Psychiatric Nursing Psychiatric Nursing Quality Guide lines Quality Guide lines Quality Guide lines Quality Guide lines

By: By: HatimHatim AbdulAzizAbdulAziz BanjarBanjar(Nursing quality coordinator and hospital risk officer)(Nursing quality coordinator and hospital risk officer)

AlAl--AmalAmal Hospital (Jeddah)Hospital (Jeddah)Mob. Mob. 00966 54057271600966 540572716hab.hab.19781978@hotmail.com@hotmail.com

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IntroductionIntroduction

� Mental health problems are an international andnational concern. More than 30% of adults areestimated to experience at least one form ofmental ill health during any one year.

� There is a lack of understanding of the role and � There is a lack of understanding of the role and value of the psychiatric nurse among health practitioners.

� there is lack of competent qualified nurses in psychiatric area and young people are not willing to educate themselves for the field of mental health care.

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The main goalThe main goal

� Providing data that will hopefully help in mapping the road to achieving high performance levels in psychiatric nursing practice and in giving an understanding to the role and value of the psychiatric nurse.

The methodThe method� Collection of multiple data from multiple sources

that discuses points in quality of psychiatric nursing.

� Emphasis on the special points of psychiatric nursing.

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What is psychiatric nursing?What is psychiatric nursing?

�� IIt t is is the specialty ofthe specialty of nursing practice nursing practice employing employing theories of human behavior as its theories of human behavior as its science and purposeful use of self as its art.science and purposeful use of self as its art.Nurses in this area receive additional training Nurses in this area receive additional training Nurses in this area receive additional training Nurses in this area receive additional training in building ain building a therapeutic alliance, psychosocial therapeutic alliance, psychosocial therapy,therapy, dealing with challenging behaviordealing with challenging behavior and and the administration of psychiatric medication.the administration of psychiatric medication.

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Basic scope of service Basic scope of service

�� Therapeutic relationshipTherapeutic relationship�� Physical and biological interventionsPhysical and biological interventions�� Psychosocial interventions: Psychosocial interventions: ( helping the patient and family in dealing with ( helping the patient and family in dealing with ( helping the patient and family in dealing with ( helping the patient and family in dealing with

each other and with the society)each other and with the society)�� Spiritual interventions: Spiritual interventions: (focus on developing a sense of meaning, (focus on developing a sense of meaning,

purposepurposeand hope for the person in their and hope for the person in their current life experience)current life experience)

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What are the trends of a psychiatric What are the trends of a psychiatric nurse?nurse?

�� Clear insight with high selfClear insight with high self--understandingunderstanding(Stigmatization and ethical dilemmas are high in (Stigmatization and ethical dilemmas are high in psychiatric nursing)psychiatric nursing)

�� Psychiatric Psychiatric and medicaland medical--surgical nursing skills surgical nursing skills and knowledge and knowledge and knowledge and knowledge

�� Good and affective communication skillsGood and affective communication skills(a therapeutic relation can only be billed with (a therapeutic relation can only be billed with affective communication) affective communication)

�� Competent, punctual, cooperative and calm Competent, punctual, cooperative and calm

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�� High since of moral values High since of moral values ( many psychiatric patients are easy to be taken ( many psychiatric patients are easy to be taken advantage of)advantage of)

�� Psychological Psychological and physical staminaand physical stamina�� Good judgment and critical thinkingGood judgment and critical thinking

(situations explodes with in moments with (situations explodes with in moments with psychiatric patients)psychiatric patients)psychiatric patients)psychiatric patients)

�� Highly observantHighly observant(many small behavioral changes of the patient (many small behavioral changes of the patient that can be considered normal by others have a that can be considered normal by others have a dramatic effect on the nursing care plan) dramatic effect on the nursing care plan)

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What are the elements needed for What are the elements needed for nursing quality?nursing quality?

�� NURSING ETHICS:NURSING ETHICS:Many elements of the nursing code of ethics have been Many elements of the nursing code of ethics have been involved with the psychiatric nursing care as methods involved with the psychiatric nursing care as methods of treatment:of treatment:

confidentialityconfidentiality-- (Breaking confidentiality can be if (Breaking confidentiality can be if there is a wellthere is a well--defined reason to share information: defined reason to share information: Benefit outweighs harm. This is an ethical dilemma ) Benefit outweighs harm. This is an ethical dilemma ) Benefit outweighs harm. This is an ethical dilemma ) Benefit outweighs harm. This is an ethical dilemma )

veracityveracity--(The only way to deal with patients with (The only way to deal with patients with hallucinations is to confront them with the truth)hallucinations is to confront them with the truth)

fidelityfidelity-- (psychiatric treatment depends trust and (psychiatric treatment depends trust and maintaining therapeutic alliance)maintaining therapeutic alliance)

non malfeasancesnon malfeasances--(many psychiatric patients are (many psychiatric patients are easy to take advantage of)easy to take advantage of)

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�� Knowledge and skills. Knowledge and skills. �� Utilization of the nursing care plan and the Utilization of the nursing care plan and the

nursing process: nursing process: assessmentassessment--(the main dependence is on (the main dependence is on

objective data)objective data)nursing Diagnosisnursing Diagnosis--(many symptoms of the (many symptoms of the

psychiatric illness is hard do defined and many psychiatric illness is hard do defined and many of them are not present all of the time) of them are not present all of the time) of them are not present all of the time) of them are not present all of the time)

�� Healthy and safe working environment.Healthy and safe working environment.�� Good retention plan Good retention plan (psychiatric nurses are (psychiatric nurses are

among the rears and highest paid in the world) among the rears and highest paid in the world) �� Standard policies and procedures. Standard policies and procedures.

