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AL-barrak 2008 ِ
General principles of psychiatric nursing
Under supervision of \
Prof. Dr Elham Fayad
Prepared by \
Mofida ALbarrak
1 \ 3 \ 1429 H
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AL-barrak 2008 ِ
General principles of psychiatric nursing
Objectives
At the end of my lecturer the audience will be able to:1. Discuss general principles of psychiatric nursing.
2. Applied the application of these principles
Introduction
The following are general principles that apply to the care of
all who show behavior disorders- mental ill as well as
physically ill is usually associated with emotional
disturbance to some degree.
These principles are based on the concept that each
individual has basic needs, the right for value, dignity, & the
potential to grow.
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AL-barrak 2008 ِ
Out line
List 12 principles of psychiatric nursing
1. Patient should be accepted as he is
2. Self understanding is used to as a therapeutic tool.
3. Consistency is used to contribute to patient's security
4. Reassurance to be given in a suitable & acceptable
manner.
5. Patient's behavior is changed through emotional
experience, by rational interpretation.
6. Unnecessary increase in patient's anxiety should be
avoided.
7. Observation of mentally ill patient is directed toward
of behavior.
8. Maintain a professional relationship.
9. Verbal & physical force must be avoided if possible
10.
Nursing care centered on patient as a person, not
on control of symptoms.
11. Routine & procedures explained at patient's level of
understanding.
12. Many procedures are modified but basic principles
remain unaffected.
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1. Patient should be accepted
exactly as she is.
a - Be non-judgemental and nonpunitive.
b- Show interest in the patient as a
person
c- Recognize and reflect on feelings
which
the
patient express.
d- Talk
with
a purpose.
e- Allow patient to express strongly
held feelings.
Acceptance conveys the feeling of being loved cared for.
Acceptance provides the patient with an experience which is
emotionally neutral, where she finds unlearning of her sick
behaviour less threatening.
Acceptance does not mean complete permissiveness but
acceptance means setting of positive behaviours to convey to
her respect as an individual human being.
Acceptance is shown in the following ways:a - Be non-judgemental and non-punitive.
We don't judge patient's behaviour as right or wrong, good
or bad.
Patient is not punished for her undesired behaviour.
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AL-barrak 2008 ِ
All direct & indirect methods of punishing must be avoided.
b- Show interest in the patient as a person by:
1. Studying patients' behaviour pattern
2. Making the patient aware that you are interested in
her.
3. Seeking out a patient
4. Using time spent with her on these things she is
interested in
5. Being aware of her likes & dislikes
6. Avoiding subject on which she feels sensitive
7. Listening to her.
8. Explain when her demands cannot be met.
9. Accepting her fears as real to her.
c- Recognize and reflect on feelings which the patient
express.
The nurse develops skill in identifying the feeling actually
expressed.
d- Talk with a purpose.
Conversation with a patient must have a goal.
Nurse's conversation with a patient must go around her needs,
wants & interests.
Indirect approaches like
*reflection,
*open-end questions,
*focusing on point
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Avoid evaluative, hostile, probing responses & use the
understanding responses which may help the patient to explore
her feelings.
e- Allow patient to express strongly held feelings.
It is better to permit the patient to express her strong
Feelings without disapproval feeling of anxiety, fear, hostility,
hatred or anger should be expected, tolerated and Allowedexpressions.
Expression of these negative feelings may be encouraged in
verbal or symbolic manner.
2. Self understanding is used to as a therapeutic
tool.
How can nurse understand herself better?
1- Exchange personal experience freely and openly
with colleagues.
2- Discuss your personal reaction with an
experienced person.
3- Participate in group conference regarding
patient care.
4- Keeping reflecting on Why one feels or acts the way
you do.
Self understanding leads to understanding of others when an
individual is aware of why she behaves as she does; it helps her
to understand the behaviour of persons with whom she relates.
Patient’s behaviour can produce a lot of anxiety, or fear in the
nurse and she must be understand why she is anxious or
frightened in order to be able to handle the patient.
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3. Consistency is used to contribute to
patient's security
a. Why consistency?
b. Areas where consistency must
operate.
c. How should consistency operate?
a. Why consistency?
Not knowing what to expect, or fear of the unknown produces
anxiety. Patient must feel that she can depend on the people
working in the ward.
b. Areas where consistency must operate.
1. Attitudes of the staff
2. Ward routine
3. Defining the limitation placed on the patient
c. How should consistency operate?
