Principles of Mental Health
Nursing
Introduction
• There are general principles that apply to
the care of all who show behavior
disorders every one has certain basic
needs that must be met no matter what
disease he is suffering from the principles
are general which are applicable to
mentally ill patients as well as physically ill
where his illness is usually associated with
emotional disturbance to some degree.
• These principles are based on the concept
that each individual has an intrinsic worth
and dignity and he has potentially to grow.
• The following principles are general in
nature & from guidelines for emotional
care of a patients.
1. ACCEPT THE PATIENT
EXACTLY AS HE IS.
• Acceptance conveys the feelings of being
loved and care: it provides the patient with
an experience, which is emotionally
neutral, where he finds unlearning of his
sick behavior is less threatening before he
can relearn the art of living with himself
with others.
• Acceptance does not mean complete
permissiveness, but setting of positive
behavior to convey to him the respect as
an individual human being acceptance is
expressed in the following ways:
Acceptance is expressed in
following ways:
A. Being non judgemental & non punitive
• We don’t judge patient’s behavior as right or
wrong, good or bad. Patient is not punished
for his undesired behavior.
• All direct and indirect methods of punishing
must be avoided.
• Chaining, restraining, putting him in a
separate room are some of the direct
punishment.
• Ignoring his presence or withdrawing his
importance is few ways of giving indirect
punishment.
B. Being sincerely interested in the patient.
• This can be demonstrated by:
• Studying patient’s behavior pattern.
• Making the patient aware in a in a manner that you are
interested in him.
• Seeking out a patient.
• Using time spent with him on these things he is
interested in.
• Being aware of his likes and dislikes.
• Explains when his demands can not be met.
• Dealing with his comments, complaints, and
expressions of approval realistically.
• Accepting his fears as real to him.
• Avoiding subjects on which he feels sensitive.
• Listening to him.
C. Recognizing & reflecting on feeling which
patient may express.
• The nurse acts as a sounding board for
patients strong or negative feelings.
• The nurse develops skill identifying the
feelings actually expressed for e.g. When
a patients says ‘I would like to break
someone’s neck; we understand that he is
angry at somebody and is expressing the
anger.
4. Talking with a purpose.
• Nurse’s conversation with
a patient must resolve
around his needs, wants
and interest.
• Direct approaches like
reflection , open – end
question, focusing on a
point, presenting reality is
more effective when the
problems are not obvious
• Avoid evaluative, hostile,
probing responses, which
E. Listening
• Listening is an active
process. Two ears
required for what the
patient says verbally
and ‘
• Third ear’ is required
for what patient is
otherwise none
verbally saying.
F. Permitting patient to express strongly held
feelings
• Strong emotions bottled up are potentially
explosive and dangerous .it is better to permit
the patient to express his strong feelings
without disposal or punishment.
• Feeling of anxiety, fear, hostility hatred or
anger should be expected, tolerated and
allowed to express.
• The nurse must accept the expression of
2) USE SELF UNDERSTANDING
AS A THERAPEUTIC TOOL
• Self understanding leads to understanding to
others.
• Patient’s behavior can produce lot of anxiety or
fear in the nurse, and she ought to understand
why she is anxious or frightened.
• We can understand ourselves better by
• Exchanging personnel experience freely with our
colleagues
• Discussing our personal reaction with an
experienced
• Participating in group conference regarding our
patient care.
3) USE CONSISTENT BEHAVIOUR TO
INCREASE PATIENT’S EMOTIONAL
SECURITY.
• Patient to be consistently and continuously
exposed to an atmosphere of quiet
acceptance.
• Permissiveness to be limited e.g. with
homicidal, suicidal, hyperactive and
suspicious patients.
• Patient is allowed to feel as he does but
limitations are put on his behavior.
• Attempt to win patient’s liking is most
4) GIVE REAASSURANCE RENCE TO
PATIENTS IN ACCEPTABLE MANNER
• Reassurance is building patient’s confidence or restoring
his confidence. While giving reassurance , we must
avoid saying to the patient ‘you will get well, “nothing to
worry”
Reassurance can be given in following manner :
• Be truly interested in patient’s problem.
• Pay attention to the patient matter however
significantly it may be.
• Allow him to be as sick as needs to be.
• Be aware how the patient actually feels.
