Standards of Practice for Psychiatric-Mental Health Nursing; NURSING PROCESS

 Standards of Practice for Psychiatric-Mental Health Nursing

The Standards of Practice for Psychiatric-Mental Health Nursing outline the responsibilities and approaches that psychiatric-mental health nurses must follow in order to provide safe, effective, and holistic care to individuals with mental health issues. Here's an expanded explanation of each standard:

STANDARD 1: ASSESSMENT

The first step in psychiatric-mental health nursing is to gather comprehensive health data from the healthcare consumer (the patient). This involves not only collecting physical health information but also understanding the psychological, social, and cultural factors that may influence the person’s mental health. This data could include interviews, observations, screening tools, medical history, family history, and any relevant psychological tests. The goal is to get a complete picture of the healthcare consumer’s mental health and well-being.

STANDARD 2: DIAGNOSIS

After gathering all relevant data, the nurse analyzes it to determine diagnoses and identify problems. This step includes recognizing patterns of symptoms and behaviors that indicate potential psychiatric conditions or risk factors. The nurse also assesses the severity of symptoms, identifies areas needing attention, and may recognize potential risks such as self-harm or the risk of harm to others. Mental health diagnoses are based on criteria from recognized diagnostic systems like the DSM-5 or ICD-10.

STANDARD 3: OUTCOMES IDENTIFICATION

In this stage, the nurse works with the healthcare consumer to identify expected outcomes and goals that are specific to the individual’s mental health needs. These outcomes may be related to symptom management, improving functioning, or achieving personal goals for mental well-being. The goals should be realistic, measurable, and focused on recovery or improvement. These outcomes are designed to guide the course of treatment and care.

STANDARD 4: PLANNING

Once outcomes are identified, the nurse develops a plan of care that outlines the strategies and interventions to achieve those goals. This plan might include pharmacological treatments, therapy, lifestyle changes, and environmental adjustments. The nurse must consider the patient’s individual needs, preferences, and the best available evidence when creating the plan. The planning stage is highly collaborative, involving both the healthcare consumer and any relevant members of the healthcare team.

STANDARD 5: IMPLEMENTATION

The implementation phase involves putting the plan into action. The psychiatric-mental health nurse follows through with the interventions outlined in the care plan. This may include providing therapeutic interventions, administering medications, coordinating care with other providers, and supporting the healthcare consumer through their treatment process.

STANDARD 5A: COORDINATION OF CARE

The psychiatric-mental health nurse plays a key role in coordinating care delivery. This involves ensuring that all members of the healthcare team, including therapists, psychiatrists, social workers, and primary care providers, are working together seamlessly. The nurse ensures that the care plan is followed and updated as necessary, ensuring that all aspects of the patient's health (mental, physical, emotional, etc.) are addressed in an integrated way.

STANDARD 5B: HEALTH TEACHING AND HEALTH PROMOTION

Part of the nurse’s role is to provide health education to the healthcare consumer and their families. This includes teaching about mental health conditions, treatment options, medications, and coping strategies. Additionally, the nurse may employ strategies to promote mental well-being, such as stress management, mindfulness, and lifestyle changes. Promoting a safe and supportive environment is also part of health promotion.

STANDARD 5C: CONSULTATION

The psychiatric-mental health nurse may be called upon to provide consultation services to other healthcare providers or professionals who need guidance or input on managing mental health issues. This could involve advising on best practices, suggesting treatment options, or helping interpret mental health assessments.

STANDARD 5D: PRESCRIPTIVE AUTHORITY AND TREATMENT

This standard applies specifically to advanced practice psychiatric nurses (APRNs), such as nurse practitioners, who have prescriptive authority. These nurses are authorized to prescribe medications, order diagnostic tests, and make referrals, all in line with state and federal regulations. They use their advanced clinical knowledge to manage treatment plans for mental health conditions, including medication management.

STANDARD 5E: PHARMACOLOGICAL, BIOLOGICAL, AND INTEGRATIVE THERAPIES

Psychiatric-mental health nurses incorporate a wide range of therapeutic approaches, including pharmacological treatments (medications), biological therapies (such as electroconvulsive therapy or transcranial magnetic stimulation), and integrative therapies (such as acupuncture or dietary interventions). The nurse uses their clinical expertise to select and apply these treatments in a way that will best meet the healthcare consumer’s needs.

