psychiatric nursing quality guid line

Psychiatric Nursing Psychiatric Nursing Quality Guide lines Quality Guide lines

By: Hatim AbdulAziz BanjarBy: Hatim AbdulAziz Banjar(Nursing quality coordinator and hospital risk officer)(Nursing quality coordinator and hospital risk officer)

Al-Amal Hospital (Jeddah)Al-Amal Hospital (Jeddah)Mob. 00966 540572716Mob. 00966 [email protected]@hotmail.com

2/11/20092/11/2009 11Hatim BanjarHatim Banjar

IntroductionIntroduction

Mental health problems are an international and national concern. More than 30% of adults are estimated to experience at least one form of mental ill health during any one year. 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.


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 method collection of multiple data from multiple sources

that discuses points in quality of psychiatric nursing.

Emphasis on the special points of psychiatric nursing.


What is psychiatric nursing?What is psychiatric nursing?

IT is the specialty ofIT is the 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 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.


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

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,

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


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

Clear insight with high self-understandingClear insight with high self-understanding (Stigmatization and ethical dilemmas are high in (Stigmatization and ethical dilemmas are high in

psychiatric nursing)psychiatric nursing) psychiatric and medical-surgical nursing skills psychiatric and medical-surgical nursing skills

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


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 and physical staminapsychological and 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)

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)


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:

confidentiality-confidentiality-(Breaking confidentiality can be if (Breaking confidentiality can be if there is a well-defined reason to share information: there is a well-defined reason to share information:

Benefit outweighs harm. This is an ethical dilemma ) Benefit outweighs harm. This is an ethical dilemma ) veracity-veracity-(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)fidelity-fidelity-(psychiatric treatment depends trust and (psychiatric treatment depends trust and

maintaining therapeutic alliance)maintaining therapeutic alliance)non malfeasances-non malfeasances-(many psychiatric patients are easy (many psychiatric patients are easy

to take advantage of)to take advantage of) 2/11/20092/11/2009 88Hatim BanjarHatim Banjar

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: assessment-assessment-(the main dependence is on (the main dependence is on objective data)objective data)nursing Diagnosis-nursing 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)

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.


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

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


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

Protecting the patient from harming himself :Protecting the patient from harming himself : That is done by monitoring patients with tendency to comet That is done by monitoring patients with tendency to comet

suicide or to cause harm to themselves and placing them suicide or to cause harm to themselves and placing them under clues observation, exploring their thought content under clues observation, exploring their thought content and try to distract them away from such ideas and try to and try to distract them away from such ideas and try to occupy their time with different activities and give them a occupy their time with different activities and give them a since of hope in life and place them in a safe environment since of hope in life and place them in a safe environment in the wards away from any external stimulators for such in the wards away from any external stimulators for such ideas and away from any harmful object that he might use ideas and away from any harmful object that he might use to cause harm to him self .to cause harm to him self .

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


Protecting the patient from being harmed by others:Protecting the patient from being harmed by others: That is done by monitoring aggressive and provoking That is done by monitoring aggressive and provoking

behaviors so physical contact ( fights) don't happen among behaviors so physical contact ( fights) don't happen among patients, delusions and wrong beliefs are also monitored to patients, delusions and wrong beliefs are also monitored to prevent patients from causing harm to each other due to prevent patients from causing harm to each other due to the delusions or beliefs and in case of any physical the delusions or beliefs and in case of any physical contact among patients nurses must interfere as quickly as contact among patients nurses must interfere as quickly as possible using the right manner of intervention also possible using the right manner of intervention also patients of deferent age groups and genders must be patients of deferent age groups and genders must be separated to prevent sexual assault ( male – female ) separated to prevent sexual assault ( male – female ) ( adult – teenagers - children ) .( adult – teenagers - children ) .

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


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 ) 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.


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 15min.chick on patient and take vital signs every 15min.

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 .2/11/20092/11/2009 1414Hatim BanjarHatim Banjar

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

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.


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. 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.


A final statementA final statement Psychiatry dose not have much luxury when it comes Psychiatry dose not have much luxury when it comes

to diagnostic lab tests and helping diagnostic aids and to diagnostic lab tests and helping diagnostic aids and many symptoms of the psychiatric illness is hard do many symptoms of the psychiatric illness is hard do defined and many of them are not present all of the defined and many of them are not present all of the time so the psychiatrist depends mostly on his time so the psychiatrist depends mostly on his observations and on the extra eye that he has ( the observations and on the extra eye that he has ( the nurse and his/her observations) to confirm diagnoses nurse and his/her observations) to confirm diagnoses and to set the correct treatment plan. That makes the and to set the correct treatment plan. That makes the qualified psychiatric nurse a valuable and rear qualified psychiatric nurse a valuable and rear commodity in today's nursing world and the way to commodity in today's nursing world and the way to perfection in psychiatric nursing starts with perfection in psychiatric nursing starts with understanding of the important role of the psychiatric understanding of the important role of the psychiatric nurse and improving the psychiatric educational level, nurse and improving the psychiatric educational level, observation skills and documentation skills of the observation skills and documentation skills of the psychiatric nurse.psychiatric nurse.


References References

Psychiatric Mental Health Nursing Psychiatric Mental Health Nursing (6th addition) 2009.(6th addition) 2009. ““Toward Improved Quality – Developing Nurse’s Toward Improved Quality – Developing Nurse’s

Continuing Vocational Training In Hospitals And Inpatient Continuing Vocational Training In Hospitals And Inpatient UnitsUnits”. 2006 – 2007 By: Välimäki M, Scott A, Lahti M & ”. 2006 – 2007 By: Välimäki 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,,

8th Edition 2009By: Lippincott Williams & Wilkins. 8th Edition 2009By: Lippincott Williams & Wilkins. Al-amal Hospital In Jeddah Policies And Procedures Al-amal Hospital In Jeddah Policies And Procedures

ManualManual, 2009, Jeddah., 2009, Jeddah. Essentials Of Psychiatric Mental Health NursingEssentials Of Psychiatric Mental Health Nursing, ,

Collaboratively Developed by ISPN and APNA, (2007-Collaboratively Developed by ISPN and APNA, (2007-2008).2008).



Psychiatric nurses are in the shadow

QUALITY

Psychiatric nursing is the coming tomorrow

psychiatric nursing quality guid line

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