Standards of Care are fundamental for enhancing the quality of services delivered to individuals experiencing mental health conditions.

These benchmarks were initially established by the American Nurses Association (ANA) in 1973 to guide best practices in the field.

Development of Code of Ethics

A robust ethical framework is crucial for psychiatric nurses. This is especially important as they increasingly engage in autonomous roles involving:

• Psychotherapeutic interventions.

• Behavioral therapies.

• Cognitive therapy approaches.

• Individual and group therapy facilitation.

Ethical considerations are paramount in:

• Maintaining patient confidentiality.

• Upholding patient rights.

• Acting as a dedicated advocate for patients’ needs and best interests.

Legal Aspects in Psychiatric Nursing

Legal frameworks significantly shape psychiatric nursing practice. Key legal considerations center on:

• Patient Rights: Primary legal concerns revolve around safeguarding the rights of individuals receiving mental health care.

• Right to Refuse Treatment: Clients possess the legal right to decline specific treatments.

• Protection from Unnecessary Confinement: Legal safeguards exist to prevent unlawful or inappropriate detention.

• Intentional Torts: Understanding and avoiding actions that could be classified as intentional torts (civil wrongs).

• Informed Consent: Ensuring patients are fully informed and provide voluntary consent for treatment.

• Confidentiality: Legal and ethical obligations to protect patient privacy and sensitive information.

• Promoting Research: Supporting and encouraging research initiatives within mental health nursing to advance the field.

The Nurse’s Role in Advancement:

• Contribution to the Profession: Nurses play a vital role in advancing nursing and the broader mental health domain.

• Innovation: This is achieved through developing novel theories and refining clinical practices.

• Research Participation: Active engagement in research activities is essential for evidence-based practice.

Cost-Effective Nursing Care:

• Economic Considerations: There is an increasing emphasis on cost-effectiveness in healthcare.

• Value Assessment: It is important to evaluate the cost-benefit ratio of psychiatric nursing.

• Training Investment vs. Care Quality: Research is needed to assess the economic viability of nurse training in relation to the quality and effectiveness of nursing care provided.

Focus of Care – Target Populations:

Psychiatric nurses are often called upon to specialize and focus their care on specific vulnerable groups, including:

• Elderly individuals.

• Children and adolescents.

• Women’s mental health needs.

• Youth mental health.

• Individuals with intellectual disabilities and co-occurring mental health issues.

• Persons with chronic and persistent mental illnesses.

Legal and Documentation Responsibilities:

• Record Keeping: Meticulous and legally sound record-keeping is a critical legal and professional responsibility for psychiatric nurses.

• Legal Compliance: Nurses must be well-versed in relevant legal issues to ensure their practice adheres to all legal and ethical standards.

• Knowledge and Skill Development: Continuous learning and acquisition of knowledge are essential for navigating the legal complexities of psychiatric nursing.

STANDARDS OF MENTAL HEALTH NURSING PRACTICE

The core purpose of establishing Standards of Psychiatric and Mental Health Nursing practice is to uphold the nursing profession’s commitment to consistently improve the quality of patient care. These standards are a revised iteration of those initially articulated by the Division on Psychiatric and Mental Health Nursing Practice in 1973, reflecting advancements and evolving best practices in the field.

Professional Practice Standards

Standard I: Theory Application

• Scientific Basis for Practice: Psychiatric nurses are expected to ground their practice in established and scientifically validated theories.

• Informed Decision-Making: Sound theoretical frameworks serve as the foundation for making informed and effective decisions in all aspects of nursing care.

• Explanation and Intervention: Psychiatric and mental health nursing is distinguished by its deliberate application of relevant theories. These theories are used to:

  • Understand and explain phenomena encountered in mental health care.

  • Provide a rational and evidence-based basis for designing and implementing nursing interventions.

Standard II: Data Collection – Comprehensive Assessment

• Continuous and Systematic Data Gathering: Nurses are responsible for ongoing and systematic data collection.

• Comprehensive Data: Data collection must be comprehensive, encompassing all relevant aspects of the patient’s condition.

• Accuracy and Systematization: Data collected must be accurate, reliable, and gathered using a systematic and organized approach.

• Assessment Skills: Effective nursing practice relies on proficient assessment skills, including:

  • Effective Interviewing Techniques: Gathering subjective data through therapeutic communication.

  • Behavioral Observation: Objectively observing and documenting patient behaviors.

  • Physical Health Assessment: Evaluating the patient’s physical health status.

  • Mental Health Assessment: Assessing cognitive, emotional, and behavioral functioning.

• Sound Clinical Judgments: Comprehensive and accurate data collection enables nurses to:

  • Formulate sound and clinically reasoned conclusions about patient needs.

  • Develop and implement appropriate and individualized intervention plans in collaboration with the client.

Standard III: Diagnosis – Clinical Judgments and Classification

• Nursing Diagnosis and Standard Classifications: Nurses utilize recognized nursing diagnoses and/or standard classifications of mental disorders.

• Expression of Conclusions: Diagnosis is used as a structured way to articulate clinical judgments about the patient’s mental health status.

• Evidence-Based Diagnosis: Diagnostic conclusions must be:

  • Supported by documented assessment data.

  • Consistent with current scientific knowledge and principles in mental health.

• Scope of Nursing Practice: Nursing diagnosis is essential as the:

  • Logical foundation for providing nursing care.

  • Mechanism for recognizing and clearly identifying actual or potential health problems.

