MENTAL HEALTH( PSYCHIATRIC) NURSING

A Presentation on TRENDS and ISSUES

Points for Discussion

A) Trends Introduction History Psychiatric Nursing In Globalization era Present scene Changes and Challenges Current trends Trends in the Role of a Psychiatric

Nurse

B) Issues

Legal Aspects

• Terminologies• Types of laws• Legal Issues

Ethical Aspects

• Principles• Dilemmas• Issues

Trends in Psychiatric Mental Health Nursing

History Institutionalization

In the Globalization Era

De Institutionalization Psychotropic Drugs

How do we integrate with Mental Health Community?

• Experience and Education• Role and Functions• Relationships with other

professions- Leininger(1973)

Present Scene of Mental Health

• 450 million people affected worldwide• Mental problems common to all countries• 1 in every 4 persons going for health

services has atleast one emotional problems

• Mental problems of Clients with Chronic disorders

• Unavailability of cost effective treatment• Lack of recognition, awareness and action

Issues around Mental health Nursing

• Hard to justify scientifically due to the lack of Research results

• Less ready to face the free market• Role differentiation based on

education and experience is unclear.

• Become Psychiatric Nurse is not an option for students!

Changes and Challenges

Demographic changes

Social changes

Economic Changes

Technological changes

Mental health care changes

a) Demographic Changes

Type of family Increasing No. of Elderly

b) Social changes

• Intergroup and intra group loyalty maintenance

• Peer Pressure

c) Economic changes

• Industrialization• Urbanization• Raised Standard

of Living

d) Technological changes

• Mass media• Electronic

Systems• Information

Technology

e) Mental Health care changes

• Increased awareness in public about Mental health

• Need to maintain mental stability

• Increased mental health problems

Current trends in Mental health carte

• Educational Programmes for Psychiatric Nurse• Development of Code of Ethics• Legal aspects in Psychiatric Nursing• Promotion of Research in Mental Health Nursing• Cost effective Nursing Care• Focus of Care• World Health Day• Mental Health Global Action Programme• Health and Human Rights• Revision of Hospital Medical Code• Getting ready for DSM-5

New Trends in the Role of a Psychiatric Nurse

New Trends in the Role of a Psychiatric Nurse

Primary Mental Health Nursing

Collaborative

Psychiatric

Nursing Practice

Clinical Nurse

Specialist

Nurse Psychotherapist

Psychiatric

Nurse Educato

r

Psycho social

Rehabilitation

Nursing

New trends

Child Psychiatric Nursing

Gerontological and Geriatric Nursing

Deaddiction

nursing

Neuro psychiatric Nursing

Community Mental

Heath nursing

Issues in Psychiatric Mental Health Nursing

Legal Aspects

Basic Terminologies

• Civil Law: Civil law defines the rights and duties of the individuals in relation to each other. Civil law protects the private and property rights of the individuals and businesses.

I. Tort• Intentional• UnintentionalII. Contract

• Criminal Law: Criminal law defines certain acts as offences against the state and in doing so makes them punishable. The criminal law is enforced by or on behalf of the State. Criminal law provides protection from conduct deemed injurious to the public welfare

• Statutory Law: A statutory law is a law that has been enacted by legislative body, such as country or city council, the state legislature or the parliament. An example statutory law such as the Indian Nursing Council Act.

• Common Law: Common laws are derived from decisions made in previous cases. These laws apply to a body of principles that evolve from court decisions resolving various controversies

• Right to Confidentiality is a basic one, and especially so in psychiatry. Although social attitudes are improving, individuals have been discriminated against in the past for no other reason than for having a history of emotional illness.

• Informed Consent is a client’s permission granted to a physician to perform therapeutic procedure, before which information about the procedure has been presented to the client with adequate time given for consideration about the pros and cons.

• Restraints generally refers to a set of leather straps that are used to restrain the extremities of an individual whose behaviour is out of control and who poses an inherent risk to the physical safety and psychological well-being of the individual and staff.

• Seclusion is another type of physical restraint in which the client is confined alone in a room from which he or she is unable to leave.

• False Imprisonment is the deliberate and unauthorized confinement of a person within fixed limits by the use of verbal or physical means.

