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STANDARDS OF PSYCHAITRIC NURSING

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The practice of psychiatric nursing is regulated by law but guided by standards of care. Standards of care pertain to professional nursing activities that are demonstrated by the nurse through the nursing process.
ANA (2000)

STANDARDS OF CARE

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The ANA The APNA The ISPN

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The ANA, in collaboration with the American Psychiatric and the of Society Mental Nurses Association

International Psychiatric

Health

Nurses, has developed a set of standards that psychiatric nurses are expected to follow as they 4/4/12

STANDARD I: ASSESSMENT

The data:

psychiatric

mental

health

nurse collects patient health

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Assessment in mental health nursing is based on the collection of data from multiple sources, such as the

Client, Family and friends, Other health care providers, Past and current medical records
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and

Clinical skills

Interview Observation Psychosocial assessment Neuropsychiatric assessment Physical assessment

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Importance of Assessment

The assessment data provides the data base for clinical decision making: diagnosis, outcomes, interventions and evaluation.

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NURSING CONDITIONS AND BEHAVIOURS

Self awareness Accurate observations Therapeutic communication Responsive dimensions of care Establish nursing contracts Obtain information from patient and family Validate data with the patient 4/4/12

STANDARD II: DIAGNOSIS:

Psychiatric or mental health nurse analyses the assessment data in determining diagnoses:

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A nursing diagnosis is a clinical judgement about individual, family or community responses to actual or potential processes. (NANDA, 2003) health problems/life

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According to NANDA, the components of nursing diagnosis are

The label or name of diagnosis Its definition; the defining characteristics of the diagnosis

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Examples

Imbalanced than place pale body of

Nutrition:

less

requirements nutritional and food mucous

related to use of substance in evidenced by loss of weight, conjunctiva membranes, electrolyte

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Risk for self-directed Violence: risk factors may include depressed mood and feeling of worthlessness and hopelessness

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The defining characteristics are particularly helpful because they reflect the behaviours that are the target of nursing interventions.

They

also for

provide

specific the

indicators
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evaluating

NURSING CONDITIONS AND BEHAVIOURS

Logical decision making Knowledge of normal parameters Inductive and deductive reasoning Identify patterns in data Compare data with norms Analyse and synthesize data Identify problems and strengths Validate problems with patient
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STANDARD III: OUTCOME IDENTIFICATION

The psychiatric mental health nurse identifies expected outcomes individualized to patients

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An outcome is a statement of a desired, achievable behaviour or expression of feelings, to be attained within a predicted period of time , that is based on the clients current status and available resources.

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Specific rather than general

Outcomes should be:

Measurable rather than subjective Attainable rather than unrealistic. Current rather than outdated. Adequate in number rather than too few or too many.

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Mutual rather than one sided

Types of outcomes:

Outcome statements are generally divided into two categories

short term long term.

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Nursing diagnosis: Alteration in thought process related to depressive ideations. Unrealistic: client will verbalize enjoyment in completing a project within three days. Realistic: client will work on a project for at least 10 minutes in a

Example

Short term outcome:

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STANDARD IV: PLANNING:

The psychiatric mental health nurse develops a plan of care that prescribes interventions to attain expected outcomes.

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NURSING CONDITIONS AND BEHAVIOURS

Application of theory Respect for patient and family Prioritize goals Identify nursing activities Validate plan with patient

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The plan of nursing care must always be individualized for the patient. Planned interventions should be based on current knowledge in the field and contemporary clinical psychiatric mental health nursing practice. Planning is done in collaboration with the patient, family, and the health care team. Documentation of the plan of care is an essential nursing activity

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STANDARD V: IMPLEMENTATION

The

psychiatric

mental

health the in the

nurse plan of care

implements identified

interventions

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Nursing interventions should be implemented in a manner that recognizes the worth and dignity of people and considers the physical, emotional, social,

cultural and spiritual needs of your client and their families.

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Nursing conditions and behaviours

Past clinical experiences Knowledge of research Responsive and action dimensions of care

Consider available resources Implement nursing activities

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Standard Va: Counselling standard Vb: Milieu therapy Standard Vc: Promotion of self care activities

Standard

Vd:

Psycho

biological interventions

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Standard Ve: Health teaching

Advanced nursing practice

Standard Vh: Psychotherapy Standard Vi: Prescriptive

Authority And Treatment

Standard Vj: Consultation

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STANDARD VI: EVALUATION:

The

psychiatric evaluates

mental the

health clients

nurse

progress in attaining expected outcomes.

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The final step in the nursing process is evaluation. In this step, nurse client evaluate progress criteria, their and as own document the as well towards

outcome evaluate practice.

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clinical

Types of evaluation:

There

are

two

types

of

evaluation:

Formative evaluation Summative evaluation.

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Documentation:

Documentation

is

critical

component of nursing practice. The general rule is: if it is not documented, it has not occurred. All the steps of nursing process pertinent to the client
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must

be

documented

in

the

NURSING CONDITIONS AND BEHAVIOURS:

Self analysis Peer review Patient and family participation Compare the patient responses and the expected outcome. Review nursing process. Modify the needed. nursing process as

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Participate in quality improvement

STANDARD I: QUALITY OF CARE:

PROFESSIONAL PERFORMANCE STANDARDS

mental of of

The the

psychiatric quality

health and

nurse

systematically

evaluates care psychiatric

effectiveness

mental health nursing practice.

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Personal and professional integrity, Openness to inquiry Critical thinking skills Identify improvement opportunities

Nursing conditions and behaviours

Collect and identify improvement data Formulate planned approaches

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STANDARD II :PERFORMANCE APPRAISAL:

Psychiatric nurse

mental

health own

evaluates

ones

psychiatric

mental

health

nursing practice in relation to

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professional

practice

Performance appraisal for psychiatric nursing is generally provided in two ways: administrative clinical

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Nursing conditions and behaviours

Self awareness Acceptance of feedback from others

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STANDARD III: EDUCATION:

The psychiatric mental health nurse acquires and maintains current knowledge in nursing practice.

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Nursing conditions and behavior

Intellectual curiosity Desire for professional growth Access to new information. Seek out new knowledge and learning experience.

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Apply

new

information

in

clinical

STANDARD IV: COLLEGIALITY:

The

psychiatric interacts of

mental with peers, and

health and health as

nurse

contributes to the professional development care colleagues.

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clinicians

others

STANDARD V: ETHICS:

The

psychiatric

mental

health actions,

nurses

assessments,

and recommendations on behalf of patients are determined and implemented manner. in an ethical

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STANDARD VI: COLLABORATION:

The

psychiatric

mental

health the in

nurse health

collaborates care

with

patient, significant others and clinicians providing care.

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STANDARD VII: RESEARCH:

The

psychiatric

mental

health

nurse contribute to nursing and mental health through the use of research methods and findings.

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STANDARD VIII: RESOURCE UTILIZATION:

The

psychiatric

mental

health

nurse considers factors related to safety, effectiveness and cost in planning and delivering patient care.

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