canadian standards for psychiatric mental health nursing

8/19/2019 Canadian Standards for Psychiatric Mental Health Nursing

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Canadian Standards forPsychiatric-Mental Health Nursing

4th Edition March 2014Standards of Practice

Canadian Federation of Mental Health Nurses • www.cfmhn.ca



How to reach us:

Canadian Federation of Mental Health Nurses

c/o First Stage Enterprises

1 Concorde Gate, Suite 109

Toronto, ON M3C 3N6

Tel: 416.426.7229

Fax: 416.426.7280

E-mail: [email protected]

www.cfmhn.ca

Canadian Standards for Psychiatric-

Mental Health Nursing4th Edition (2014)

Authors

Gloria McInnis-Perry, RN, PhD, DNSc, CNS, CPMHN(C) (PEI), Chair

Ann Greene, RN, MEd, CPMHN(C) (BC), Co-chair

Elaine Santa Mina, RN, PhD (ON) Co-chair

Sue Chong, RN, MSN., BA., CPMHN(C) (BC)

Marlee Groening, RN, BSN, MN (BC)

Gwen Campbell MacArthur, RPN, RN, BScN, MN (BC)

Kathy Wong, RN, BScN, MEd, CPMHN(C) (ON)

Sylvie Buisson, RN, MEd, CPMHN(C) (QC)

Edna Carloss, RN, BScN (NS)

Robert Meadus, RN, PhD (NL)

Acknowledgements

Leigh Blaney, RN, BSN, MA, CPMHN(C) (BC)

Margaret Osborne, RN, PhD (AB)

Brittany Schutte, RN, BScN (AB)

Robb Desrocher, RN, BA (MB)

Carrie McCallum, RN, BScN, CPMHN(C) (ON)

Mari-M Gagnon, RN, MN, CPMHN(C) (QC)Joanna Cox, RN, BScN, BA (NS)

Aboriginal Nurses Association of Canada (ANAC)

Reference: Canadian Federation of Mental Health Nurses. (2014).

Canadian Standards for Psychiatric-Mental Health Nursing (4th Ed.). Toronto, ON.

Author. Gloria McInnis-Perry (PhD), Ann Greene (MEd), Elaine Santa Mina (PhD), et al.

© 2014 Canadian Federation of Mental Health Nurses.



Canadian Standards of Psychiatric-Mental Health Nursing 1

Table of ContentsIntroduction .......................................................................................................................3

Standards Development ....................................................................................................4

Purpose of Standards ........................................................................................................4

Current Issues ...................................................................................................................5

Beliefs/Values ....................................................................................................................5

Standards ..........................................................................................................................7

Standard I: Provides Competent Professional Care Through the Development of a

Therapeutic Relationship ................................................................................................... 7

Standard II: Performs/Refines Client Assessments Through the Diagnostic and Monitoring

Function ............................................................................................................................8

Standard III: Administers and Monitors Therapeutic Interventions.......................................9

Standard IV: Effectively Manages Rapidly Changing Situations .........................................10

Standard V: Intervenes Through the Teaching-Coaching Function .................................... 11

Standard VI: Monitors and Ensures the Quality of Health Care Practices ..........................11

Standard VII: Practices Within Organizational and Work-Role Structure ...........................12

Glossary ..........................................................................................................................13

References ......................................................................................................................14

Appendix ......................................................................................................................... 16



Canadian Standards of Psychiatric-Mental Health Nursing2




IntroductionPsychiatric-mental health nurses provide mental health care to individuals, families, groups,

communities, and populations in many settings. Over time, psychiatric-mental health

nursing practice responds to changes in the needs of patients and clients, an expansion of

knowledge about health care and nursing, and a growing array of alternative care delivery

technologies (Fritzsche, 2008). Psychiatric-mental health nurses adapt to change byexpanding their knowledge and understanding of mental health and mental illness while

delivering competent, evidenced-informed, safe, and ethical care.

