Module 4

Standards of Psychiatric-Mental Health Nursing Practice

THE STANDARDS OF PSYCHIATRIC NURSING PRACTICE
The Standards of Psychiatric Nursing Practice sets out the minimum acceptable level of
performance
required of a Registered Psychiatric Nurse. These standards articulate the legal and professional
obligations of all RPNs. They apply to all practice settings, domains and roles, regardless of an
individual RPN’s educational preparation or professional experience. It is the professional
responsibility of each Registered Psychiatric Nurse to know, understand and adhere to these
standards. Throughout this guide, indicators illustrate how to meet each standard. These
indicators are representative but not comprehensive. In actual practice, specific indicators may
vary according to the situation and context of the psychiatric nurses’ role. It is the professional
responsibility of the
Registered Psychiatric Nurse to articulate how they meet each standard.

To promote positive client outcomes, RPN practice is guided by a code of ethics, competencies,
and standards of practice. The diagram above depicts the five key standards of practice and
how they interact to guide the entire profession.
STANDARDS OF PSYCHIATRIC NURSING PRACTICE
STANDARD 1. THERAPEUTIC RELATIONSHIPS
 The Registered Psychiatric Nurse establishes collaborative professional,
interpersonal, and therapeutic relationships with clients.
A Registered Psychiatric Nurse:
1. Continually applies the therapeutic use of self within professional practice.
2. Recognizes and addresses power imbalances in therapeutic relationships.
3. Ensures client needs remain the focus of the therapeutic relationship.
4. Does not exploit the vulnerability of persons encountered through their practice.
5. Will not engage in any sexual behavior while in a therapeutic relationship with a client, with or
without consent.
6. Will not enter into a close personal or intimate relationship with a client or a former client who has
received psychotherapeutic treatment from the Registered Psychiatric Nurse.
7. Uses professional judgment, effective communication and interpersonal skills, and practices with
integrity to establish, maintain and terminate the therapeutic relationship.
8. Recognizes and addresses transference and counter-transference and their impact on the therapeutic
relationship.
9. Applies critical thinking and professional judgment in therapeutic relationships.
10. Establishes and negotiates boundaries in therapeutic relationships.
11. Practices according to the principles of informed consent and confidentiality.
12. Will make best efforts to find suitable alternatives to treating their own family or friends.
13. Develops partnerships using a client-centered, integrated and holistic approach.

