in-service education programmes.

2. EDUCATION

Nursing conditions Intellectual curiosityDesire for professional

growthAccess to new

information

Nursing behaviors→Seek out new

knowledge and learning experiences

→Apply new information in clinical practice

→Demonstrate increasing mastery of nursing

3. ETHICS

Nurse will maintain the personal and professional code of ethics in accordance with legal status and dedicates the qualitative activities to render nursing care activities.

3. ETHICS

Nursing conditionsAbility to engage in

introspectionSensitivity to social and

moral issuesCommitment to value

clarification process

Nursing behaviors→Guide practice by the

code for nurses→Practice with legal and

ethical responsibility→Act as patient and

family advocate

4. RESEARCH

Nurses are contributing to psychiatric nursing and mental health field by innovations theory and practice and participates in Research programmes communicates their research findings through publications. Implements innovative research strategies for improving the client’s condition.

4. RESEARCH

Nursing conditionsQuest for new

knowledge or answer to questions

Acute observational and analytical skills

Persistence and attention to detail

Nursing behaviors→Review reports of

nursing research→Generate questions and

identify clinical problems

→Implement research findings in practice

5. RESOURCE UTILIZATION

Nurses as a member of multidisciplinary team, co-ordinates with interdisciplinary health care professional and utilize varied resources for adopting nursing process to the client in-order to provide qualitative services.

5. RESOURCE UTILIZATION

Nursing conditionsKnowledge of political

and economic environment

Ability to evaluate costs and benefits of treatment

Skill in negotiating and accessing resources

Nursing behaviors→Fact-based decision

making→Cost-effective allocation

of resources→Patient advocacy on an

individual and collective basis

6. LEADERSHIP

Learning experiences are provided for other nursing personnel by adopting different leadership styles and fulfilling supervisory responsibilities.

6. LEADERSHIP

Nursing conditionsProfessional self-

efficacyCreativity, flexibility and

openness to changeCommitment to

improving the current system

Nursing behaviors→Professional

assertiveness→Thoughtful risk-taking→Teach and mentor

others→Participate in

organizational/system governance

7. PROFESSIONAL PRACTICE EVALUATION

The psychiatric mental health registered nurse evaluates his/her own practice in relation to the professional practice standards and guidelines, relevant statutes, rules, and regulations.

8. COLLEGIALITY

The psychiatric mental health registered nurse interacts with and contributes to the professional development of peers and colleagues.

9. COLLABORATION

The psychiatric mental health registered nurse collaborates with patients, family and others in the conduct of nursing practice.

ANY QUESTION

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THANK YOU. . . . .