Changes in government legislation and policy also affect the field of mental health

tremendously since Canada’s mental health system operates under the provisions of federal

provincial, and territorial Mental Health Acts and related legislation. Psychiatric-mental health

nurses have long advocated for improvements to Canada’s mental health system and are

pleased with the Mental Health Commission’s recent Mental Health Strategy for Canada

(2012) entitled Changing Directions, Changing Lives. This strategy document, informed

by consumers, families, and health professionals, provides a framework for change of the

mental health system through six key recommendations. In general, the report recommends

establishing diverse community-focused services that use a recovery-based approach. All

nurses, including psychiatric-mental health nurses, support Canada’s mental health strategy

and collaborate with others to facilitate implementation.

To maintain quality care in a changing professional field, the Canadian Standards of

Psychiatric-Mental Health Nursing provide direction to all nurses and to the public on

acceptable practices of a psychiatric-mental health nurse. Revision of the Standards is

necessary to ensure that psychiatric-mental health nursing remains contemporary, relevant,

and responsive to the current needs of individuals, families, communities, and the health

care system.

We begin the fourth edition of the Canadian Standards of Psychiatric-Mental Health

Nursing with a brief discussion of the Standards development process, the purpose of the

Standards, various current issues, and the beliefs and values which inform the Standards.

We then present the revised practice standards, a glossary, and an appendix. In the

appendix, we include a historical overview of psychiatric-mental health nursing since it

provides context to the evolution of our practice and standards.




Standards provide a guide for the evaluation of psychiatric-mental health nursing practice

within a professional and ethical framework.

Current Issues

Professional standards reflect the current state of knowledge and understanding of

a discipline and are therefore contextual and dynamic. The theoretical framework for

understanding practice influences how the individual psychiatric-mental health (PMH) nurse

achieves the accepted standards of practice. Psychiatric-mental health nurses’ embrace

the social, cultural, economic, and political contexts for caregiving, which strongly influence

nursing practice (CNA, 2002b). The social justice paradigm goes further to consider the

social determinants of health, and values equity and the empowerment of the individual

in recovery as well as in health care. Various contextual forces can challenge psychiatric-

mental health nurses to provide service from a social justice paradigm. Current issues

considered in the Standards include:

• inequities in population demographics and increases in cultural diversities (e.g., age,

gender, ethnicity, race, sexual orientation, language, socio-economic status, and

spirituality);

• inequities in financial allocation of acute and chronic care resources;

• increased prevalence of concurrent disorders (addictions);

• a trend toward policy and program planning for the integration of addictions and mental

health;

• multiple morbidities that result in increased acuity and complexity;

• a focus on determinants of health in understanding psychiatric-mental health issues and

needs;

• an expanded view of the health care team to include partnership/collaborative

relationships with clients and their natural support systems and with advocacy and self-

help groups;

• stigma and discrimination;

• promotion of recovery and well-being;

• support of Canada’s mental health strategy, Changing Directions, Changing Lives;

• increased psychiatric-mental health nursing research that is evidence-informed and/or

presents best practices in psychiatric-mental health care.

Beliefs/Values

Psychiatric-mental health nursing is a specialized area of nursing practice, education,

and research. The PMH nurse uses evidence-informed and experiential knowledge from

nursing and related health sciences. This practice is grounded in the values as stated in the

Canadian Nurses Association Code of Ethics (CNA, 2008a). Practice involves the promotion

of mental health and the prevention, treatment, and management of mental disorders.