STANDARD 2. COMPETENT, EVIDENCE-INFORMED PRACTICE

 The Registered Psychiatric Nurse continually acquires and integrates evidence
informed knowledge and builds on psychiatric nursing education and lifelong
learning.
A Registered Psychiatric Nurse:
1. Applies evidence-informed knowledge, skill, critical thinking and professional judgment to
assess, plan, implement, and evaluate in the practice of psychiatric nursing.
2. Incorporates evidence-informed knowledge to promote safety and quality in psychiatric
nursing practice.
3. Uses communication skills effectively.
4. Integrates cultural competence and cultural safety into their practice with diverse clients.
5. Recognizes potential risks and hazards, and implements interventions to promote a safe
environment.
6. Integrates infection prevention and control principles in providing psychiatric nursing care.
7. Documents the application of the clinical decision-making process in a responsible,
accountable and ethical manner.
8. Applies documentation principles to ensure effective written/electronic communication.
9. Remains current in knowledge relevant to their practice.
10. Incorporates knowledge of therapeutic modalities and conceptual models of psychiatric
nursing.
11. Coordinates client care and/or health services throughout the continuum of care.
12. Establishes, maintains and coordinates a plan of care based on a comprehensive psychiatric
nursing assessment.
STANDARD 3. PROFESSIONAL RESPONSIBILITY AND ACCOUNTABILITY
 The Registered Psychiatric Nurse is accountable and responsible for safe,
competent and ethical psychiatric nursing practice that meets the standards of
the profession and legislated requirements.
A Registered Psychiatric Nurse:
1. Maintains current registration/licensure.
2. Practices in accordance with all relevant legislation and regulation including the Standards of
Psychiatric Nursing Practice.
3. Exercises professional judgment when agency policies and procedures are unclear or absent.
4. Assumes responsibility and accountability for continuing competence, and for meeting
continuing competence requirements.
5. Seeks out the necessary resources using skill and professional judgment to address personal
and professional limitations.
6. Recognizes the competencies and limitations of colleagues and/or students when assigning
responsibilities.
7. Responds to and/or reports unsafe practice, professional incompetence, professional
misconduct, and incapacity or fitness-to-practice issues to the appropriate authority.
8. Complies with any legal duty to warn and report, including abuse or potential harm to the
public.
9. Self-reports to the regulatory body conditions that compromise their fitness to practice.
10. Uses technology, electronic communication and social media responsibly and
professionally.
STANDARD 4. LEADERSHIP AND COLLABORATION IN QUALITY PSYCHIATRIC NURSING
PRACTICE
 The Registered Psychiatric nurse enhances the safety, quality and effectiveness
of psychiatric nursing practice through leadership and collaboration.
A Registered Psychiatric Nurse:
1. Engages in practices that promote physical, environmental and psychological safety.
2. Evaluates the effectiveness of interventions in psychiatric nursing practice.
3. Participates in quality improvement activities to initiate change in psychiatric nursing practice
and in the health care system.
4. Collaborates with client, team members, families and other stakeholders to develop
comprehensive psychiatric nursing care to achieve the client’s health goals.
5. Mentors colleagues and stakeholders for the advancement of psychiatric nursing practice
and quality health care.
6. Promotes collaborative practice among health care professionals through respectful working
relationships and appropriate documentation practices.
7. Acts as a leader, teacher and role model to students, beginner practitioners and colleagues,
supporting, Instructing and/or mentoring them in their professional development.
8. Takes action to resolve professional practice issues.
9. Collaborates with and advocates for clients.
10. Demonstrates professional leadership through:
i) Building trusting relationships
ii) Creating empowering environments
iii) Supporting knowledge development and integration within the health care team
iv) Advancing psychiatric nursing practice and quality health care
v) Leading and sustaining change and balancing competing values and priorities
STANDARD 5. PROFESSIONAL ETHICAL PRACTICE
 The Registered Psychiatric Nurse understands, upholds and incorporates the
profession’s Code of Ethics into their professional practice.
A Registered Psychiatric Nurse:
1. Practices with honesty, integrity and respect, demonstrating the ethics, standards, principles,
guidelines and values of the profession.
2. Applies the Code of Ethics in all areas of their practice.
3. Identifies the effect of their own values, beliefs and experiences in relationships with clients,
recognizes potential conflicts, and takes action to prevent or resolve them.
4. Applies ethical and legal considerations in maintaining confidentiality in all forms of
communication. 5. Supports the human, legal and moral rights of clients, including the right to
make informed decisions and the right to live at risk.

A. Structure Criteria and Standards

1. Qualifications of the Nurse
 Personal
Qualities of a good Nurse:
1.Caring nature
 deal with the sick and injured and their families on a daily basis, and must be
able to show that they truly care about the situation.
2.Empathic attitude
 Nurses must be able to put themselves in their patients’ shoes to provide the
quality care needed.
3.Detail oriented
 Nurses must remember to make entries on patients’ charts and to bring
medications at the correct times.
4.Emotionally stable
 Nurses feel the joy of seeing a new baby born as well as the pain of losing a long-
term patient. Emotional stability is crucial to deal with the wide range of
emotions nurses must endure.
5.Adaptable
 People are unpredictable at the best of times, but become even more so under
stress, so a nurse’s typical workday will require flexibility and adaptability.
6.Hardworking
 Nursing is a never ending job. It is unusual for a hospital or medical canter to be
overstaffed, which of course means more workload on each nurse in the unit.
7.Quick thinker
 When a nurse notices something is not right with a patient, they must be able to
make decisions quickly and put their plans into action instantly, because a
fraction of a second can mean the difference between life and death.
8.Physical endurance
 Nurses are on their feet all day, sometimes 12 or more hours at a time, and are
often required to assist patients with activities that require physical strength.
9.Good judgment
 A nurse must be able to look at a patient’s current state and accurately assess
what is needed, especially during emergencies.
10.Good communication skills
 Nurses must communicate with other nurses, doctors, patients, and patients’
families clearly