STANDARD 5F: MILIEU THERAPY

Milieu therapy refers to the therapeutic use of the environment. This standard emphasizes creating a safe, structured, and supportive environment where the healthcare consumer feels comfortable and encouraged to engage in their recovery process. The nurse works with the healthcare consumer and their families to establish an environment that is conducive to healing, focusing on recovery, safety, and promoting social skills.

STANDARD 5G: PSYCHOTHERAPY

Psychiatric-mental health nurses, particularly those who are licensed and trained, may use psychotherapy techniques to help individuals address their mental health issues. This can include various counseling approaches (e.g., cognitive-behavioral therapy, dialectical behavior therapy) that aim to improve the consumer's coping mechanisms, help them regain functioning, and reduce symptoms of mental illness.

STANDARD 5H: PSYCHOTHERAPY (Advanced Practice)

This standard applies to advanced practice psychiatric nurses who are specifically trained to conduct psychotherapy. They provide individual, group, couples, and family therapy. These therapies are based on evidence-based practices and focus on improving mental health outcomes. They rely on the therapeutic relationship between the nurse and the consumer to foster emotional healing and problem-solving.

STANDARD 6: EVALUATION

Finally, the psychiatric-mental health nurse engages in evaluation to assess whether the outcomes and goals of the care plan have been met. This includes regular assessment of the healthcare consumer's progress, adjusting interventions as necessary, and modifying the plan if outcomes are not being achieved. This is an ongoing process that ensures the plan of care remains relevant and effective, fostering a continuous cycle of improvement.

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These standards help to ensure that psychiatric-mental health nurses deliver evidence-based, holistic care that addresses the physical, mental, and emotional well-being of those they serve. They focus on collaboration, ongoing assessment, and a commitment to promoting recovery and improving mental health.

Standards of Practice for Psychiatric-Mental Health Nursing

Psychiatric-mental health nursing focuses on the care of individuals, families, and groups who are experiencing mental health issues, emotional distress, or psychiatric disorders. The Standards of Practice provide a structured framework to guide psychiatric-mental health nurses (PMH nurses) in delivering safe, evidence-based, and compassionate care.

ADPIE= ADPI (A.B.C.D.E.F.G.H) E

I= CHAMP

CHAMP=

C-COORDINATION OF CARE, COUNSELLING, CRISIS INTERVENTION, COMMUNICATION THERAPY

H- HEALTH EDUCATION/HEALTH EDUCATION

A-ASSERTIVE COMMUNITY TREATMENT

M- MILIEU THERAPY, MEDITATION THERAPY,

P-PSYCHOTHERAPY, PSYCHOPHARMACOLOGY THERAPY

Standard 1: Assessment (COASTMAP)

The psychiatric-mental health registered nurse (PMH-RN) systematically collects comprehensive data regarding the healthcare consumer’s physical, psychological, emotional, social, and spiritual health. This includes:

• Conducting interviews to understand the individual’s mental health history, symptoms, and concerns.
• Observing behavior, mood, and cognitive functioning.
• Gathering information from family members, caregivers, and other healthcare professionals.
• Utilizing standardized screening tools and assessments to evaluate mental health status, substance use, and risk factors such as suicidal ideation or self-harm.
• Considering cultural, developmental, and socioeconomic factors that may impact the individual’s mental health.

The goal of assessment is to establish a thorough understanding of the healthcare consumer’s needs, strengths, and challenges, forming the foundation for diagnosis and treatment planning.

Standard 2: Diagnosis

The PMH-RN analyzes assessment data to identify actual or potential mental health diagnoses, behavioral problems, and other areas requiring intervention. This includes:

• Recognizing patterns of symptoms that align with mental health conditions (e.g., depression, anxiety disorders, schizophrenia).
• Identifying co-occurring disorders, such as substance use disorders alongside mental illness.
• Assessing the individual’s level of risk for self-harm, suicide, aggression, or other safety concerns.
• Establishing nursing diagnoses that guide care planning, focusing on both psychological and physiological aspects of mental health.

This standard ensures that healthcare professionals create an accurate and individualized understanding of the patient's condition.

Standard 3: Outcomes Identification

The PMH-RN establishes expected outcomes that are realistic, measurable, and tailored to the healthcare consumer’s specific needs. These outcomes guide treatment and recovery by:

• Setting achievable goals related to symptom management, coping skills, and emotional regulation.
• Collaborating with patients, families, and healthcare teams to define meaningful progress markers.
• Focusing on holistic well-being, including social reintegration, medication adherence, and self-care strategies.

