Principles of Mental Health Nursing

PRINCIPLES OF MENTAL
HEALTH NURSING
KANWALJEET KAUR
MGM MTCN
AURANGABAD
 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.
 The principles are general in nature and it is a guidelines
for emotional care of a patients.
 These principles are based on the concept that each
individual has an intrinsic worth and dignity and he has
potentially to grow.
1. Accept the patient exactly as he is
 Acceptance conveys the feelings of being loved & cared.
 Acceptance means being non judgmental
 Acceptance does not mean complete permissiveness but setting of positive
behaviours to convey to him the respect as an individual human being.
A) be non-judgemental and non-punitive

 The patient behaviour is not judged as right or wrong or bad.
 The patient is not punished for his undesirable behaviour.
 All direct & indirect methods of punishment must be avoided.
 A nurse who shows acceptance does not reject the patient even when he
behaves contrary to her expectations.
B) Show interest in the patient as a person
 Studying patient’s behaviour
 Allowing him to make his own choices & decision as far as possible.
 Being aware of his likes & dislikes
 Being honest with him
 Taking time & energy to listen what he is saying
 Avoiding sensitive subjects & issues.
C) Recognizing & reflecting on feeling which patient may express:

–
When the patient talks it is not the content is important to note, but the
feeling behind the conversation which has to be recognized &
reflected.
D) Talking with a purpose:
The nurse’s conversation with a patient must resolves around his
needs, wants and interests.
E) Listening:
The nurse should take time & energy to listen to what the patient is
saying. she must be a sympathetic listener & show genuine interest
F) Permitting patient to express strongly held feelings:

Strong emotions bottled up are potentially explosive & dangerous. It is
better to permit the patient to express his strong feelings without
disapproval or punishment.
2. Use self understanding as a therapeutic tool
 A psychiatric nurses should have a realistic self concept & should be able to
recognize one’s own feelings.
 Patients behaviour can produce lot of anxiety or fear in the nurse, and she
ought to understand why she is anxious or frightened
 Her ability to aware & to accept her own strengths& limitations should help
her to see the strengths & limitations in other people.
 Nurse can understand herself better by
i) exchanging personal experiences freely and frankly with her colleagues.
ii) Discussing her personal reaction with an experienced person.
iii) participating in-group conference regarding her patient care.
3. Use consistent behaviour to increase patients
emotional security
 There should be a consistency in the attitude of staff, ward routine & in
defining the limitation placed on the patient.
How should consistency operate?
 Patient to be continuously exposed to an atmosphere of acceptance
 Consistence to be maintained from nurse & shift to shift
 Permissiveness to be limited e.g. with patients who are homicidal, suicidal,
hyperactive & suspicious.
 Patient is allowed to fell as she does but limitations are put on his behavior
 Limit & its reinforcement requires a great deal of tact & understanding &
should be done in a quiet & matter of fact way.
4. Give reassurance to patients in subtle and
acceptable manner
 Be truly interested in patient problems.

 Pay attention to the matters that are important to the patient, however
insignificant it may be.
 Allow her to be as sick as she needs to be.
 Be aware & accept how the patient really feels
 Do things for the patient without asking anything of the patient in
return,
 Sit beside patient even when she does not want to talk.
 Listen to personal problems without showing surprise or
disapproval.
 Agree that the patient has a problem and think along with her
to solve it.
 Provide patient acceptable outlets of anxiety
 Avoid saying statements ‘you will get well’, your fears are
groundless’, ‘you are a nice person’ and ‘nothing to worry’.
5. Change patients behaviour through emotional
experience and not by rational interpretation.
 The more beliefs are challenged, the more the patient becomes
defensive.
 Corrective emotional experience can bring about behavior change.
 Help the patient feel emotionally secure to enable her to develop
& use understanding of her own behavior.
 Understanding cannot be forced. Insight & understanding of ones
own behavior is painful.
 Interpretation is only done when patient is ready for it.
6. Avoid unnecessary increase in patients anxiety
 This may differ from patient to patient, but some general types of situations
which increase anxiety are
 Direct contradiction of patient's psychotic ideas.
 Demands on patient which she obviously cannot meet
 Failure.
 Indiscriminate use of professional terms.
 Insincerity.
 Calling attention to patient's defects.
 Threats, sharp command, & indifference
 Lack of proper orientation
 Nurse's own anxiety.
7. Demonstrate objective observation to understand and
interpret the meaning of patients behaviour
Every thing the patient does or says is observed & analysed, to seek its motivation & to understand
what she is trying to accomplish.
We improve our skills of observation by continuously predicting a patients behaviour.
Objectivity is an ability to evaluate exactly what patient wants to say and not to mix up your own
feelings, opinion or judgement.
Indications of lack of objectivity in nurse’s observation When?
 1- Nurse is critical to the patient.
 2- Defending or justifying herself.
 3- Demanding that patient should treat her in a certain way.
 4- Evaluating patient’s behaviour as right or wrong.
 5. Nurse needs to be honest with her.
8. Maintain realistic nurse-patient relationships
 A professional relationship focuses upon the personal and emotional