Psychiatric-Mental Health Nurses believe in:

• the centrality of therapeutic nurse-client relationships, based on trust and mutual

respect, to practice;




• the alleviation of stigma and discrimination;

• the promotion of recovery and well-being for people of all ages living with mental health

problems and illnesses;

• the conduct and utilization of research for improvement in care;

• social action to promote political and social awareness to influence health and

organizational policy;

• working in collaborative relationships with the individual, family, community, different

populations, and social agencies;

• a holistic approach that is essential to understanding the unique experience of the client;

• equitable access to culturally competent care;

• reflective ethical practice and a commitment to continuous learning;

• the protection of human rights in the context of civil commitment and relevant aspects

of jurisprudence;

• advocating for practice environments that facilitate and ensure safe and positive work

relationships;

• fostering a legacy of moral and visionary psychiatric-mental health nursing leaders.




StandardsStandard I: Provides Competent Professional

Care through the Development of a

Therapeutic Relationship A primary goal of psychiatric-mental health nursing is the promotion of mental health and the

prevention or diminution of mental disorder. The development of a therapeutic relationship is

the foundation from which the psychiatric-mental health nurse can “enter into partnerships

with clients, and through the use of the human sciences, and the art of caring, develop

helping relationships” (RNAO, 2002b).

The nurse:

1. assesses and clarifies the influences of personal beliefs, values, and life experience

on the therapeutic relationships and distinguishes between social and therapeutic

relationships;

2. works in partnership with diverse and heterogeneous populations, families, and relevant

others to determine goal-directed needs and to establish an environment that is

conducive to goal achievement;

3. uses a range of therapeutic verbal and non-verbal communication skills that include

empathy, active listening, observing, genuineness, and curiosity;

4. recognizes the influence of age, culture, class, ethnicity, language, stigma, and social

exclusion on the therapeutic process and negotiates care that is sensitive to these

influences;

5. mobilizes and advocates for resources that improve community integration and increase

the ability of diverse and heterogeneous populations and their families, including thoseisolated geographically, to access mental health services;

6. understands and responds to human reactions to distress and loss of control that may

be expressed as anger, anxiety, fear, grief, helplessness, hopelessness, and humour;

7. recognizes and respects the client’s expert and unique knowledge, and facilitates the

client’s behavioural, developmental, emotional, or spiritual change while acknowledging

and supporting the client’s participation, responsibility, and choices in his/her care;

8. respects the client’s and family’s lived expertise and unique knowledge in promoting

recovery;

9. fosters mutuality of the relationship by reflectively critiquing therapeutic effectiveness

through client and family responses and feedback, clinical supervision, and self-

evaluation;

10. understands the nature of chronic illness and applies the principles of health promotion

and disease prevention when working with clients and families in the promotion of

recovery.




Standard II: Performs/Refines Client

Assessments through the Diagnostic and

Monitoring FunctionEffective assessment, diagnosis, and monitoring is central to the nurse’s role and depends

upon theory as well as upon understanding the meaning of the health or illness experience

from the perspective of the client. The nurse explains the assessment process to the client

and provides feedback. Knowledge is integrated with the nurse’s conceptual model of

nursing practice, which provides a framework for processing client data and for developing

client-focused plans of care. The nurse makes professional judgements based upon

evidence, and recognizes and includes the client as a valued partner.

The nurse:

1. collaborates with clients and with other members of the health care team to gather

holistic, client-centered assessments through observation, engagement, examination,

interview (using respectful, recovery focussed language), and consultation while

attending to confidentiality and pertinent legal statutes;

2. assesses, documents, and analyzes data to identify health status, potential for wellness,

health care deficits, potential for risk to self and others; alterations in thought content

and/or process, affect behaviour, communication and decision-making abilities;

substance use and dependency; and history of trauma and/or abuse (emotional,

physical, neglect, sexual, or verbal);

3. formulates and documents a plan of care in collaboration with the client, family, and

mental health team that supports recovery and reintegration/social inclusion in the

community through discharge planning and provision for ongoing support, all while

recognizing variability in the client’s ability to participate in the process;

4. refines and expands client assessment information by assessing and documenting

significant change(s) in the client’s status, and by comparing new data with the baseline

assessment and client goals;

5. assesses and anticipates potential needs and risks, collaborating with the client to

examine his/her environment for risk factors such as self-care, housing, nutrition,

economic support, psychological state, and social interactions;

6. determines the most appropriate and available therapeutic modality that meets the

client’s needs, and assists the client to access necessary resources.




