UNIT-1

PRINCIPLES AND STANDARDS OF

PSYCHIATRIC NURSING
INTRODUCTION

Psychiatric nursing is a specialized area in nursing field. It is a medical

speciality where the experts in the field of studies the abnormal behaviour of the
individuals, its causes, manifestations,treatment and rehabilitation and prevention of
mental illness.

DEFINITION

Psychiatric nursing is a “specialized area of nursing practice, combination of

science and arts by employing theories of human behaviour applied in the diagnosis
and treatment of human response to actual or potential mental health programme”.

It deals with-
 Promotion of mental health
 Prevention of mental illness
 Care of client with mental illness
 Cure of mental illness
 Rehabilitation of mentally ill patients

PRINCIPLES OF PSYCHIATRIC NURSING

Psychiatric mental health nursing is to provide highly individualized

comprehensive care. There are certain principles that apply to the care of all who
show behaviour disorder irrespective of the mental illness that they are suffering from
and or promotion of mental health. Prevention of mental illness and treatment and
rehabilitation of respective clients.

1. The nurse accepts the client as a human being who has value and worth
exactly as he is/ as he is:
It is based on belief that each individual is unique and has inherent value,
combined with the feeling of nurse’s appreciation of the client’s uniqueness and
inherent value. Acceptance conveys the feeling of being level cared. It helps the
client to relearn the art of living with him/ her and with others. Acceptance is
setting positive behaviour to convey him/ her respect as an individual human.
 Acceptance can be expressed in following:

1. Nurse should be non judgemental and non punitive.

Nurse should not judge client’s behaviour as right/ wrong, good

or bad. All the direct and indirect method of punishment must be
avoided. E.g. chaining, restraining

2. Nurse shows interest in the client as a person by

 Studying the clients behaviour patterns

 Making the client aware in a subtle manner that you (nurse) are
interested in him/ her.
 Seeking out a clients
 Making the client aware in a subtle manner that you ( nurses)
interested in him/ her.
 Using time spent with him/ her on those things he/ she is
interested in.
 Being aware of his/her demands cannot be met

3. Nurse should recognize and reflect on feelings which client/ client

may express

 Nurse act as a surrounding board for clients strong or

negative feelings. The nurse develops the skills in identifying the
feeling actually expressed by the clients
 Nurse should give more importance to understanding the
feeling behind the client conversation and not to the content when
the client talks.
4. Nurse talks with a client with a purpose

The conversation with a client must revolve around his/her needs,

wants and interest. It should be based on achieving the nursing goals and
or therapeutic goals. The client must get benefit of our talk. Nurse
should avoid evaluative, hostile, probing response which may help the
client to explore his or her feelings.

5. Active listening
 Nurses needs to listen attentively to what the client is saying. It is
an active process. Nurses should encourage client to talk through brief,
non directive comments, showing interest in what client is saying.

6. Permit client to express strongly held feelings.

It is better to permit the client to express his/her strong feelings

without disapproval or punishment. Expression of negative feeling may
be encouraged in verbal or symbolic manner. The nurse must make the
client as comfortable with his/her illness as possible.

2. Nurse ability to use herself/ himself as a therapeutic tool

 Self understanding leads to understanding of others. The ways of nurse
understanding herself/ himself better are as follows:
 Nurse should exchange personal experience freely and frankly with their
colleagues
 Nurses should discuss their personal reaction with experienced persons
or senior nurses in the field.
 Nurses should participate in group conference regarding their client
care

 Nurses should keep reflecting on why they feel or act the way they do.

3. Nurse should use self awareness and self disclosure when dealing with
clients
 They are the free energy that can be used more profitably and
give the persons an increasing degree of control over his/ her behaviour.
 The nurse should expand their self awareness by examining
their beliefs and feelings and must be combined together which in turn
provide the bases for those principles thus direct the nursing care.

4. The nurses view the client as a holistic being with a multiplicity of

interrelated and interdependent needs.

The human beings are complex system of interrelated parts, the whole of
which is greater than sum of its parts. She can be helpful to the client since she/ he
has expertise in many areas of nursing.
5. The nurses focuses on the clients strength and assets not on his/her
weakness and liabilities
These principles based on the belief that each individual has strength
and potential for growth and combined with feelings of hope, about the client’s
ability to grow.

6. The nurse has potential for establishing a relationship with most if not all
clients
This principle says that all human beings are similar in understanding
and communicating with each other

7. The nurse explores the client behaviour for the need, it is designed to meet
or the message it is communicating
This principle is based on that all behaviour are purposeful and designed
to meet a need or to communicate a message, combined with the nurses
feelings of curiosity about client even though they may not reciprocate his/ her
feelings, behaviour.

