1. Psychiatric Nursing
Quality Guide lines
By: Hatim AbdulAziz Banjar
(Nursing quality coordinator and hospital risk officer)
Al-Amal Hospital (Jeddah)
Al-
Mob. 00966 540572716
hab.1978@hotmail.com
hab.1978@hotmail.com
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2. Introduction
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.
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3. The 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.
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4. What is psychiatric nursing?
It is the specialty of nursing practice
employing theories of human behavior as its
science and purposeful use of self as its art.
Nurses in this area receive additional training
in building a therapeutic alliance, psychosocial
therapy, dealing with challenging behavior and
the administration of psychiatric medication.
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5. Basic scope of service
Therapeutic relationship
Physical and biological interventions
Psychosocial interventions:
( helping the patient and family in dealing with
each other and with the society)
Spiritual interventions:
(focus on developing a sense of meaning,
purpose and hope for the person in their
current life experience)
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6. What are the trends of a psychiatric
nurse?
Clear insight with high self-understanding
self-
(Stigmatization and ethical dilemmas are high in
psychiatric nursing)
Psychiatric and medical-surgical nursing skills
medical-
and knowledge
Good and affective communication skills
(a therapeutic relation can only be billed with
affective communication)
Competent, punctual, cooperative and calm
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7. High since of moral values
( many psychiatric patients are easy to be taken
advantage of)
Psychological and physical stamina
Good judgment and critical thinking
(situations explodes with in moments with
psychiatric patients)
Highly observant
(many small behavioral changes of the patient
that can be considered normal by others have a
dramatic effect on the nursing care plan)
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8. What are the elements needed for
nursing quality?
NURSING ETHICS:
Many elements of the nursing code of ethics have been
involved with the psychiatric nursing care as methods
of treatment:
confidentiality-
confidentiality-(Breaking confidentiality can be if
there is a well-defined reason to share information:
well-
Benefit outweighs harm. This is an ethical dilemma )
veracity-
veracity-(The only way to deal with patients with
hallucinations is to confront them with the truth)
fidelity-
fidelity-(psychiatric treatment depends trust and
maintaining therapeutic alliance)
non malfeasances-(many psychiatric patients are
malfeasances-
easy to take advantage of)
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9. Knowledge and skills.
Utilization of the nursing care plan and the
nursing process:
assessment-
assessment-(the main dependence is on
objective data)
nursing Diagnosis-(many symptoms of the
Diagnosis-
psychiatric illness is hard do defined and many
of them are not present all of the time)
Healthy and safe working environment.
Good retention plan (psychiatric nurses are
among the rears and highest paid in the world)
Standard policies and procedures.
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10. How is nursing Quality
measured?
Competency
Effectiveness
Respect and Caring
Safety
Appropriateness
Timing
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11. How is patient safety cared for ?
Protecting the patient from harming himself :
That is done by monitoring patients with tendency to comet
suicide or to cause harm to themselves and placing them
under clues observation, exploring their thought content
and try to distract them away from such ideas and try to
occupy their time with different activities and give them a
since of hope in life and place them in a safe environment
in the wards away from any external stimulators for such
ideas and away from any harmful object that he might use
to cause harm to him self .
Protecting the patient from case prognoses.
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12. Protecting the patient from being harmed by others:
That is done by monitoring aggressive and provoking
behaviors so physical contact ( fights) don't happen among
patients, delusions and wrong beliefs are also monitored to
prevent patients from causing harm to each other due to
the delusions or beliefs and in case of any physical
contact among patients nurses must interfere as quickly as
possible using the right manner of intervention also
patients of deferent age groups and genders must be
separated to prevent sexual assault ( male – female )
( adult – teenagers - children ) .
Protecting the patient from any medical or nursing errors.
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13. Protecting the patient from the physical
surrounding:
That is done by making sure that the patient is
placed in a save place and free from any
harmful objects that might injure the patient or
be used to cause harm for him e.g. ( only plastic
food utilities can be used in the ward , no sharp
objects are allowed in the ward )
The patients consciousness level must be
monitored to prevent any possible danger of
falling down, for patients that are endangered of
falling down during sleep precautions like
sidereal, placing patients in beds clause to the
door, decreasing bed height must be taken.
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14. Patient safety during restrain episodes
That is done by following the correct and safe steps to administer
restrains :
never use restrains with out a medical order.
never use retrains as a punishment method or for personal revenge.
always tell the patient the reason from restraining him.
make sure that restrains do not block the blood circulation .
chick on patient and take vital signs every 15min.
15min.
make sure room temperature is appropriate .
always restrain the patient in a supine position.
make sure that the patient's physical needs are met.
do not apply restrains to cases of resent ophthalmic surgery, spinal surgery,
harts conditions, chest and respiratory problems.
the restrain room physical surrounding must be appropriate and equipped
with a monitoring camera.
patient should be on monitors through all the restraining time .
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15. Patient safety during seclusion episodes
That 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.
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16. Nurses safety during P.T encounter
Never face an aggressive P.T on your own.
Always be calm and use an appropriate voice
tone.
Never turn your back to the patient.
Always keep eye contact.
Always keep an arm space between the nurse
and the patient during confrontation.
When trying to physically control the patient
approach him from the back and sides.
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17. A final statement
Psychiatry dose not have much luxury when it comes
to diagnostic lab tests and helping diagnostic aids and
many symptoms of the psychiatric illness is hard do
defined and many of them are not present all of the time
so the psychiatrist depends mostly on his observations
and on the extra eye that he has ( the nurse and his/her
observations) to confirm diagnoses and to set the
correct treatment plan. That makes the qualified
plan.
psychiatric nurse a valuable and rear commodity in
today's nursing world and the way to perfection in
psychiatric nursing starts with understanding of the
important role of the psychiatric nurse and improving
the psychiatric educational level, observation skills and
documentation skills of the psychiatric nurse.
nurse.
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18. References
Psychiatric Mental Health Nursing (6th addition) 2009.
2009.
“Toward Improved Quality – Developing Nurse’s
Continuing Vocational Training In Hospitals And Inpatient
Units”.
Units”. 2006 – 2007 By: Välimäki M, Scott A, Lahti M &
Chambers M (eds.)
Lippincott’s Manual Of Psychiatric Nursing Care Plans,
Plans,
8th Edition 2009By: Lippincott Williams & Wilkins.
2009By:
Al-amal Hospital In Jeddah Policies And Procedures
Al-
Manual, 2009, Jeddah.
Manual, 2009, Jeddah.
Essentials Of Psychiatric Mental Health Nursing, Nursing,
Collaboratively Developed by ISPN and APNA, (2007- 2007-
2008)
2008).
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19. PSYCHIATRIC NURSES ARE IN THE SHADOW
QUALITY
PSYCHIATRIC NURSING IS THE COMING TOMORROW
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