STANDARDS OF MENTAL HEALTH NURSING

The purpose of Standards of Psychiatric and Mental Health Nursing practice is to fulfill the
profession's obligation to provide a means of improving the quality of care. The standards
presented here are a revision of the standards enunciated by the Division on Psychiatric and
Mental Health Nursing Practice in 1973.
Professional Practice Standards
Standard I: Theory
The nurse applies appropriate theory that is scientifically sound as a basis for decisions regarding
nursing practice. Psychiatric and mental health nursing is characterized by the application of
relevant theories to explain phenomena of concern to nurses and to provide a basis for
intervention.
Standard II: Data Collection
The nurse continuously collects data that are comprehensive, accurate and systematic.Effective
interviewing, behavioral observation, physical and mental health assessment enable the nurse to
reach sound conclusions and plan appropriate interventions with the client.
Standard Ill: Diagnosis
The nurse utilizes nursing diagnoses and/ or standard classification of mental disorders to
express conclusions supported by recorded assessment data and current scientific premises.
Nursing' s logical basis for providing care rests on the recognition and identification of those
actual or potential health problems that are within the scope of nursing practice.
Standard IV: Planning
The nurse develops a nursing care plan with specific goals and interventions delineating nursing
actions unique to each client's needs. The nursing care plan is used to guide therapeutic
intervention and effectively achieve the desired outcomes.
Standard V:Intervention
The nurse intervenes as guided by the nursing care plan to implement nursing actions that
promote, maintain or restore physical and mental health, prevent illness and effect rehabilitation.
(a) Psychotherapeutic interventions: The nurse uses psychotherapeutic interventions to assist
clients in regaining or improving their previous coping abilities and to prevent further disability.
(b) Health teaching: The nurse assists clients, families and groups to achieve satisfying and
productive patterns of living through health teaching.
(c) Activities of daily living: The nurse uses the activities of daily living in a goal directed way to
foster adequate self-care and physical and mental well being of clients.
(d) Somatic therapies: The nurse uses knowledge of somatic therapies and applies related
clinical skills in working with clients.
(e) Therapeutic environment The nurse provides, structures and maintains a therapeutic
environment in collaboration with the client and other health care providers.
(f) Psychotherapy The nurse utilizes advanced clinical expertise in individual, group and family
psychotherapy, child psychotherapy and other treatment modalities to function as a
psychotherapist and recognizes professional accountability for nursing practice.
Standard VI: Evaluation
The nurse evaluates client responses to nursing actions in order to revise the database, nursing
diagnoses and nursing care plan.
Professional Performance Standards
Standard VII: Peer Review The nurse participates in peer review and other means of evaluation
to assure quality of nursing care provided for clients.
Standard VIII: Continuing Education
The nurse assumes responsibility for continuing education and professional development and
contributes to the professional growth of others.
Standard IX: Interdisciplinary Collaboration
The nurse collaborates with other health care providers in assessing, planning, implementing and
evaluating programs and other mental health activities.
Standard X: Utilization of Community Health Systems
The nurse participates with other members of the community in assessing, planning,
implementing and evaluating mental health services and community systems that include the
promotion of the broad continuum of primary, secondary and tertiary prevention of mental
illness.
Standard XI: Research
The nurse contributes to nursing and the mental health field through innovations in theory and
practice and participation in research.
CURRENT ISSUES AND TRENDS IN CARE (SCOPE)
A psychiatric nurse faces various challenges because of changes in patient care approach. Some
of these changes that affecther role are as follows:
Demographic Changes
• Type of family (increased number of nuclear families)
• Increasing number of the elderly group
Social Changes
• The need for maintaining intergroup and intragroup loyalties
• Peer pressure
Economic Changes
• Industrialization
• Urbanization
• Raised standard of living
Technological Changes
• Mass media
• Electronic systems
• Information Technology
Mental Health Care Changes
• Increased awareness in the public regarding mental health
• Need to maintain mental stability
• Increased mental health problems
The above changes set the current trends in mental health care. Some of these are:
Educational Programs for the Psychiatric Nurse
• Diploma in Psychiatric Nursing (The first program was offered in 1956 at NIMHANS,
Bangalore).
• M.Sc in PsychiatricNursing (Thefirst program was offered in 1976at Rajkumari Amrit Kaur
College of Nursing, New Delhi).
• M.Phil in Psychiatric Nursing (1990, M.G. University, Kottayam).
• Doctorate in Psychiatric Nursing (offered at
MAHE, Manipal; RAK College of Nursing,
Delhi;NIMHANS, Bangalore).
• Short-term training programs for both the degree and diploma holders in nursing.
Standards of Mental Health Nursing
The development of standards for nursing practice is a beginning step towards the attainment of
quality nursing care. The adoption of standards helps to clarify nurses' areas of accountability,
since the standards provide the nurse, the health agency, other professionals, clients, and the
public, with a basis for evaluating practice. Standards also define the nursing profession's
accountability to the public. These standards are therefore a means for improving the quality of
care for mentally ill people.