needs of the patient and not on nurse's needs.
 Such a relationship is therapeutically oriented & is always based on
patient's needs.
 Nurse keeps analysing the interaction between herself & the patient to
prepare herself to guide the patient towards mature behaviour.
 Nurse must differentiate between patient's demands & actual needs.
9. Avoid physical and verbal force as much as
possible
 Any kind of force applied on patient results in psychological trauma.
 If the nurse is knowledgeable in predicting patient's behavior, she can prevent an
onset of undesirable behavior.
 If force needs to be used. Carry out the procedure quickly, firmly & efficiently
with adequate help.
 Anger or annoyance should not be shown.
 No verbal comments should be made during the procedure, except to tell the
patient.
 Never let the patient feel that she is being punished, attend to her needs as usual.
 Never remind the patient again about the incidence.
 Nursing team must have self-control & understanding in carrying out the
procedure.
10. Provide nursing care to the patient as a person and
not on control of symptoms of a disease that he has
 Every behavior \ symptom is meaningful. Two patients showing the

same symptom may be expressing different needs.
 Analysis and study of symptoms are necessary to reveal their
meaning and their significance to the patient.
11. Explain routines and procedures at patients
levels of understanding
 Every patient has a right to known what is being done & why it is
being done.
 Every procedure should be explained at her level of understanding.
 Explaining to the patient reduces anxiety.
 But the explanation should never be withheld, thinking that
psychiatric patients are not having contact with reality or have no
ability to understand.
12. Many procedures are modified but basic
principles remain unaltered
 For examples
 Enema, surgical dressing, catheterization & given medication
 the nursing principles to be kept in mind are
Safety
Comfort
Privacy
Maintaining therapeutic effectiveness
Economy of time, energy and material
Standards of mental health nursing practice
 The purpose of standards is to fulfil the professions obligation to

provide a means of improving the quality of care.
 The standards reflects the current state of knowledge in the field and
are therefor provisional, dynamic and subject to testing the
subsequent change.
 Standards represent agreed upon levels of practice and to provide
guidance in achieving excellence in care.
Problems in applying principles
 Nurse Discomfort
 Lack of Objectivity
 Halo
 Horn Error
 Leniency/Strictness
 Central tendency
 Recent behaviour bias
 Personal bias
 Manipulating the evaluation
 Nurse anxiety
 Nurse Discomfort
 Experience can be unpleasant when patient has not respond well.
 Lack of objectivity
 In assessment method, commonly used factors such as attitude,
appearance and personality are difficult to measure.
 Factors may have little to do with patient performance.
 Nurse assessment based primarily personnel characteristics may
place patient and institution in untenable positions.
 Halo Error
 Occurs when nurse generalizes one positive performance feature
or incident to all aspects of patient performance resulting in
wrong assessment.
 Horn Error
 Evaluation error occur when nurse generalizes one negative
performance feature or incident to aspects of patient performance
resulting in wrong assessment.
 Leniency/Strictness
 Leniency is giving undeserved high abnormality
 Strictness is being unduly critical of patients performance.
 Central Tendency
 Error occurs when patients are incorrectly rated near average
or middle of scale.
 Recent Behaviour Bias
 Patients behaviour often improves and productivity tends to rise
several days or weeks before coming to hospital.
 Only natural for nurse to remember recent behaviour more clearly
than actions from more distant past.
 Maintaining records of performance.
 Personal Bias
 Nurse allow individual difference such as gender, race or age to
affect assessment they give.
 Effects of cultural bias, or stereotyping, can influence assessment.
 Manipulating the Evaluation
 Sometimes, nurses control virtually every aspect of nursing
process and are in position to manipulate system.
 Patient anxiety
 Assessment process may create anxiety for patient.
 Other factors
 Data collected inappropriately
 Inaccurate record
 Lack of skills of nurse.
 Standard I – Theory
 Standard II – Data collection
 Standard III – Diagnosis
 Standard IV – Planning
 Standard V – Intervention
 Standard VI – Evaluation
 Standard VII – Peer review
 Standard VIII – Continuing education
 Standard IX – Interdisciplinary collaboration
 Standard X – Utilization of community health systems
 Standard XI - Research

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PRINCIPLES OF MENTAL

A) be non-judgemental and non-punitive

C) Recognizing & reflecting on feeling which patient may express:

F) Permitting patient to express strongly held feelings:

 Be truly interested in patient problems.

 A professional relationship focuses upon the personal and emotional

 Every behavior \ symptom is meaningful. Two patients showing the

 The purpose of standards is to fulfil the professions obligation to

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