1. patient to be continuously exposed to an atmosphere of
acceptance
2. consistence to be maintained from nurse & shift to shift
3. Permissiveness to be limited e.g. with patients who are
homicidal, suicidal, hyperactive & suspicious.
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4. patient is allowed to fell as she does but limitations are
put on his behavior
5. Limit & its reinforcement requires a great deal of tact
& understanding, & should be done in a quiet &
matter of fact way.
6. The attempt to win patients' liking (favoritism) is most
dangerous for the patient.
4. Reassurance to be given in a
suitable & acceptable
manner.
a. Reassurance
b. Avoid saying to the patient
c. How to give reassurance?
a. Reassurance
Reassurance is building patient's confidence
b. Avoid saying to the patient
1. You will get well
2. Your fears have no base
3. You are a nice person
4. All will end well
5. Nothing to worry
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c. How to give reassurance?
1. Be truly interested in patient problems.
2. Pay attention to the matters that are important to the
patient, however insignificant it may be.
3. Allow her to be as sick as she needs to be.
4. Be aware & accept how the patient really feels
5. Do things for the patient without asking anything of the
patient in return,
6. Sit beside patient even when she does not want to talk.
7. Listen to personal problems without showing surprise
or disapproval.
8. Agree that the patient has a problem and think along
with her to solve it.
9. Provide patient acceptable outlets of anxiety.
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5. patient's behavior is changed through emotional
experience, by rational interpretation.
1. Major focus is on felling aspect & not on intellectual
aspect.
2. Patients' defensive behavior against anxiety
producing stress is based on strong emotional needs
3. The more beliefs are challenged, the more the patient
becomes defensive.
4. Corrective emotional experience can bring about
behavior change.
5. Help the patient feel emotionally secure to enable her
to develop & use understanding of her own behavior.
6. Understanding cannot be forced. Insight &
understanding of ones own behavior is painful.
7. Interpretation is only done when patient is ready for it,
i.e. secure enough to tolerate it & able to apple it to
alter her behavior.
8. Attitudes are also not identified for the patient, when
she is ready to tolerate, them she will identify them
herself.
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6. Unnecessary increase in
patient's anxiety should be
avoided
a. What is anxiety?
b. What factors, situation, topics
or approaches can increase
anxiety?
a. What is anxiety?
It is a threat to biological integrity of the self system (ego)
of the person.
b. What factors, situation, topics or approaches can
increase anxiety?
This may differ from patient to patient, but some general
types of situations which increase anxiety are
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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.
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7. Observation of mentally ill patient is directed
toward of behavior.
a. Why
- Every thing the patient does or says is observed & analysed,
to seek its motivation & to understand what she is trying to
accomplish.
- Asking you self what is the goal of the patient care?
Why did she behave the way she did? Objectivity is an essential
component of observation.
b. What do we mean by objectivity?
Objectivity is an ability to evaluate exactly what a
patient wants to say & not mix up your own feeling, opinion,
or judgment.
Objectivity is not coldness, indifference, & absence of feeling,
but it is an ability not to let your own judgment get confused
with emotional warmth.
How can you be objective?
One important way is to keep indulging in introspection, make
sure that your own emotional needs don't come first before
patients needs.
Maintain an objective attitude in the care of patients
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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.
N.B.
Self understanding can help the care provider to be
more objective.
8. Maintain a professional relationship.
1. 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.
2. Nurse keeps analysing the interaction between herself & the
patient to prepare herself to guide the patient towards
mature behaviour.
3. Nurse must differentiate between patient's demands &
actual needs.
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AL-barrak 2008 ِ
9. Verbal & physical force must be avoided if 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.
1. Carry out the procedure quickly, firmly & efficiently
with adequate help.
2. Anger or annoyance should not be shown.
3. No verbal comments should be made during the
procedure, except to tell the patient.
4. Never let the patient feel that she is being punished,
attend to her needs as usual.
5. Never remind the patient again about the incidence.
6. Nursing team must have self-control & understanding
in carrying out the procedure.
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10. Nursing care centered on patient as a person, not on
control of symptoms.
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. Routine & procedures explained at patient's level
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.
12. Many procedures are modified but basic
principles remain unaffected
For example
Enema, surgical dressing, catheterization & given
medication
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Summary
Teaching principles of psychiatric nursing is an essential
component in preparing nursing students. The pervious part
outlines & discusses the importance & application of these
principles.
Reference
Townsend. Maryc. (2003) Psychiatric Mental Health nursing
concepts of care fourth edition, F.A. Davis Company