Development of Code of Ethics
This is very important for a psychiatric nurse as she takes up independent roles in psychotherapy,
behavior therapy, cognitive therapy, individual therapy, group therapy, maintains patient's
confidentiality, protects his rights and acts as patient's advocate.
Legal Aspects in Psychiatric Nursing
Knowledge of the legal boundaries governing psychiatric nursing practice isnecessary to protect
the public, the patient, and the nurse. The practice of psychiatric nursing is influenced by law,
particularly in its concern for the rights of patients and the quality of care they receive. The
client's right to refuse a particular treatment, protection from confinement, intentional torts,
informed consent, confidentiality, and record keeping are a few legal issues in which the nurse
has to participate and gain quality knowledge.
Promotion of Research in Mental Health Nursing
The nurse contributes to nursing and the mental health field through innovations in theory and
practice and participation in research.
Cost Effective Nursing Care
Studies need to be conducted to find out the viability in terms of cost involved in training a
nurse and the quality of output in terms of nursing care rendered by her.
Focus of Care
A psychiatric nurse has to focus care on certain target groups like the elderly, children, women,
youth, mentally retarded and chronic mentally ill.
New Trends in Role of a Psychiatric Nurse
Primary Mental Health Nursing
Psychiatric nurses are moving into the domain of primary care and working with other nurses
and physicians to diagnose and treat psychiatric illness in patients with somatic complaints.
Cardiovascular, gynecological, respiratory, and gastrointestinal and family practice settings are
appropriate for assessing patients for anxiety, depression and substance abuse disorders.
Collaborative Psychiatric Nursing Practice
Patients who are having difficulty being stabilized on their medications or who have co-morbid
medical illnesses are seen in a psychiatric nursing clinic where nurses and physicians collaborate
to provide high quality patient care.
Registered Psychiatric Nurse (RPN)
A Registered Psychiatric Nurse provides psychiatric mental health nursing care to individuals,
families, and groups to enable them to function at an optimal level of psychological wellness
through more effective adaptive behaviors and increased resilience to stress. She works with
children, adolescents, adults and elderly with dysfunctional behavior patterns, and developmental
handicaps. A registered psychiatric nurse works as an independent entity. She works in various
kinds of inpatient facilities and community settings.
Clinical Nurse Specialist (CNS)
The Clinical Nurse Specialist provides consultative services to nursing personnel. She attends
clinical teaching programs, demonstrates therapies, conducts in-service education programs,
initiates and participates in curriculum revision/ changes and nursing research.
Case Management
Using case management a psychiatric mental health nurse is responsible for assessing needs,
identifying services, and monitoring and evaluating client status. A case manager coordinates
care through collaboration with all involved health professionals ensuring accessibility and
availability of care.
Nurse Psychotherapist
The psychiatric nurse can take up psychotherapy roles as in individual therapy, group therapy,
counseling, etc.
Psychiatric Nurse Educator
The main function of psychiatric nurse educator is planning and changing the curriculum
according to the needs of the society and learner. The Indian Nursing Council included
psychiatric nursing as compulsory for the qualifying examination in B.Sc Nursing program in
1965, and from 1986 it became a component in General Nursing and Midwifery course as well.
The number of nurses in the field of teaching psychiatric nursing needs to be enhanced. This is a
big challenge for nursing curriculum planners.
Psychosocial Rehabilitation Nursing
It is concerned with helping people with chronic mental illness to lead more independent and
satisfactory lives in the community.
Child Psychiatric Nursing
In child psychiatric nursing the nurse identifies emotional and behavioral problems of the
children and provides comprehensive care.
Gerontological and Geriatric Nursing
Gerontological nursing provides emotional support to those people who have retired from
services,who have no financial sources and helps them in understanding the situation, and
developing new coping mechanisms. Geriatric nursing is expanding the psychiatric nursing
practice to aged people who have been affected by emotional and behavioral disorders such as
dementia, chronic schizophrenia, delirium, etc.
Deaddiction Nursing
A psychiatric nurse in these units identifies psychosocial problems and maintaining factors
in addicts. She also provides various therapies to the addicts and their family members.
Neuropsychiatric Nursing
Psychiatric nursing practice is extended to patients who are suffering from neuropsychiatric
disorders such as dementia, epilepsy, brain tumor, head injury with behavioral problems, HIV
infection with behavioral problems, etc.
Community Mental Health Nursing
Community mental health nursing is the application of knowledge of psychiatric nursing
in preventing mental illness, promoting and maintaining mental health of the people. It
includes early diagnosis, appropriate referrals, care and rehabilitation of mentally ill people.
Advanced Practice Roles
These include: Nursing leadership in forensic health units, crisis intervention, risk assessment
and management in community settings.