Clearly defined outcomes help ensure that interventions align with the patient’s goals and promote recovery.

Standard 4: Planning

The PMH-RN develops an individualized care plan that prescribes evidence-based strategies to achieve the identified outcomes. This process involves:

• Selecting appropriate interventions, such as cognitive-behavioral techniques, crisis management, or medication therapy.
• Considering patient preferences, values, and cultural background when designing the plan.
• Addressing both short-term stabilization and long-term mental health management.
• Collaborating with interdisciplinary teams, including psychiatrists, social workers, and therapists.

A well-structured plan supports the patient's journey toward mental wellness and stability.

Standard 5: Implementation

The PMH-RN puts the care plan into action, ensuring that interventions are carried out effectively. This includes:

• Administering prescribed treatments and therapies.
• Providing emotional support and crisis intervention.
• Engaging patients in structured therapeutic activities.
• Monitoring progress and adjusting interventions as needed.

The implementation phase is crucial for ensuring that care strategies are delivered effectively and consistently.

Standard 5A: Coordination of Care

The PMH-RN ensures seamless collaboration among healthcare professionals, caregivers, and community resources to enhance patient care. This involves:

• Communicating with team members to provide comprehensive care.
• Referring patients to specialized services, such as substance abuse treatment or vocational rehabilitation.
• Ensuring continuity of care across different settings, such as inpatient, outpatient, and community-based programs.

Standard 5B: Health Teaching and Health Promotion

The PMH-RN educates patients and their families about mental health conditions, coping strategies, and self-care practices, including:

• Psychoeducation on managing symptoms, medication adherence, and stress reduction techniques.
• Promoting lifestyle modifications that support mental well-being, such as exercise, nutrition, and sleep hygiene.
• Advocating for mental health awareness and stigma reduction in the community.

Standard 5C: Consultation

The PMH-RN provides expert advice and recommendations to healthcare teams, policymakers, and community organizations on mental health care and best practices.

Standard 5D: Prescriptive Authority and Treatment

The psychiatric-mental health advanced practice registered nurse (PMH-APRN), such as a nurse practitioner, has the authority to:

• Prescribe psychotropic medications in accordance with legal regulations.
• Perform advanced clinical procedures.
• Make referrals to psychiatrists or specialized services.

Standard 5E: Pharmacological, Biological, and Integrative Therapies

The PMH-RN incorporates knowledge of medication management, biological treatments, and complementary therapies such as:

• Administering and monitoring psychiatric medications.
• Educating patients on medication effects, side effects, and adherence.
• Integrating alternative therapies like mindfulness, acupuncture, or nutritional therapy.

Standard 5F: Milieu Therapy

The PMH-RN plays a key role in creating a structured, therapeutic environment that promotes healing and recovery. This includes:

• Establishing a safe and supportive atmosphere in psychiatric units.
• Encouraging social interaction and therapeutic community involvement.
• Implementing behavioral interventions that reinforce positive coping strategies.

Standard 5G: Psychotherapy

The PMH-RN uses therapeutic communication and counseling techniques to support patients in their recovery, including:

• Building a trusting nurse-patient relationship.
• Using interventions like cognitive-behavioral therapy (CBT) to help patients develop healthier thought patterns.
• Assisting with emotional processing, grief, and trauma recovery.

Standard 5H: Advanced Psychotherapy

The PMH-APRN (such as a psychiatric nurse practitioner or clinical nurse specialist) provides formal psychotherapy services, including:

• Conducting individual, family, group, and couples therapy sessions.
• Utilizing evidence-based frameworks such as dialectical behavior therapy (DBT), trauma-informed therapy, or psychodynamic approaches.
• Addressing complex psychological conditions through structured therapeutic methods.

Standard 6: Evaluation

The PMH-RN continuously assesses the effectiveness of interventions and modifies care plans as needed by:

• Reviewing progress toward patient goals.
• Adjusting treatments based on patient response.
• Collaborating with patients and healthcare teams to refine care strategies.

Ongoing evaluation ensures that mental health care remains patient-centered, effective, and responsive to changing needs.

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Conclusion

The Standards of Practice for Psychiatric-Mental Health Nursing provide a comprehensive guide to delivering high-quality mental health care. By following these standards, psychiatric-mental health nurses play a critical role in promoting recovery, enhancing quality of life, and supporting individuals in achieving mental well-being.