The professional motive is the desire and perpetual effort to do the thing as well as it can be done,

which exists just as much in the Nurse, as in the Astronomer in search of a new star,
or in the Artist completing a picture.
- Florence Nightingale

1.2. American Nurses Association Standards of Practice for

Psychiatric Mental Health Nursing and DSM

Objectives:
At the end of the lecture discussion, the students shall be able to:
 Describe the nursing process and the challenges it presents for those working
with psychiatric patients.
 Analyze the conditions and behaviors of the psychiatric nurse for each of the
Standards of Practice.
 Describe how accountability and autonomy relate to the psychiatric nurse’s
professional role responsibilities.
 Analyze the conditions and behaviors of the psychiatric nurse for each of the
Standards of Professional Performance.
 Identify and how the Diagnostic and Statistical Manual, fourth edition, Text
Revision (DSM-IV-TR) Diagnostic and Statistical Manual, fifth edition (DSM-
5) is used for diagnosing psychiatric conditions.

Discussion:

By establishing a therapeutic nurse–patient relationship and using the nursing process, the
nurse promotes the patient’s mental health and well-being. This chapter discusses the Standards
of Care and the Standards of Professional Performance as described in Psychiatric–Mental
Health Nursing: Scope and Standards of Practice.
 The Standards of Practice describe what the psychiatric nurse does.
 The Standards of Professional Performance describe the context in which the
psychiatric nurse performs these activities.
Neither set of standards stands alone. Together they complete the picture of
contemporary psychiatric nursing practice.

STANDARD OF CARE
 -are authoritative statements by professional organizations that describe the
responsibilities for which nurses are accountable.
-when legal problems or lawsuits arise, these professional standards are used to determine
safe and acceptable practice and to assess the quality of care
-a two part document- statement of psychiatric-mental health clinical nursing practice and
Standards of psychiatric mental health clinical nursing practice.
-published in 1994 and revised in 2000 by the ANA,APNA,Assoc. of child and
adolescent psychiatric nurses, and the society for education and research in psychiatric-mental
health nurse.
- this document outlines the AREAS OF CONCERN AND STANDARDS OF CARE for
today’s psychiatric-mental health nurse
-

STANDARDS OF PSYCHIATRIC- MENTAL HEALTH CLINICAL NURSING

PRACTICE

 Standard 1. Assessment
The psychiatric–mental health registered nurse collects comprehensive
health data that is pertinent to the patient’s health of situation.

 Standard 2. Diagnosis
The psychiatric–mental health registered nurse analyzes the assessment
data to determine diagnoses of problems, including level of risk.

 Standard 3. Outcomes Identification

The psychiatric–mental health registered nurse identifies expected
outcomes for a plan individualized to the patient or the situation.

 Standard 4. Planning
The psychiatric–mental health registered nurse develops a plan that
prescribes strategies and alternatives to attain expected outcomes.

 Standard 5. Implementation

The psychiatric–mental health registered nurse implements the identified

plan.

Standard 5A. Coordination of Care

The psychiatric–mental health registered nurse coordinates care
delivery.
 Standard 5B. Health Teaching and Health Promotion
The psychiatric–mental health registered nurse employs strategies
to promote health and a safe environment.
Standard 5C. Milieu Therapy
The psychiatric–mental health registered nurse provides,
structures, and maintains a safe and therapeutic environment in
collaboration with patients, families, and other health-care
clinicians.
Standard 5D. Pharmacological, Biological, and Integrative Therapies
The psychiatric–mental health registered nurse incorporates
knowledge of pharmacological, biologic, and
complementary interventions with applied clinical skills to
restore the patient’s health and prevent further
disability.

Standard 5E. Prescriptive Authority and Treatment

The psychiatric–mental health advanced practice registered nurse
uses prescriptive authority, procedures, referrals,
treatments, and therapies in accordance with state and
federal laws and regulations.

