Canadian Standards of Practice for the Psychiatric Mental Health Nurse
The goal of psychiatric mental health nursing is the promotion of mental health and the prevention of mental disorders. The purpose of having standards is to provide direction for professional practice in order to promote safe, competent, and ethical service for clients. Standards are organized by a “Domain of Practice” framework with competencies classified within seven domains.
Domains include biological, social, sociobiological, psychological, psycho-social, psycho-biological and spirituality encompasses them all.
Standard one is to provide competent professional care through the development of a therapeutic relationship. It is based on trust and mutual respect. It is important to recognize the influences of culture, language, and ethnicity of the client.
Standard two is to perform client assessment through diagnostic and monitoring functions. This is where the nurse collaborates with the client and other members of the health care team for a holistic approach. Documentation and analysis of baseline data are collected.
Standard three utilizes evidence-based intervention to provide safe and effective nursing care. The administration of medication is done with close monitoring. Assist and educated clients to select choices that support positive changes in their life.
Standard four effectively manages rapidly changing situations while monitoring client safety. Resources are used to manage actual and potential crises.
Standard five intervenes through the teaching and coaching function. It determines clients learning needs through a collaborative process.
Standard six monitors and ensures the quality of health care practices. It identifies workplace attitudes and beliefs that may affect the nurses’ ability to perform duties safely.
Standard seven practices within the organizational and work-role structure. Works in partnership with client, family, and others to facilitate a safe supportive environment for all individuals.
Mental Health Assessment
The purpose of psychiatric assessment is to establish a report by health history, physical exam, and mental status examination. It also develops an understanding of how the client understands the meaning of health illnesses. This helps form a nursing diagnosis, goals, and interventions.
Observation is the first component of an interview. Here we read body language, facial expression, and perceptual disturbances. Next is the examination where nurses collect data such as health history, physical, and diagnostic tests. During an examination, there are several things health care professionals will pay attention to such as speech, appearance, mood, affect, cognition, and many more. Finally is the interview where the patient is the primary source of information but we can also talk to family, and look in their chart.
The mood is the pervasive sustained emotion that colors an individual’s perception. Affect is the expression of a mood in observable behaviors. Blunt effect is a limited range of emotions. Labile affect is intense frequently shifting emotional extremes.
Speech is observed for quality, quantity, rate, and frequency. Everyone has different strengths in how well they can respond and communicate with social clues. Speach is used to convey a person’s understanding of the situation. Speech gives health care professionals clues about a person’s thoughts, emotions, and cognitive ideas.
Perception can be either illusion or hallucination. Hallucinations can be auditory, visual, and tactile. It is false sensory perceptions not associated with real external stimuli. Illusions are misperception of a real external stimulus.
Insight is someone’s ability to understand the reality of a set of circumstances. Judgment is the ability to reach a logical decision about a situation
Always assess if the patient is a suicide risk. Ask them about suicide attempts, suicidal ideation, and threats of suicide.
Thought can only be assessed through language. Health care professionals must ask “how are you feeling”. Though content includes what the person is thinking about including their beliefs, ideas, obsessions, and preoccupations.
Alterations in People with Mental Illness
There are many signs to watch out for when observing and interviewing an individual. Delusions are a false fixed belief based on incorrect inference about reality. It cannot be corrected and is not shared by others. It is inconsistent with the level of education or cultural background. Clang associations are relating ideas based on sound or rhyme. Neologisms are the inventing of words by the client. Flight of ideas is rapid, continuous verbalization with frequent shifting in a topic. Echolalia is like an echo, imitation, or repeating what someone says.
Always assess the level of consciousness and their orientation to person, place, and time. Test retention and recall of information. For memory get them to recall 3 unrelated words at five-minute intervals for 15 minutes. Test Attention and concentration ability by asking them to subtract three from 20 or to spell mouse backward.
Therapeutic Groups
Group therapy is a great way for clients to get extra support. This creates awareness that they are not alone. They gain information from others and the instructor. They also gain insight into how their behaviors affect others.
Milieu Therapy is an environment designed to meet the clients’ emotional and interpersonal needs. This includes the physical surroundings, activities, and cultural setting. This will validate the clients’ individuality. It will support the clients’ safety in a familiar environment.
There are many different types of help support groups. Interactive groups are for self-help. Structured groups are for cognitive-behavioral and psychoeducational help. Common Nursing intervention groups are groups such as medication management and symptom management.
Medication
Medication is selected based on its effect and the client’s symptoms. Many medications take time to reach a therapeutic level, so be patient before switching to a new medication. The lowest effective dose is always given. Medications cannot be abruptly stopped. Please talk to a health care professional if you are considering to stop taking your medication. Follow up is needed to ensure compliance, make adjustments, and manage side effects.
Recovery
Recovery is a quality of life. Nurses and the health care team aim to enable individuals to have a meaningful, fulfilling life. This is supported by the strengths of the individual, family, and community. This occurs when the client is taking their meds regularly, therefore, decreasing their mental health symptoms and therefore increases their wellbeing.
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