Standard IV: Effectively Manages Rapidly

Changing Situations The effective management of rapidly changing situations is essential in critical circumstances

that may be termed psychiatric emergencies. These situations include risk factors for

self-harm, aggressive behaviours, and rapidly changing mental and physical health states

(SERPN, 1996).

The nurse:

1. utilizes the therapeutic relationship throughout the management of rapidly changing

situations;

2. assesses the client using a comprehensive holistic approach for actual or potential

health issues, problems, risk factors, and/or crisis/emergency/catastrophic situations;

3. knows about resources required to manage actual and potential crisis/emergency/

catastrophic situations and plans access to these resources;

4. monitors client safety and utilizes continual assessment to detect early changes in client

status, and intervenes accordingly;

5. implements timely, age-appropriate, and client-specific crisis/emergency/catastrophic

interventions as necessary;

6. uses trauma-informed care when managing crisis situations with clients to minimize

further trauma and interference with recovery objectives;

7. commences critical procedures when necessary which, in an institutional setting,

includes suicide precautions, emergency restraint, elopement precautions, and

infectious disease management and, in a community setting, includes community

support systems such as police, ambulance, and crisis response resources;

8. utilizes a least restraint approach to care;

9. develops and documents the management plan of care and intervention;

10. coordinates care to prevent errors and duplication of efforts where rapid intervention is

imperative;

11. evaluates the effectiveness of the rapid responses with the client and modifies critical

plans as necessary;

12. involves, with client collaboration, the family and significant others to identify the

precipitates of the event and to plan ways to minimize risk of recurrence;

13. participates in process review with the client, family, health care team, and other service

providers as needed;

14. utilizes safety measures to protect client, self, and colleagues from potentially abusive

situations in the work environment;

15. participates in and implements activities that improve client safety in the practice setting




Standard V: Intervenes through the Teaching-

Coaching Function All interactions are potentially teaching/learning situations. The PMH nurse attempts to

understand the life experience of the client and uses this understanding to support and

promote learning related to health and personal development. The nurse provides health

promotion information to individuals, families, communities, and different populations.

The nurse:

1. collaborates with the client to determine learning needs, emphasizing and supporting

the client’s potential for recovery;

2. plans and implements health promotion education with the client while considering the

context of the client’s life experiences, readiness, culture, literacy, language, preferred

learning style, and available resources;

3. explores options and resources with the client to build knowledge for making informed

choices related to health needs and for accessing the system as needed;

4. incorporates knowledge of diverse learning models and principles, including theprinciples of recovery, when creating learning opportunities for clients;

5. provides guidance, support, and relevant information (with appropriate critiques) to

clients, families, and significant others;

6. documents the teaching/learning process (assessment, implementation, client

involvement, and evaluation);

7. determines with the client the effectiveness of the educational process and

collaboratively develops or adapts it to meet learning needs;

8. engages in teaching/learning opportunities as a partner with clients, families, and

community agencies.

Standard VI: Monitors and Ensures the Quality

of Health Care Practices The nurse has a responsibility to advocate for clients’ rights to receive the lease restrictive

form of care and to respect and affirm clients’ rights to self-determination in a safe

and equitable manner. The PMH nurse must be informed about relevant legislation, its

interpretation, and its implications for nursing practice.