Standard 5F. Psychotherapy

The psychiatric–mental health advanced practice registered nurse conducts
individual, couple, group, and family psychotherapy using evidence-based
psychotherapeutic frameworks and nurse–patient therapeutic relationships.
Standard 5G. Consultation
The psychiatric–mental health advanced practice registered nurse provides
consultation to influence the identified plan, enhance the abilities of other
clinicians to provide services for patients, and effect change.

 Standard 6. Evaluation
The psychiatric–mental health registered nurse evaluates progress toward
attainment of expected outcomes.

STANDARDS OF PROFESSIONAL PERFORMANCE

The conditions and behaviors related to each standard of professional performance are
shown in Figure below. The Standards of Professional Performance apply to self-definition, self-
regulation, accountability, and autonomy for practice by psychiatric nurses, both individually and
as a group.
STANDARDS OF PROFESSIONAL PERFORMANCE

 Standard 1. Quality of Practice

The psychiatric–mental health registered nurse systematically enhances the
quality and effectiveness of nursing practice.

 Standard 2. Education
The psychiatric–mental health registered nurse attains knowledge and competency
that reflect current nursing practice.

 Standard 3. Professional Practice Evaluation

The psychiatric–mental health registered nurse evaluates one’s own practice in
relation to the professional practice standards and guidelines, relevant
statues, rules, and regulations.

 Standard 4. Collegiality
The psychiatric–mental health registered nurse interacts with and contributes to
the professional development of peers and colleagues.

 Standard 5. Collaboration
The psychiatric–mental health registered nurse collaborates with patients, family,
and others in the conduct of nursing practice.

 Standard 6. Ethics
The psychiatric–mental health registered nurse integrates ethical provisions in all
areas of practice.
  Standard 7. Research
The psychiatric–mental health registered nurse integrates research findings into
practice.

 Standard 8. Resource Utilization

The psychiatric–mental health registered nurse considers factors related to safety,
effectiveness, cost, and impact on practice in the planning and delivery of
nursing services.

 Standard 9. Leadership
The psychiatric–mental health registered nurse provides leadership in the
professional practice setting and the profession.

THE DIAGNOSTIC AND STATISTICAL MANUAL (DSM)

 The Diagnostic and Statistical Manual (DSM) is a publication of the

American Psychiatric Association (APA).
 It is the official guideline for diagnosing psychiatric disorders.
 The DSM also serves as a tool for collecting epidemiological statistics
about

A Brief History
The APA first published a predecessor of DSM in 1844, as a statistical
classification of institutionalized mental patients. It was designed to improve
communication about the types of patients cared for in these hospitals. This forerunner to
DSM also was used as a component of the full U.S. census. After World War II, DSM
evolved through four major editions into a diagnostic classification system for
psychiatrists, other physicians, and other mental health professionals that described the
essential features of the full range of mental disorders. The current edition, DSM-5,
builds on the goal of its predecessors (most recently, DSM-IV-TR, or Text Revision, published
in 2000) of providing guidelines for diagnoses that can inform treatment and management
decisions.

 Diagnostic and Statistical Manual of Mental Disorders, fourth edition, Text

Revision IV-TR (DSM-IV-TR)
  In the medical model of psychiatry, the health problems are mental
disorders or mental illnesses that are classified in the DSM-IV-TR,
which describes the symptoms of mental disorders (APA, 2000).
 DSM-IV-TR, included a five-axis system whereby:
 Axis I - psychiatric diagnosis;
 Axis II - reserved for personality disorders;
 Axis III - identified general medical
conditions;
 Axis IV - environmental stressors, and;
 Axis V - provided a tool that measured global
functioning with a specific
number from 0 to 100.

 Diagnostic and Statistical Manual of Mental Disorders V (DSM-5)

 DSM-5, 2013 edition describes criteria for 157 disorders.
 The development of the DSM-5 was influenced by clinical field trials
conducted by psychiatrists, advanced practice psychiatric mental health
nurses, psychologists, licensed clinical social workers, licensed
counselors, and licensed marriage and family therapists.
 Organizes diagnoses for psychiatric disorders on a developmental
hierarchy.