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How is nursing Quality How is nursing Quality measured?measured?

�� Competency Competency �� Effectiveness Effectiveness �� Respect and Caring Respect and Caring �� SafetySafety�� SafetySafety�� AppropriatenessAppropriateness�� Timing Timing

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How is patient safety cared for ?How is patient safety cared for ?

�� Protecting the patient from harming himself :Protecting the patient from harming himself :ThatThat isis donedone byby monitoringmonitoring patientspatients withwith tendencytendency toto cometcometsuicidesuicide oror toto causecause harmharm toto themselvesthemselves andand placingplacing themthemunderunder cluesclues observation,observation, exploringexploring theirtheir thoughtthought contentcontentandand trytry toto distractdistract themthem awayaway fromfrom suchsuch ideasideas andand trytry totooccupyoccupy theirtheir timetime withwith differentdifferent activitiesactivities andand givegive themthem aaoccupyoccupy theirtheir timetime withwith differentdifferent activitiesactivities andand givegive themthem aasincesince ofof hopehope inin lifelife andand placeplace themthem inin aa safesafe environmentenvironmentinin thethe wardswards awayaway fromfrom anyany externalexternal stimulatorsstimulators forfor suchsuchideasideas andand awayaway fromfrom anyany harmfulharmful objectobject thatthat hehe mightmight useusetoto causecause harmharm toto himhim selfself ..

�� Protecting the patient from case prognoses.Protecting the patient from case prognoses.

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�� Protecting the patient from being harmed by others:Protecting the patient from being harmed by others:ThatThat isis donedone byby monitoringmonitoring aggressiveaggressive andand provokingprovokingbehaviorsbehaviors soso physicalphysical contactcontact (( fights)fights) don'tdon't happenhappen amongamongpatients,patients, delusionsdelusions andand wrongwrong beliefsbeliefs areare alsoalso monitoredmonitored totopreventprevent patientspatients fromfrom causingcausing harmharmtoto eacheach otherother duedue totothethe delusionsdelusions oror beliefsbeliefs andand inin casecase ofof anyany physicalphysicalcontactcontact amongamong patientspatients nursesnurses mustmust interfereinterfere asas quicklyquickly asaspossiblepossible usingusing thethe rightright mannermanner ofof interventionintervention alsoalsopossiblepossible usingusing thethe rightright mannermanner ofof interventionintervention alsoalsopatientspatients ofof deferentdeferent ageage groupsgroups andand gendersgenders mustmust bebeseparatedseparated toto preventprevent sexualsexual assaultassault (( malemale –– femalefemale ))(( adultadult –– teenagersteenagers -- childrenchildren )) ..

�� Protecting the patient from any medical or nursing errors.Protecting the patient from any medical or nursing errors.

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�� Protecting the patient from the physical Protecting the patient from the physical surrounding: surrounding: That is done by making sure that the patient is That is done by making sure that the patient is placed in a save place and free from any placed in a save place and free from any harmful objects that might injure the patient or harmful objects that might injure the patient or be used to cause harm for him e.g. ( only plastic be used to cause harm for him e.g. ( only plastic food utilities can be used in the ward , no sharp food utilities can be used in the ward , no sharp objects are allowed in the ward )objects are allowed in the ward )objects are allowed in the ward )objects are allowed in the ward )The patients consciousness level must be The patients consciousness level must be monitored to prevent any possible danger of monitored to prevent any possible danger of falling down, for patients that are endangered of falling down, for patients that are endangered of falling down during sleep precautions like falling down during sleep precautions like sidereal, placing patients in beds clause to the sidereal, placing patients in beds clause to the door, decreasing bed height must be taken.door, decreasing bed height must be taken.