The nurse:

1. identifies philosophies, attitudes, values, and beliefs of the workplace culture that affect

the nurse’s performance, safety, and compassion, and responds appropriately;

2. understands how the determinates of health affect community well-being and PMH

nursing practice;

3. understands relevant legislation and its implications for nursing practice, and utilizes it

appropriately;




4. expands and incorporates knowledge of innovations and changes in mental

health psychiatric nursing practice to ensure safe, confidential, and effective care;

5. ensures and documents ongoing review and evaluation of psychiatric-mental health

nursing care activities;

6. participates in dialogue and critical reflection about the interdependent functions of the

team within the overall plan of care;

7. advocates for the client within the context of the health care environment;

8. advocates for continuous improvement to the organizational/systemic structures

consistent with the principles of safe, ethical, and competent care;

9. recognizes the dynamic changes in health care locally and globally and, with

stakeholders, supports strategies to manage these changes.

Standard VII: Practices Effectively within

Organizational and Work-Role StructurePsychiatric-mental health nursing care occurs in both community and hospital settings. For the

PMH nurse, care requires a therapeutic relationship involving reflective, ethical, and evidence-

based practice within complex and dynamic situations. The PMH nurse must be able to plan

and implement collaborative care, apply recovery principles, promote mental health, consult

with community members, and advocate for the mental health of their clients and others.

The nurse:

1. collaborates with clients/families/significant others and other stakeholders to facilitate

safe, supportive, and respectful environments for all persons;

2. actively participates to sustain and promote a climate which supports ethical practiceand a moral community;

3. understands and utilizes quality outcome indicators and strives for continuous quality

improvement;

4. seeks to utilize constructive and collaborative approaches to resolve differences among

members of the health care team which may impact care;

5. participates in developing, implementing, and critiquing mental health policy which

fosters recovery and continuity of care;

6. advocates and supports a nursing leadership role;

7. supports and helps to mentor and coach newly graduated nurses;

8. utilizes knowledge of collaborative strategies for social action in working with consumer

and advocacy groups;

9. pursues opportunities to reduce stigma and to promote social inclusion and community

integration for clients.




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Appendix A History of Canada’s Psychiatric-Mental Health NursingUntil the late nineteenth century, people with mental illness were usually cared for by their families. From that time, institutional

care for the person with mental illness considered “dangerous to be at large” became available as provinces passed

legislation for the formal admission of this group to asylums headed by physicians titled “medical superintendents” and staffed

by lay attendants. Early in the twentieth century, several asylums in Ontario, Nova Scotia, and Quebec initiated specializedmental health nurse training schools modeled closely on general hospital schools. Under the auspices of general nursing

leaders, mental hospital graduate nurses eventually became eligible for general nurse registration in those provinces. Asylum

training schools appeared some time later in western Canadian asylums as well, but those graduates generally were not

eligible for provincial nurse registration and eventually formed a separate registration system.

Public funding for Canada’s mental hospitals remained a challenge, and problems of limited resources and overcrowding soon

made the institutions difficult to manage, resulting in a poor reputation. Influenced by the mental hygiene movement of the

1920s, ideas about care of the person with mental illness gradually shifted to place more emphasis upon prevention of mental

illness and promotion of mental health among the general population. Following World War Two, the health care system

rapidly expanded, new psychotropic medications became available, and care of the mentally ill diversified. Large mental

hospitals remained, but as general hospitals created psychiatric departments and outpatient clinics, services expanded.

Beginning in the mid-1960s, the focus of mental health care slowly shifted from institutional to community-based care,with a wider range of available professional services. The number of patients cared for in the provincial hospitals decreased

significantly.

Throughout the postwar years and during the transition to community care, psychiatric-mental health nursing remained

central to the care of the person with mental illness; however, the role of nurses and their education changed. In all provinces,

psychiatric-mental health nursing is now a component of generic nursing education programs that prepare graduates for

positions in this speciality as part of the professional work of nursing. Today, psychiatric-mental health nurses are an integral

part of multidisciplinary teams, providing a wide range of inpatient and community mental health care services in partnership

with consumers and their families.

