MENTAL HEALTH NURSING
Dr. K.Lalitha
Professor
Department of Nursing, NIMHANS,
Bangalore
PRINCIPLES OF PSYCHIATRIC
NURSING
Every one has basic needs
Principles are general for
Physically ill and mentally ill.
Has intrinsic worth and dignity
Has potentiality to grow
1. ACCEPT THE PATIENT AS HE IS
Conveys the feeling of being loved
and cared.
Unlearning of sick behavior is less
threatening
Does not mean complete
permissiveness
Set positive behaviour to gain
respect.
1.1 BE NON-JUDGMENTAL AND NON-PUNITIVE
Behaviours are neither judged not
punished.
Direct and indirect punishments
are avoided.
1.2 SHOW INTEREST IN THE PATIENT AS A
PERSON
Studying patients behaviour
pattern
Making the patient aware in a subtle
manner that you are interest in him
Seeking out a patient
Using time spent with him on those
things he is interested in.
Being aware of his likes and
dislikes
Explain when his demands cannot
be met
Dealing with his comments,
complaints and expression of
approval realistically
Accepting his fears as real to him
Avoid sensitive subjects and
1.3 RECOGNIZE AND REFLECT ON
FEELINGS
WHICH PATIENT MAY EXPRESS
Identifying strong negative feelings
(Anger, Worthlessness).
Content of talk is not important
Reflects the understanding of his
feelings
1.4 TALK WITH A PURPOSE
Find out Needs, wants and
interests
of him
Use reflections, open-end
questions
and focusing
Avoid evaluative, hostile, probing
responses
1.5 LISTEN
An active process
Third ear is required
Give brief, non-directive comments
and interest.
1.6 PERMIT PATIENT TO EXPRESS STRONGLY
HELD FEELINGS
Strong emotions re dangerous.
Let him express anxiety, fear
hostility, hatred or anger.
Be a listener without disapproval
and punishing.
2. USE SELF-UNDERSTANDING AS A
THERAPEUTIC TOOL
Why one becomes the way.
Exchange personal experience with
colleagues
Discuss with experienced persons
Participate in group conference
Introspect on why we feel or act
the way we do.
3. USE CONSISTENT BEHAVIOUR TO
INCREASE
PATIENTS EMOTIONAL SECURITY
Reflect consistency in attitudes,
ward routine and defining the
limitation
Demonstrate consistency through
Convey acceptance
Maintain from nurse to nurse, shift
to shift
Limit permissiveness (Homicidal,
suicidal, Hyper-active and
Suspicious)
Allow patient to feel as he does,
but limit his behaviour.
Plan for reinforcing positive
behaviour
Dont attempt to win patients
liking
4. GIVE REASSURANCE TO PATIENTS IN SUBTLE
AND ACCEPTABLE MANNER
Reassurance is building patients confidence
Empathize with the patient to reassure.
Avoid false promises
Reassure by
Showing interest
Attending to the matters that are most
important to the patients
Allowing him to be sick, as he needs to be
Being aware and accepting how he really feels.
Giving unconditional services
Being with the patient physically
Listening to his problems without
surprise or disapproval
Agreeing with his problems and
thinking along with him to solve
them.
Providing outlet for his anxieties.
5. CHANGE PATIENTS BEHAVIOUS
THROUGH EMOTIONAL EXPERIENCE &
NOT BE RATIONAL INTERPRETATION
Focus on feeling and not on
intellectual aspects
Telling and advising is of no use
Role-play, socio-drams and
transactional analysis- to provide
corrective emotional experience
Help him in self-understanding
Insight development is painful
6. AVOID UNNECESSARY
INCREASE IN
PATIENTS ANXIETY
Anxiety is a feeling of
apprehension
Increase in apathy may be due to,
i. Contradicting psychotic ideas.
ii. Demanding the patients to
complete the set tasks that he
cannot obviously meet.
iii. Making him to face repeated
failure
iv. Using big sentences,
professional terms while talking
to him.
v. Careless conversation within
patients hearing about his
personal life.
vi. Calling attention to patients
defects
vii. Being insincere.
viii. Giving no orientation about the
wards,
about his co-patients about ward
staff,
policies, routines and procedure.
ix. Threats, passing sharp commands
and
showing indifference.
x. Asking questions about family,
work,
7. DEMONSTRATE OBJECTIVE
OBSERVATION
Objectivity is evaluating exactly.
Improve objectivity through introspection.
Lack of objectivity is due to
i.
Nurses emotional needs take precedence
ii.
Defending or Justifying herself
iii.
Demanding that patient should treat her in a
certain way
iv.
Evaluating the patients behaviour right or
wrong
Identify personal limitations and cause
for faults in objectivity.
8. MAINTAIN REALISTIC NURSE-PATIENT RELATIONSHIP
Focus: Personal and emotional needs of
patients.
Relationship is planned with
therapeutic orientation.
Analyze the interaction with patients.
Identify patients demands and actual
needs
It is an interpersonal process to bring
adaptive ness, integration in patients.
9. AVOID PHYSICAL AND VERBAL FORCE AS
MUCH AS POSSIBLE
Force results in psychological trauma for few.
Some patients welcome punishment
While using physical restrains
Do it quickly, firmly with help
Dont show anger or annoyance
Tell the reason for tying and how long
Attend to his needs as usual
After releasing restraints, never remind him
Predict patients behavior in advance.
10. PROVIDE NURSING CARE TO THE
PATIENT AS A
PERSON AND NOT ON CONTROL OF
SYMPTOMS OF
THE DISEASE THAT HE HAS
Every behaviour is caused
Symptoms are reflections of his
problems
Analyze symptoms find the
cause and reveal to the patient.
11.EXPLAIN ROUTINES AND
PROCEDURES AT
PATIENTS LEVELS OF
UNDERSTANDING
Respect patients rights.
Explanation reduces anxiety
Explanation depends on patients
span of attention, level of anxiety
and ability to decide.
12. MANY PROCEDURES ARE
MODIFIED BUT
BASIC PRINCIPLES REMAIN
UNALTERED
Nursing principles
Safety
Comfort
Individuality
Privacy
Maintaining therapeutic effectiveness
Fine workmanship
THANK YOU
