Practical Standard Of Psychiatric Nursing

Practical Standard of Psychiatric Nursing

The ANA delineates standards of care as those professional activities in which psychiatric nurses use the nursing process to assess, diagnose, plan, implement and evaluate various form of care.

Standard I: Assessment
The registered psychiatric nurse collects information in order to assess the individual's health status through observations based on knowledge of nursing and of behavioral and physical sciences.
Factors that affect data collection include the quality of the nurse-client relationship, developmental stage, culture, educational level, communications skills and language, mental status and cognitive function. Data collection is based on various theoretical frame works that enable the nurse to interpret, validate and organize findings and set up a plan of care.

Standars II: Diagnosis
Diagnoses are synonymous with client problems. The criteria for psychiatric nursing diagnose include recognizing and identificying patterns of response or actual or potential mental illness and mental health define within the scope of psychiatric mental health nursing practice. Furthermore, diagnosing involves making inferences and using judgment regarding client problems.
Diagnoses comply with accepted classification system developed by the North American Nursing Diagnosis Association that are used in clinical settings to identify client actual and potential adaptive and maladaptive responses. They are validated by clients, significant others, and other mental health professionals. These findings are documented to promote identification of client outcomes, care plans, and research (ANA, 1994).

Standard III: Outcome Identification
The psychiatric mental health nurse identifies expected outcomes individualized to the client.
Rationale
Within the context of providing nursing care, the ultimate goal is to influence health outcomes and improve the client’s health status.
Nursing conditions
Critical thinking skills
Partnership with patient and family
Nursing behaviors
Hypothesizing
Specify expected outcomes
Validate goals with patient
Key elements
Outcomes should be mutually identified with the patient
Outcomes should be identified as clearly and objectively as possible
Well written outcomes helps nurses determine the effectiveness and efficiency of their interventions.

Standard IV: Planning
The major treatmet intent of identification of client outcomes is health promotion and restoration, that is, what the client can expect from nursing interventions or treatment. Client outcomes must be realistic, attainable, therapeutic, individualized, measurable, and cost effective.
An individualized plan of care directs therapeutic interventions that facilitate the successful resolution of client problems by restoring physical and mental health, preventing illness, and effecting rehabilitation. It is a blueprint that guides nurses and mental health professionals in identifying client outcomes, effective treatment options, and client activities and delegates specific function of the mental health team.
One of the most important task facing the nurse and ptient is to assign priorities to goals. Since the nursing care plan is dynamic and should adapt to the patient’s coping responses throughout contact with the health care system, priorities are constantly changing. If the focus is always on the patient’s behavioral responses, priorities can be set and modified as the patient changes. This personalizes nursing care plan and the patient participates in its planning and implementation.

Standard V: Implementation
After the nurse assesses the client, identifies the problems or nursing diagnoses, establishes client outcomes, and develops a plan of care, how will he or she implement the plan? Application of knowlwdge and testing hypotheses are critical components of implementation and intervention. An array of interventions can be used to promote health and minimize the deleterious effects of mental illness. Specific interventions are determined by the identified client needs and may include milieu therapy, strss management, education, behavior modification, and various psychotherapies.
Implementation is an open, dynamic process, and interventions are continuously being monitored by client responses. This process enhances nurse-client collaboration, maximizes resources and minimizes the fragmentation of health care services.
Standard Va: Counseling
The psychiatric mental health nurse uses counseling interventions to assist clients in improving or regaining their previous coping abilities, fostering mental health and preventing mental illness and disability.
Standard Vb: 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 Vc: 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 well being.
Standard Vd: Psychobiological Interventions
The psychiatric mental health nurse uses knowledge of psychobiological interventions and applies clinical skills to restore the client’s health and prevent further disability.
Standard Ve: Health Teaching
The psychiatric mental health nurse, through health teaching, assists clients in achieving satisfying, productive, and healthy patterns of living.
Standard Vf: Case Management
The psychiatric mental health nurse provides case management to coordinate comprehensive health services and ensure continuity of care.
Standard Vg: Health Promotion and Health Maintenance
The psychiatric mental health nurse employs strategies and interventions to promote and maintain mental health and prevent mental illness.
Advanced Practice Interventions Vh-Vj: The following interventions (Vh-Vj) may be performed only by the certified specialist in psychiatric mental health nursing.
Standard Vh: Psychotherapy
The certified specialist in psychiatric mental health nursing uses individual, group, and family psychotherapy, child psychotherapy, and other therapeutic treatments to assist clients in fostering mental health, preventing mental illness and disability, and improving or regaining previous health status and functional abilities.
Standard Vi: 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 Vj: Consultation
The certified specialist provides consultation to health care providers and others to influence the plans of care for clients and to enhance the abilities of others to provide psychiatric and mental health care and effect change in systems.

Standard VI: Evaluation
Rationale
Nursing care is a dynamic process involving change in the client’shealth status over time, giving rise to the need for new data, different diagnoses, and modifications in the plan of care. Therefore evaluation is a continuous process of appraising the effect of nursing interventions and the treatment regimen on the client’s health status and expected health outcomes.
Nursing conditions
Supervision
Self-analysis
Peer review
Patient and family participation
Nursing behaviors
Compare patient’s responses and expected outcome
Review nursing process
Modify nursing process as needed
Participate in quality improvement activities
Key elements
Evaluation is an ongoing process
Patient and family participation in evaluation is essential
Goal achievement should be documented and revisions in the plan of care should be implemented as appropriate
When evaluating care the nurse should review all previous phases of the nursing process and determine whether the expected outcomes for the patient have been met. Key words for the eavaluation phase of the nursing process are mutual, continous, adequate, effective, appropriate, efficient, and flexible.

References:
Sundeen, Sandra J and Gail Wiscarz Stuart. 1995. Principles and Practice of Psychiatric Nursing Fifth Edition. St. Louis Missouri: Mosby Year Book Inc.
Antai-Otong, Deborah. 1995. Psychiatric Nursing Biological & Behavioral Concept. Philadelphia: WB. Saunders Company.
http://www.rpnas.com/public/jsp/content/documentation/standards.jsp (diakses: Rabu, 9 Desember 2009)