• Sit beside patient when he does not want to talk.
• Accept patient’s silence.
• Listen to problem without showing surprise.
• Agree with his problem and think with him to solve
the problem.
5) Change patient’s behavior through
emotional experience and not by rational
interpretation.
• Major focus in psychiatry is on feeling
aspect and not on intellectual aspect.
Telling and advising the patient is not
effective in changing behavior.
• Role play and emotional drama and
transactional analysis are few ways of
creating emotional experience in a patient.
• When an alcoholic is told that his drunkard
behavior is more hurting to his wife and
children he does not agree to our
interpretation. What the same acted by a
role of his wife, children and alcoholic, he
gains more understanding.
• Understanding cannot be forced as insight
and understanding one’s own behavior is
painful. Interpretation is only done when
patient is ready.
6) AVOID UNECESSARY INCREASE
IN PATIENT’S ANXIETY
• Anxiety is a feeling of fear for an unknown object
or event.
• It is a threat to biological integrity of a person.
Psychiatric patients have already some amount of
anxiety so psychiatric nurses should not further
increase their anxiety by:
• Contradicting his psychotic ideas.
• Demanding the patient to complete set task.
• Making him to face repeated failure.
• Using big sentences, professional terms while
talking with him.
• Care less conversation with patient
• Calling attention to patient’s defect.
• Being insincere
• Giving no orientation to ward co-patient’s staff
policies routine and procedures.
• Treats passing sharp commands and showing in
difference.
• Asking questions about family, friends, and
home in first meeting.
• Showing nurses own anxiety.
7) DEMONSTRATE OBJECTIVE OBSERVATION TO
UNDERSTAND AND INTERPRET THE MEANING OF
PATIENT’S BEHAVIOUR
• We need to observe the patient when he
says or does.
• Analysis of the observation should be done to
draw thaw the motivation or purpose behind
his talk or action.
• While working with patient learn his basic
problems guess what he will do. Keep asking
yourself what is the goal of patient and why
he behaves like this.
• Be objective.
• Objectivity is not coldness but it is
indifference and absence of feelings and
ability not to let your own judgment confused
The indications for lack of objectivity in
nurse’s observation are:
• Nurse is critical of patient
• Defending or justifying herself
• Demanding that the patient should her in a
certain way
• Evaluating the patient’s behavior right or
wrong
8) MAINTAIN REALISTIC NURSE
PATIENT RELATIONSHIP
• Realistic and professional relationship
focuses on the personal and emotional
needs of patient.
• It is therapeutically oriented and planned
• It is always based on patient’s needs
• Nurse differentiate between patient’s
demands and actual needs
• It is for purpose or bringing adaptive ness,
integration and maturity in relations.
9) AVOID PHYSICAL AND VERBAL
FORCE AS MUCH AS POSSIBLE
• Any kind of force results in psychological trauma in
patient
• Restraining the violent patient is an e.g. of
physical restrain.
If all needs to be use the following points to be kept
in mind:
•Carry out procedure quickly , firmly and effectively
•Do not show anger while tying
•Tell him the reason and tell that he will be allowed to
mix with others when he get the control on him.
•Attend his needs as usual never show him that he is
being punished
•After he becomes controlled never remind him
again about the incidence.
10) NURSING CARE IS CENTERES ON THE
PATIENT AS A PERSON AND NOT ON CONTROL
OF SYMTOMS
• Every is caused, understand the meaning
behind the behavior.
• Two patients showing the same symptoms
may have different needs .e.g. one may
have headache due to sleeplessness and
other may have due to hypoglycemia
• Analysis and study of symptoms is
necessary to reveal their meaning and
their significant to patient
11) EXPLAIN ROUTINE PROCEDURE AT
PATIENT’S UNDERSTANDING LEVEL
• Every patient has right to know what is
being done and why it is being done on
him
• Every procedure should be explained at
his understanding level to reduce his
anxiety
• Character of explanation depends on:
patient’s attention, level of anxiety, and
level of ability to decide.
12) MANY PROCEDURES ARE
MODIFIED BUT BASIC REMAINS
UNULTERED
The nursing principles remain same such
as:
• Safety
• Comfort
• Individuality and privacy
• Maintain therapeutic effectiveness ,
workmanship during procedure
• Economy of time, energy and material