8. The nurse views the client behaviour non judgemental while assessing him/
her to learn more effective adaptations
This principle is based on the belief that behaviour is learned and is the
best possible adaptation in the individual is capable of making at the time
combined with the nurses feeling of caring about the client

9. The quality of nurse client interactions is a major determinant of the

degree to which the client will be able to alter his/her behavioural
adaptation in the directions of more satisfying, satisfactory interpersonal
relationship.
The principle is based on the belief that an individual learns behaviour
adaptations in interactions with significant others combined with nurse feelings
of competency in his/ her ability to interact therapeutically with the mentally ill
person.

10. Nurse should use consistent behaviour to contribute to the clients

emotional security
o Consistency is needed to develop a feeling in the client that he/
she can depend on the people working in the ward. Nurse should operate
consistency in the following manner
 o Patient to be constantly and continuously exposed to an
atmosphere of quiet acceptance
o Consistency to be maintained from nurse to nurse and shift to
which must be planned properly
o Permissiveness to be limited. Eg. With the client with homicidal,
suicidal.
o Limit and its reinforcement requires great deal of tact and
understanding and should be done on quiet and matter of fact way.

11. Nurses should give reassurance to the clients in a subtle and acceptable
manner
It is given for building up their confidence/ or restoring their confidence.

There are many ways to give reassurance like

1) Be truly interested in client problem

2) Be aware and accept how the client really feels
3) Allow him to be sick as he needs to be
4) Provide client with acceptable outlets of anxiety
12. Nurses attempt to change the client behaviour through experience and not
by rational interpretation
Psychiatric mental health nursing focus on the feeling aspect of the client
and not on the intellectual aspect. The client should not be advised or telling is not
effective because the client defensive behaviour against anxiety producing stress or
his belief is based on strong emotional needs. The more belief are challenged the
more client becomes defensive. Corrective emotional experience can bring about
behaviour change

13. Nurses should avoid unnecessary increase in clients anxiety

a) Nurses should understand what factors, situation, topics, or approaches
can increase anxiety. The examples of anxiety when it will be aggravated

b) Direct contradictions of client’s psychotic ideas

c) Demand on client which he previously cannot meet

d) Indiscriminate use of professional term

e) Insincerity

14. Nurses should demonstrate objective observations to understand and

interpret the meaning of the clients behaviour
Nurses need to observe what the client says or does these observation
need to be analyzed by nurses to seek its motivation and understand which
 he/she is trying to accomplish. The nurses improve the skills of observation by
continuous prediction of client behaviour. When the nurse wants to be
objective the only one way is to keep indulging in introspection. Maintain an
objective attitude and balance and live a balance life.

15. Nurse should maintain realistic nurse client relationship

It is an interpersonal process. It is for the purpose of bringing adaptive ness,
integration, and more maturity in the client’s personality. It focuses upon the
personal and emotional needs of the client and not on the nurses needs such as
relationship is therapeutically oriented and planned, is always based on client
needs. Nurse keeps analyzing the interaction between herself and the client to
prepare herself to guide the client toward mature behaviour.

16. Nurses, as much as possible, should avoid physical and verbal force.
1. Any kind of force applied on the client results in psychological trauma.
Restraining the violent client in the cot is an example of physical force. If the
force should be used the nurse should keep the following points in her mind.
2. Carry out the procedure quickly, firmly and efficiently with adequate help
3. Anger and annoyance not be shown
4. Never remind the client about incidence
5. Nursing team must have self control and understanding in carrying out the
procedure.

17. Nursing care centred on the client as a person nor on control of symptoms
Every behaviour is caused, understanding the meaning behind his
behaviour. His symptoms were on reflection of his problem. Two clients showing
the same symptoms may be expressing two different needs.

18. Nurse should explain routines and procedures at the client level of
understanding
Every client has right to know what is being done to him, and why it is
being done. Nurse’s explanation reduces the anxiety. The nature of explanation
depends on client’s span of attention, level of anxiety, level of understanding
and ability to decide.

19. Nurses should maintain the basic principles of nursing while following any
procedure.
In the field of psychiatric mental health nursing certain procedures may
be modified medications Eg; a client who is highly suspicious may refuse to
have oral tablets than the ingestion of medication can be modified to parentral
administration.
 The following principle of nursing will be followed

 Providing safety
 Providing comfort
 Providing individual care
 Maintaining economy of time, energy and material

STANDARDS OF PSYCHIATRIC NURSING PRACTICE

Professional practice standard

Standards of care pertain to professional nursing activities that are demonstrated by
the nurse through the nursing process. These involve assessment, diagnosis, out come
identification, planning, implementation and evaluation. The nursing process is the
foundation of clinical decision making and encompassing all significant action taken
by nurses in providing psychiatric- mental health care to all clients

Standard I Assessment

The psychiatric- mental health nurse collects client health data

Standard II Diagnosis

The psychiatric - mental health nurse analyses the assessment data in

determining diagnoses

Standard III Outcome identification

The psychiatric mental health nurse identifies outcomes individualized to the

client

Standard IV Planning

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

Standard V Implementation

The psychiatric- mental health nurse implements the interventions identified in

the plan of care

Standard V-A Counselling

The psychiatric mental health nurse uses counselling interventions to assist

clients improving or regaining their previous coping abilities, fostering mental health,
and preventing mental illness and disabilities
Standard V-B Milieu therapy