(Boschma, 2003 & Tipliski, 2002)




Standard Statement Reference number(s)

Current Issues

1. inequities in population demographics and increases in cultural diversities (e.g., age,

gender, ethnicity, race, sexual orientation, language, socio-economic status, and spirituality)

13, 16, 34, 47

2. inequities in financial allocation of acute and chronic care resources 6, 40

3. increased prevalence of concurrent disorders (addictions) 13, 19

4. a trend toward policy and program planning of the integration of addictions and mental

health

13, 19, 49

5. multiple morbidities resulting in increasing acuity and complexity 2

6. a focus on determinants of health in understanding psychiatric-mental health issues and

needs

2, 4, 5, 13, 16, 17, 20, 34,

36, 37, 38, 39, 40, 49, 57

7. an expanded view of the health care team to include partnership/collaborative relationships

with clients and their natural support systems and with advocacy and self-help group

3, 4, 6, 7, 13, 35, 36, 38,

46

8. stigma and discrimination 6

9. promotion of recovery and well-being 6

10. support of Canada’s mental health strategy 36

11. increased psychiatric mental health nursing research that is evidence-informed and/or

presents best practices in psychiatric mental health care

6

Beliefs and Values

1.the centrality of the therapeutic nurse-client relationships, based on trust and mutual

respect, to practice

5, 6, 21, 27, 32, 34, 35, 37,

42, 43, 44, 47, 49, 50, 57

2. the alleviation of stigma and discrimination 6, 7, 12, 13, 16, 17, 35, 36,

37, 49, 50, 54

3. the promotion of recovery and well-being for people of all ages living with mental health

problems and illnesses

18, 20, 33, 35, 36

4. the conduct and utilization of research for improvement in care 12, 13, 16, 17, 21, 36, 49,

505. social action to promote political and social awareness to influence health and

organizational policy

13, 16, 17, 19, 20

6. working in collaborative relationships with the individual, family, community, different

populations, and social agencies

4, 6, 7, 21, 35, 13, 46, 57

7. a holistic approach that is essential to understanding the unique experience of the client 4, 5, 6, 7, 13, 17, 21, 27,

28, 30, 35, 38, 39, 44, 47,

48, 50, 54, 57

8. equitable access to culturally competent care 4, 6, 13, 16, 30, 32, 35, 38,

50, 52, 54

9. reflective ethical practice and a commitment to continuous learning 6, 21, 25, 27, 35, 42, 43,

49, 50

10. the protection of human rights in the context of civil commitment and relevant aspects of

jurisprudence

27

11. advocating for practice environments that facilitate and ensure safe and positive work

relationships

21, 27

12. fostering a legacy of moral and visionary psychiatric mental health nursing leaders 37

Appendix B





Standard I: Provides Competent Professional Care through the Development of a Therapeutic Relationship

1. assesses and clarifies the influences of personal beliefs, values and life experience on the

therapeutic relationships and distinguishes between social and therapeutic relationships

6, 7, 27, 35, 37, 44, 49, 50,

57

2. works in partnership with diverse and heterogeneous populations, families, and relevant

others to determine goal directed needs and to establish an environment that is conducive to

goal achievement

3, 6, 35, 36, 42

3. uses a range of therapeutic verbal and non-verbal communication skills that include

empathy, active listening, observing, genuineness, and curiosity

42, 43, 44

4. recognizes the influence of age, culture, class, ethnicity, language, stigma, and social

exclusion on the therapeutic process and negotiates care that is sensitive to these influences

6, 13, 35, 36, 41, 46, 47,

49, 54, 57

5. mobilizes and advocates for resources that increase the ability of diverse and

heterogeneous populations and their families to access to mental health services and that

improve community integration, including those isolated geographically

1, 2, 13, 16, 18, 20, 36,

40, 39, 49

6. understands and responds to human reactions to distress and loss of control that may be

expressed as anger, anxiety, fear, grief, helplessness, hopelessness, and humour

43, 50

7. recognizes and respects the client’s expert and unique knowledge, and facilitates the

client’s behavioural, developmental, emotional, or spiritual change while acknowledging and

supporting the client’s participation, responsibility, and choices in his/her care.