  • Framework for defining health problems that fall within the defined scope of professional nursing practice.

Standard IV: Planning – Individualized Care Plans

• Nursing Care Plan Development: Nurses are responsible for creating individualized nursing care plans.

• Specific Goals and Interventions: Care plans must include:

  • Clearly defined and measurable goals for patient outcomes.

  • Specific nursing interventions designed to achieve these goals.

• Unique Client Needs: The care plan should be tailored to address the distinctive and individual needs of each client.

• Guiding Therapeutic Intervention: The nursing care plan serves as:

  • A roadmap for therapeutic interventions.

  • A framework to ensure interventions are focused and purposeful.

• Desired Outcomes: The ultimate aim of the care plan is to:

  • Effectively guide nursing actions to achieve the desired and patient-centered outcomes of care.

Standard V: Intervention – Implementation of Care Plan

• Guided Intervention: Nurses implement interventions as outlined and directed by the individualized nursing care plan.

• Nursing Actions for Health Promotion and Restoration: Nursing interventions are specifically designed to:

  • Promote overall physical and mental health and well-being.

  • Maintain existing levels of health and functioning.

  • Restore health and functioning when compromised.

  • Prevent the onset or worsening of illness.

  • Facilitate rehabilitation processes.

• Specific Intervention Categories: Nursing interventions in mental health encompass a range of therapeutic modalities:

  • (a) Psychotherapeutic Interventions:

    • Coping Skills Enhancement: Nurses utilize psychotherapeutic techniques to:

      • Assist clients in regaining or strengthening their existing coping mechanisms and abilities.

      • Prevent further functional decline or disability related to mental health challenges.

  • (b) Health Teaching:

    • Promoting Healthy Living Patterns: Nurses engage in health teaching to:

      • Assist clients, families, and groups in developing and adopting satisfying and productive lifestyle patterns.

      • Educate on strategies for mental health promotion, illness prevention, and self-management.

  • (c) Activities of Daily Living (ADLs):

    • Goal-Directed ADL Utilization: Nurses intentionally utilize activities of daily living in a therapeutic and goal-directed manner to:

      • Foster and enhance clients’ ability to perform adequate self-care.

      • Promote overall physical and mental well-being through structured daily routines and activities.

  • (d) Somatic Therapies:

    • Knowledge and Skills in Somatic Therapies: Nurses utilize their knowledge base of somatic therapies.

    • Clinical Skill Application: They apply related clinical skills effectively when working with clients who are receiving somatic treatments (e.g., medication management, ECT).

  • (e) Therapeutic Environment:

    • Collaborative Environment Creation: Nurses actively collaborate with clients and other healthcare providers to:

      • Structure and establish a therapeutic environment.

      • Maintain a therapeutic milieu that is conducive to healing, recovery, and positive patient outcomes.

Standard VI: Evaluation – Outcome Assessment and Plan Revision

• Client Response Evaluation: Nurses are responsible for systematically evaluating client responses to implemented nursing actions and interventions.

• Data-Driven Revision: Evaluation findings are used to:
  * Revise and update the patient database with new information.
  * Refine and modify the nursing diagnoses based on ongoing assessment.
  * Adapt and revise the nursing care plan to ensure it remains relevant and effective in meeting the client’s evolving needs.

Professional Performance Standards

Standard VII: Peer Review – Quality Assurance

• Peer Evaluation and Quality Assurance: Nurses actively participate in peer review processes and other quality evaluation mechanisms.

• Assuring Quality of Care: Peer review and evaluation are essential to:

  • Systematically assess the quality of nursing care being provided to clients.

  • Identify areas for improvement and ensure consistent delivery of high-quality care.

Standard VIII: Interdisciplinary Collaboration – Team-Based Care

• Collaborative Practice: Nurses engage in active collaboration with other healthcare providers from various disciplines.

• Multidisciplinary Teamwork: Collaboration spans all phases of care:
  * Assessing patient needs and contributing to comprehensive assessments.
  * Planning care collaboratively with the team.
  * Implementing integrated treatment plans.
  * Evaluating the effectiveness of programs and mental health activities from a team perspective.

Standard IX: Utilization of Community Health Systems – Community Engagement

• Community-Based Mental Health: Nurses extend their professional involvement beyond direct patient care settings to engage with the broader community.

• Community Health Initiatives: They participate with other community members in:
  * Assessing the mental health needs of the community.
  * Planning and developing mental health services and systems.
  * Implementing community-based mental health programs and initiatives.
  * Evaluating the effectiveness and impact of community mental health services.

• Continuum of Prevention: Nurses contribute to building and strengthening a comprehensive continuum of mental health services within the community, encompassing:
  * Primary Prevention: Promoting mental wellness and preventing the onset of mental illness.
  * Secondary Prevention: Early identification and intervention to reduce the impact of mental illness.
  * Tertiary Prevention: Rehabilitation and support to minimize disability and improve quality of life for individuals with established mental illnesses.

Standard X: Research – Advancing the Field

• Contribution to Knowledge and Practice: Nurses play a critical role in advancing the field of nursing and mental health through research and scholarly activities.

• Innovation in Theory and Practice: This contribution is achieved through:
  * Developing and refining nursing theories relevant to mental health.
  * Innovating and improving nursing practice through evidence-based approaches.

• Research Participation: Active engagement in research initiatives is essential for:
  * Generating new knowledge in mental health nursing.
  * Evaluating the effectiveness of nursing interventions.
  * Contributing to the evidence base that informs best practices in the field.