• Gravely Disabled is generally defined as a condition in which an individual, as a result of mental illness, is in danger of serious physical harm resulting from inability to provide for basic needs, such as food, clothing, shelter, medical care and personal safety.

• Negligence: The omission (of a person) to do something which a reasonable person, guided by those ordinary considerations which ordinarily regulated human affairs, would do or the doing of something which a prudent and reasonable person would not do.

• Malpractice:“The failure of one rendering professional services to exercise that degree of skill and learning commonly applied under all the circumstances in the community by the average prudent reputable member of the profession with the result of injury, loss or damage to the recipient of those services or to those entitled to rely upon them.”

• Libel: Written Defamation• Slander: Oral defamation• Invasion of Privacy: is a charge that

may result when a client is searched without probable cause.

• Assault is an act that results in a person’s genuine fear and apprehension that he or she will be touched without consent.

• Battery is the unconnected touching of another person.

Types of Laws

Types of Laws

Statutory Lawa)Tort

b)Contract

Common Law

Legal Issues

• Right to Confidentiality is a basic one, and especially so in psychiatry. Although social attitudes are improving, individuals have been discriminated against in the past for no other reason than for having a history of emotional illness.

Informed Consent• Informed Consent is a client’s

permission granted to a physician to perform therapeutic procedure, before which information about the procedure has been presented to the client with adequate time given for consideration about the pros and cons.

3 major elements of informed consent

Knowledge

Competency

Free Will

Restraints and Seclusion• Restraints generally refers to a set of

leather straps that are used to restrain the extremities of an individual whose behaviour is out of control and who poses an inherent risk to the physical safety and psychological well-being of the individual and staff.

“Talking down”- a less Restrictive measure• Seclusion is another type of physical

restraint in which the client is confined alone in a room from which he or she is unable to leave.

Orders re issued for R&S?

False Imprisonment

• False Imprisonment is the deliberate and unauthorized confinement of a person within fixed limits by the use of verbal or physical means.

Commitment Issues

Voluntary Admissions

Involuntary Commitment

Emergency Commitment

The Mentally ill person in need of Treatment

Involuntary Outpatient Commitment(IOC)

The Gravely Disabled Client

Malpractice and Negligence

Malpractice is the failure of one rendering professional services to exercise that degree of skill and learning commonly applied under all the circumstances in the community by the average prudent reputable member of the profession with the result of injury, loss or damage to the recipient of those cervices or to those entitled to rely upon them

Negligence is the omission (of a person) to do something which a reasonable person, guided by those ordinary considerations which ordinarily regulated human affairs, would do or the doing of something which a prudent and reasonable person would not do.

Failure to prevent Dangerous Client

behaviour• “ Tarasoff Duty to warn”An interesting Love story???!!!

Sexual Involvement with Clients

Breaching Confidentiality

Failure to Honour individual Rights

Control of Violent or Self destructive behaviours

Law suits that occur in Psychiatric Nursing

• Breach of Confidentiality• Defamation of Character

LibelSlander

• Invasion of PrivacyAssaultBattery

How to avoid Liability?

Practice within the scope of the nurse practice act.

Observe the hospital’s and department’s policy manuals.

Measure up to established practice standards.

Always put the client’s rights and welfare first.

Develop and maintain a good interpersonal relationship with each client and his or her family.

Ethical Aspects

Ethical Principles

Autonomy

Beneficence

Fidelity

JusticeNon Malefience

Veracity

Ethical Dilemmas in Mental Health

An ethical dilemma is a situation in which ethical principles conflict or when there is no one clear course of action in a given situation.

Ethical Decision Making

• Assessment Subjective and Objective data

• Problem Identification Conflict

• Plan Explore benefits and Consequences Principles and Theories Select an alternative

• Implementation• Evaluation

Let’s Decide!

Should a client who is loud and intrusive to other

clients on a hospital unit be secluded from the

others?

When a therapeutic relationship has ended, can a health care professional nurse ever have a social or intimate relationship with someone he or she met as a client?

Are clients who are psychotic necessarily

incompetent or do they still have the right to refuse

hospitalization and medication?