18, 42

8. respects the client’s and family’s lived expertise and unique knowledge in promoting

recovery

39, 48

9. fosters mutuality of the relationship by reflectively critiquing therapeutic effectiveness

through client and family responses and feedback, clinical supervision, and self-evaluation

7

10. understands the nature of chronic illness and applies the principles of health promotion

and disease prevention when working with clients and families in the promotion of recovery

16, 35

Standard II: Performs/Refines Client Assessments through the Diagnostic and Monitoring Function

1. collaborates with clients and with other members of the health care team to gather holistic,

client centered assessments through observation, engagement, examination, interview (using

respectful, recovery focussed language), and consultation while attending to confidentiality

and pertinent legal statutes

21, 27, 47

2. assesses, documents, and analyzes data to identify health status, potential for wellness,

health care deficits, potential for risk to self and others, alterations in thought content and/

or process, affect behaviour, communication and decision-making abilities, substance use

and dependency, and history of trauma and/or abuse (emotional, physical, neglect, sexual, or

verbal)

47

3. formulates and documents a plan of care in collaboration with the client, family, and mental

health team that supports recovery and reintegration/social inclusion in the community

through discharge planning and provision for ongoing support, all while recognizing variability

in the client’s ability to participate in the process

43, 47

4. refines and expands client assessment information by assessing and documentingsignificant change(s) in the client’s status, and by comparing new data with the baseline

assessment and client goals

49, 50

5. assesses and anticipates potential needs and risks continuously, collaborating with the

client to examine his/her environment for economic, psychological, and social risk factors

such as self-care, housing, and nutrition

39, 49, 50

6. determines the most appropriate and available therapeutic modality that meets the client’s

needs, and assists the client to access necessary resources

41, 49





Standards III: Administers and Monitors Therapeutic Interventions

1. utilizes and evaluates evidence-based interventions to provide ethical, culturally

competent, safe, effective, and efficient nursing care consistent with the mental, physical,

spiritual, emotional, social, and cultural needs of the individual

1, 2, 3, 6, 27, 35, 46, 49,

50

2. provides information to clients and families/significant others in accordance with relevant

legislation

1, 3, 6, 18, 35, 37, 39

3. assists, educates, and empowers clients to select choices which support informed

decision-making and provides information about the possible consequence(s) of the choice

3, 6, 18, 27, 35, 49

4. supports clients to draw on their own assets and resources for self-care, daily living

activities, resource mobilization, and mental health promotion

13, 39

5. determines clinical intervention, using knowledge of client’s responses 43, 47

6. uses technology appropriately to perform safe, effective, and efficient nursing intervention 2

7. uses knowledge of age-specific implications of psychotropic medications and administers

medications accurately and safely, monitoring therapeutic responses, reactions, untoward

effects, toxicity, and potential incompatibilities with other medications or substances and

provides medication education with appropriate content

37, 49

8. utilizes therapeutic elements of group process 37, 45, 51

9. incorporates knowledge of family dynamics, cultural values, and beliefs in the provision of

care

6, 13, 18, 37, 39, 46, 57

10. collaborates with the client, health care providers, and community members to access

and coordinate resources such as employment, education, and volunteering, and seeks

feedback from the client and others regarding interventions

1, 3, 18, 42

11. encourages and assists clients to seek out mutual support groups and to strengthen

social support networks as needed

46

12. seeks out the client’s response to, and perception of, nursing and other therapeutic

interventions and incorporates it into practice

3, 6, 7, 39, 42, 51

13. ensures care for individuals of different populations (e.g., incarcerated individuals,

individuals with intellectual disabilities) from therapeutic and rehabilitative perspectives