 Professional:
Profession
 Is a calling that requires special knowledge, skill and preparation.
 An occupation with ethical components, that is devoted to the promotion of
human & social welfare.
 A profession is “an occupation or calling requiring advanced training and
experience in some specific or specialized body of knowledge which provides
service to society in that special field.
Nursing as a profession:
NURSING
 Is a disciplined involved in the delivery of health care to the society.
 Is a helping profession.
 Is service-oriented to maintain health and well- being of people.
 Is an art and a science.
NURSE
 originated from a Latin word NUTRIX, to nourish.
Characteristics of Nursing:
 Nursing is caring.
 Nursing involves close personal contact with the recipient of care.
 Nursing is concerned with services that take humans into account as
physiological, psychological, and sociological organisms.
 Nursing is committed to promoting individual, family, community, and national
health goals in its best manner possible.
 Nursing is committed to personalized services for all persons without regard to
color, creed, social or economic status.
 Nursing is committed to involvement in ethical, legal, and political issues in the
delivery of health care.
2. Functions of the Nurse
 Care givers: include those activities that assist the client physically and psychologically
while preserving the client dignity.
 Communicator: integrated to all nursing role. In the role of communicator nurse
identify nurse identify client’s problem and then communicate them verbally or in
writing to other member of the health team.
 Teacher: the nurse help client learn about their health and the health care procedure.
 Client advocate: act to protect the client.
 Counselor: counseling is the process of helping a client to recognize and cope with
stressful psychological or social problem and to develop and improve the personal
relationship.
 Change agent: make modification on their own behavior.
 Leader: influence the other to work together to accomplish to specific goal.
 Manager: manages the nursing care oat individual family and community.
 Research consumer: use research to improve cleat care.
3. Physical Facilities and Equipment
 The range of psychiatric facilities includes psychiatric hospitals and neuro-psychiatric
nursing units of general hospitals, facilities of the psychiatric medical infirm,
geropsychiatric units, alcohol and drug addiction treatment facilities both inpatient and
outpatient and mental health clinics.
 Efficiency and cost effectiveness
 The design of successful psychiatric facility should:
 Promote staff efficiency by minimizing distance of necessary travel
between frequent used spaces.
 Allow easy visual supervision of patients by limited staff. Nurse stations
on in patient units should be designed to provide maximum visibility of
patient’s areas.
 Includes all needed spaces but no redundant ones. This requires careful
pre design programming.
  For inpatient units, provide a central meeting area or living room for staff
and patients and provide smaller rooms where patients can visit their
families.
 Make efficient use of space by locating support places so that they may
be shared by adjacent functional areas and by making prudent use of
multi-purpose spaces.
 Cleanliness
 Psychiatric facility should be easy to clean and maintain. That is facilitated by:
 Appropriate, durable finishes for each functional space.
 Proper detailing of such features as doorframes, casework and finish
transition to avoid dirt-catching and hard to clean services and joints.
 Security and Safety
 The potential suicide patients are a special concern of psychiatric facilities. The
facilities must not unwittingly create opportunities for suicide. Design to address
this and other safety and security issues includes:
 Plumbing, electrical and mechanical devices design to be tamper proof.
 Use of breakaway shower- rods and bars, no clothes hooks.
 Elimination of all jumping opportunities.
 Control of entrance and exit by staffs.
 Provision for patient bedroom doors to be opened by staff in case of
emergency.
 Laminated glass of windows inpatient units.
 Fiber reinforced gypsum board for walls.
 Eliminate the use of door knobs and handles.
 Solid material’s specified for ceiling

B. Process Criteria and Standards

NURSING PROCESS
 Specific to the nursing profession
 A framework for critical thinking
 Its purpose is to: “Diagnose and treat human responses to actual or potential health
problems”

NURSING DIAGNOSIS VS. MEDICAL DIAGNOSIS

Within the scope of nursing practice Within the scope of medical practice
Identify responses to health and illness Focuses on curing pathology
Can change from day to day Stays the same as long as the disease is present

 Organized framework to guide practice

  Problem solving method - client focused
 Systematic- sequential steps
 Goal oriented- outcome criteria
 Dynamic-always changing, flexible
 Utilizes critical thinking processes
Advantages of Nursing Process
 Provides individualized care
 Client is an active participant
 Promotes continuity of care
 Provides more effective communication among nurses and healthcare professionals
 Develops a clear and efficient plan of care
 Provides personal satisfaction as you see client achieve goals
 Professional growth as you evaluate effectiveness of your interventions
5 Steps in the Nursing Process
 Assessment
 Nursing Diagnosis
 Planning
 Implementing
 Evaluating

C. Outcome Criteria and Standards

1. Progress and Effects of Nursing Care
 Of quality in nursing documentation and care facilities continuity of care and patient
safety. Lack of communication between healthcare providers is associated with errors
and adverse events.
 High quality nursing care aims to promote structured consistent and effective
communication between caregivers and facilities continuity and patient safety.
 Quality of healthcare means providing the care the patient needs when the patient
needs it, in affordable, safe, effective manner.
 The quality of care also engaging and involving the patient, so the patient takes
ownership in preventive treatment care and in the treatment of diagnosed conditions.