The psychiatric mental health nurse provides, structures, and maintains a

therapeutic environment in collaboration with the client and other health care
providers

Standard V-C Self- care activities

The psychiatric mental health nurse structures interventions around the client’s
activities of daily living to foster self care and mental and physical wellbeing

Standard V-D Psychobiologic interventions

The psychiatric mental health nurse uses knowledge of psychobiologic

interventions and applies clinical skills to restore client’s health and prevent further
disability

Standard V-E Health teaching

Through health teaching she, assist client in achieving satisfying, productive

and healthy patterns of living

Standard V-F Case management

She provides case management to coordinate comprehensive health services

and ensure continuity of care

Standard V-G Health promotion and maintenance

She employs strategies and interventions to promote and maintain mental health and
ensure continuity of care.

Advanced practice interventions V-H to V-J

The following interventions (V-H to V-J) may be performed only by the

certified specialist in psychiatric- mental health nursing.

Standard V-H Psychotherapy

The certified nurse in psychiatric mental health nursing uses individual, group
and family psychotherapy, and other therapeutic treatments to assist clients in
fostering mental health, and improving or regaining previous health status and
functional abilities.
Standard V-I prescription of pharmacological agents

The certified specialist uses prescription of pharmacological agents in

accordance with the state nursing practice act, to treat symptoms of psychiatric illness
and improve functional health status.

Standard V-J Consultation

The certified specialist provides consultation to health care providers and

others to influence the plan of care for clients, and to enhance the abilities of others to
provide psychiatric and mental health care and affect change in system.

Standard VI Evaluation

She evaluates the client’s progress in attaining expected outcomes.

Standards of professional performance:

It describes a competent level of behaviour in the professional role, including

activities related to quality of care, performance appraisal, education, collegiality,
ethics, collaboration, research, and resource utilization. All the psychiatric mental
health nurses are expected to engage in professional role activities appropriate to their
education, position and practice setting.

The nurses should be self directed and purposeful in seeking necessary

knowledge and skills to enhance career goals. Other activities such as membership in
professional organization, certification in speciality or advanced practice, continuing
education and further academic education are desirable methods of enhancing the
psychiatric mental health nurses professionalism.

Standard I Quality of care

The psychiatric mental health nurse systematically evaluates the quality of care
and effectiveness of psychiatric mental health nursing practice
Standard II Performance appraisal

The psychiatric mental health nurse evaluates his or her own psychiatric mental
health nursing practice in relation to professional practice standards and relevant
statutes and regulations.

Standard III Education

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

Standard VI Collaboration

The psychiatric mental health nursing collaborates with the client, significant
others and health care providers in providing care

Standard VII Research

The psychiatric mental health nurse contributes to nursing and mental health
through the use of research

Standard IV Collegiality

The psychiatric mental health nurse contributes to the professional

development of peers, colleagues and others

CONCLUSION

Psychiatric nurses provide holistic care to the client with emphasis on the
psychological component, which is the core value of nursing care. In order to provide
essential nursing care nurses should have a thorough knowledge regarding the
principles and standards of psychiatric nursing care.

JOURNAL ABSTRACT

A Journal published by the registered Canadian nurses in 2010 mentioned that

there are mainly 4 standards of psychiatric nursing practice.
They are
STANDARD 1: THERAPEUTIC INTERPERSONAL RELATIONSHIPS

Registered Psychiatric Nurses establish professional, interpersonal, and

Therapeutic relationships with individual, groups, families, and communities.

STANDARD 2: APPLICATION AND INTEGRATION OF THEORY-BASED

KNOWLEDGE

Registered Psychiatric Nurses apply and integrate theory-based knowledge

relevant to professional practice derived from psychiatric nursing education
and continued life-long learning.

STANDARD 3: PROFESSIONAL RESPONSIBILITY

Registered Psychiatric Nurses are accountable to the public for safe,

competent, and ethical psychiatric nursing practice.

STANDARD 4: PROFESSIONAL ETHICS

Registered Psychiatric Nurses understand, promote, and uphold the ethical

Values of the profession.

BIBLIOGRAPHY

1) K. Lalitha. Mental Health and Psychiatric Nursing, 1st edition, Bangalore:

V.M.G. Book House, 2007, 269-276.
2) R.Sreevani. A Guide To Mental Health And Psychiatric Nursing. 1st edition,
New Delhi: Jaypee publishers, 2004, 135-138.
3) Bimla Kapoor. Text Book Of Psychiatric Nursing. 1st edition, New Delhi:
Kumar publishing house, 2004, 113-130.
4) K P Neeraja. Essentials of mental health and psychiatric nursing. first
edition,jaypee publishers, volume no.1
5) Journal of Canadian nurses association, standards of psychiatric nursing