6, 39

Standard IV: Effectively Manages Rapidly Changing Situations

1. utilizes the therapeutic relationship throughout the management of rapidly changing

situations

5, 37, 43, 50, 57

2. assesses the client using a comprehensive holistic approach for actual or potential health

issues, problems, risk factors, and/or crisis/emergency/catastrophic situations

5, 37, 50, 57

3. knows resources required to manage actual and potential crisis/emergency/catastrophic

situations and plans access to these resources

37

4. monitors client safety and utilizes continual assessment to detect early changes in client

status, and intervenes accordingly

5, 37, 50

5. implements timely, age appropriate, and client specific crisis/emergency/catastrophic

interventions as necessary

6, 35, 37, 43

6. uses trauma-informed care when managing crisis situations with clients to minimize further

trauma and interference with recovery objectives

37, 43, 44, 47, 49

7. commences critical procedures when necessary which, in an institutional setting, includes

suicide precautions, emergency restraint, elopement precautions, and infectious disease

management, and, in a community setting, includes community support systems such as

police, ambulance services, and crisis response resources

5, 6, 12, 27, 39, 50, 57

8. utilizes a least restraint approach to care 27, 37

9. develops and documents the plan and intervention 1





9. recognizes the dynamic changes in health care locally and globally and, in collaboration

with stakeholders, supports strategies to manage these changes

16, 39, 40

Standard VII: Practices within Organizational and Work-Role Structure

1. works in collaborative partnerships with clients/families/significant others and other

stakeholders to facilitate environments that ensure the safety, support, and respect for all

persons

1,2, 4, 12, 13, 16, 36, 38,

39, 42, 49

2. actively participates to sustain and promote a climate which supports ethical practice and

the establishment of a moral community

6, 21, 25, 27, 35, 36, 58

3. understands and utilizes quality outcome indicators and strives for continuous quality

improvement

1, 2, 16, 21, 27

4. seeks to utilize constructive and collaborative approaches to resolve differences among

members of the health care team which may impact care

21, 22, 27

5. participates in developing, implementing, and critiquing mental health policy which fosters

recovery and continuity of care

16, 17

6. advocates and supports a nursing leadership role 6, 35

7. supports and participates in the mentoring and coaching new graduates 38

8. utilizes knowledge of collaborative strategies for social action in working with consumer

and advocacy groups

40

9. pursues opportunities to reduce stigma and to promote social inclusion and community

integration for clients

6




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CFMHN works with others to influence policy and decision making and provides expertise on community health nursing issues.

La CFMHN s’associe à d’autres organismes pour influencer les politiques et les décisions, et elle fournit des conseils sur les

questions relatives aux soins infirmiers communautaire en santé mentale.

Your FederationHelping meet your professional goals

An associate group of the Canadian Nurses’ Association (CNA),

we are a national voice for psychiatric and mental health (PMH)

nursing. Our objectives are to:

• Assure national leadership in the development and

application of nursing standards that inform and affect

psychiatric and mental health nursing practice.

• Examine and influence government policy, and address

national issues related to mental health and mental illness.

• Communicate and collaborate with national and

international groups that share our professional interests.

• Facilitate excellence in psychiatric and mental health nursing

by providing our members with educational and networking

resources.

Formed in 1988, the Federation pioneered national credentialingin psychiatric and mental health nursing and achieved CNA

certification status seven years later.

Because of our efforts, nurses across the country can qualify

for the national psychiatric and mental health nursing credential.

Nurses with certification are eligible to use the CPMHN(C)

designation after their names and wear the official CNA

certification pin – a sign of professional achievement.

There is a National Certification Exam available to allMental Health Nurses through CNA. For more information

on the certification process please see www.cna-nurses.ca



Canadian Federation of Mental Health Nurses

Fédération Canadienne des Infirmières et Infirmiers en Santé Mentale

c/o First Stage Enterprises

1 Concorde Gate, Suite 109

Toronto, ON M3C 3N6

Tel: 416.426.7229

Fax: 416.426.7280