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Chapter 6

The Nursing Process in


Psychiatric/Mental Health
Nursing

The Nursing Process


It is a systematic framework for the
delivery of nursing care.
It uses a problem-solving approach.
It is goal-directed, its objective being the
delivery of quality client care.
It is dynamic, not static.

Standards of Care
The standards of care for psychiatric nursing are
written around the six steps of the nursing process.
Standard I. Assessment
The psychiatric/mental health nurse collects client
health data.
P 90-97 in text
Here, the nurse writes while
Interviewing the client

Standards of Care
Standard II. Diagnosis
The psychiatric/mental health nurse
analyzes the assessment data in
determining diagnoses

Nursing Diagnosis
The nursing Diagnosis describes the
clients condition
For example: Disturbed sensory
perception, evidenced by hearing voices

Standards of Care (cont.)


Standard III. Outcome Identification
The psychiatric/mental health nurse identifies expected
outcomes that are measurable and realistic and
individualized to the client.
For example:
The client will demonstrate
trust in one staff member
In 5 days. The client will express
understanding that the voices are not
real (not heard by others ) in 10 days.

Standards of Care (cont.)


Standard IV. Planning
The psychiatric/mental health nurse
develops a plan of care that is negotiated
among the client, nurse, family, and
healthcare team and prescribes evidencebased interventions to attain expected
outcomes.

Standards of Care (cont.)


Standard IV. Planning (cont.)
Nursing Interventions Classification (NIC) - a
comprehensive, standardized language
describing treatments that nurses perform in all
settings and in all specialties
NIC interventions based on research and reflect
current clinical practice

Standards of Care (cont.)


Standard V. Implementation
The psychiatric/mental health nurse
implements the interventions identified in
the plan of care. Specific interventions:
Standard Va. Counseling: to assist

clients in improving coping skills and


preventing mental illness and disability
Standard Vb. Milieu therapy: to provide and
maintain a therapeutic environment for client
Standard Vc. Self-care activities: to
foster independence and mental and
physical well-being

Standards of Care (cont.)


Standard Vd. Psychobiological
interventions: to restore the clients
health and prevent further disability
Standard Ve. Health teaching: to assist
clients in achieving satisfying, productive,
and healthy patterns of living
Standard Vf. Case management: to
coordinate comprehensive health services
and ensure continuity of care

Standards of Care (cont.)


Standard Vg. Health promotion and health
maintenance: implements strategies with
clients to promote and maintain mental health
and prevent mental illness

Standards of Care (cont.)


Advanced practice interventions also
include:
Standard Vh. Psychotherapy:
provides therapy for individuals,
groups, families, and children to
foster mental health and prevent disability
Standard Vi. Prescriptive authority and
treatment: provides pharmacological
intervention, in accordance with
state and federal laws and regulations,
to treat symptoms of psychiatric illness
and improve functional health status

Standards of Care (cont.)


Advanced practice interventions (cont.)
Standard Vj. Consultation:
provides consultation to enhance
the abilities of other clinicians to
provide services for clients and
effect change in the system

Standards of Care (cont.)


Standard VI. Evaluation
The psychiatric/mental health nurse
evaluates the clients progress in attaining
expected outcomes.

Applying Nursing Process


Role of the nurse in psychiatry
The nurse assists the clients successful
adaptation to stressors within the environment.
Goals are directed toward change in thoughts,
feelings, and behaviors that are age-appropriate
and congruent with local and cultural norms.
The nurse is a valuable member of the
interdisciplinary team, providing a service that is
unique and based on sound knowledge of
psychopathology, scope of practice, and legal
implications of the role.

Documentation of the Nursing


Process

Documentation of the steps of the nursing


process is often considered as evidence in
determining certain cases of negligence by
nurses.
It is also required by some agencies that
accredit healthcare organizations.

Documentation of the Nursing Process


(cont.)

Examples of documentation that


reflect use of the nursing process

Problem-Oriented Recording (POR)


Has a list of problems as its
basis
Uses subjective, objective,
assessment, plan, intervention,
and evaluation (SOAPIE) format

Documentation of the Nursing Process


(cont.)
Focus Charting
Main perspective is to choose a
focus for documentation. A focus
may be
a nursing diagnosis
a current client concern or behavior
a significant change in the clients status or
behavior
a significant event in the clients therapy

The focus cannot be a medical diagnosis.


It uses data, action, and response (DAR)
format.

Documentation of the Nursing Process


(cont.)

APIE method

A problem-oriented system
Utilizes flow sheets as accompanying
documentation
Uses assessment, problem, intervention,
and evaluation (APIE) format