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�� Patient safety during restrain episodesPatient safety during restrain episodesThat is done by following the correct and safe steps to administer That is done by following the correct and safe steps to administer

restrains :restrains :never use restrains with out a medical order.never use restrains with out a medical order.never use retrains as a punishment method or for personal revenge.never use retrains as a punishment method or for personal revenge.always tell the patient the reason from restraining him.always tell the patient the reason from restraining him.make sure that restrains do not block the blood circulation .make sure that restrains do not block the blood circulation .chick on patient and take vital signs every chick on patient and take vital signs every 1515min.min.make sure room temperature is appropriate .make sure room temperature is appropriate .always restrain the patient in a supine position.always restrain the patient in a supine position.make sure that the patient's physical needs are met.make sure that the patient's physical needs are met.do not apply restrains to cases of resent ophthalmic surgery, spinal surgery, do not apply restrains to cases of resent ophthalmic surgery, spinal surgery, harts conditions, chest and respiratory problems.harts conditions, chest and respiratory problems.the restrain room physical surrounding must be appropriate and equipped the restrain room physical surrounding must be appropriate and equipped with a monitoring camera.with a monitoring camera.patient should be on monitors through all the restraining time .patient should be on monitors through all the restraining time .

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�� Patient safety during seclusion episodesPatient safety during seclusion episodesThat is done by following the correct safety measures:

never use seclusion with out a medical order.never use seclusion as punishment or for personal revenge.always tell the patient the reason of putting him in seclusion.chick on patient every 15 min.make sure that the room is harm free.make sure that the room physical surrounding is appropriate make sure that the room physical surrounding is appropriate and equipped with a monitoring camera. make sure that the patient physical needs are met.seclusion should not be done to cases in risk of self harm, autism, cardiac and respiratory disorders and phobic patients.

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Nurses safety during P.T encounter Nurses safety during P.T encounter

�� Never face an aggressive P.T on your own.Never face an aggressive P.T on your own.�� Always be calm and use an appropriate voice Always be calm and use an appropriate voice

tone. tone. �� Never turn your back to the patient.Never turn your back to the patient.�� Never turn your back to the patient.Never turn your back to the patient.�� Always keep eye contact.Always keep eye contact.�� Always keep an arm space between the nurse Always keep an arm space between the nurse

and the patient during confrontation.and the patient during confrontation.�� When trying to physically control the patient When trying to physically control the patient

approach him from the back and sides.approach him from the back and sides.

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A final statementA final statement�� PsychiatryPsychiatry dosedose notnot havehave muchmuch luxuryluxury whenwhen itit comescomes

toto diagnosticdiagnostic lablab teststests andand helpinghelping diagnosticdiagnostic aidsaids andandmanymany symptomssymptoms ofof thethe psychiatricpsychiatric illnessillness isis hardhard dododefineddefined andand manymany ofof themthem areare notnot presentpresent allall ofof thethe timetimesoso thethe psychiatristpsychiatrist dependsdepends mostlymostly onon hishis observationsobservationsandand onon thethe extraextra eyeeye thatthat hehe hashas (( thethe nursenurse andand his/herhis/herobservations)observations) toto confirmconfirm diagnosesdiagnoses andand toto setset thetheobservations)observations) toto confirmconfirm diagnosesdiagnoses andand toto setset thethecorrectcorrect treatmenttreatment planplan.. ThatThat makesmakes thethe qualifiedqualifiedpsychiatricpsychiatric nursenurse aa valuablevaluable andand rearrear commoditycommodity inintoday'stoday's nursingnursing worldworld andand thethe wayway toto perfectionperfection ininpsychiatricpsychiatric nursingnursing startsstarts withwith understandingunderstanding ofof thetheimportantimportant rolerole ofof thethe psychiatricpsychiatric nursenurse andand improvingimprovingthethe psychiatricpsychiatric educationaleducational level,level, observationobservation skillsskills andanddocumentationdocumentation skillsskills ofof thethe psychiatricpsychiatric nursenurse..

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References References

�� Psychiatric Mental Health Nursing Psychiatric Mental Health Nursing ((66th addition) th addition) 20092009..�� ““ Toward Improved Quality Toward Improved Quality –– Developing Nurse’s Developing Nurse’s

Continuing Vocational Training In Hospitals And Inpatient Continuing Vocational Training In Hospitals And Inpatient UnitsUnits”. ”. 2006 2006 –– 2007 2007 By: By: VälimäkiVälimäki M, Scott A, Lahti M & M, Scott A, Lahti M & Chambers M (eds.)Chambers M (eds.)

�� Lippincott’s Manual Of Psychiatric Nursing Care PlansLippincott’s Manual Of Psychiatric Nursing Care Plans,,�� Lippincott’s Manual Of Psychiatric Nursing Care PlansLippincott’s Manual Of Psychiatric Nursing Care Plans,,88th Edition th Edition 20092009By: Lippincott Williams & Wilkins.By: Lippincott Williams & Wilkins.

�� AlAl--amalamal HospitalHospital InIn JeddahJeddah PoliciesPolicies AndAnd ProceduresProceduresManualManual,, 20092009,, JeddahJeddah..

�� EssentialsEssentials OfOf PsychiatricPsychiatric MentalMental HealthHealth NursingNursing,,CollaborativelyCollaboratively DevelopedDeveloped byby ISPNISPN andand APNA,APNA, ((20072007--20082008))..

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PSYCHIATRIC NURSES ARE IN THE SHADOW

QUALITY

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PSYCHIATRIC NURSING IS THE COMING TOMORROW