Psychiatric-Mental Health Nursing: Scope and Standards of Practice
these standards provide the basis for
- criteria for certification
- legal definition of nursing,
- national council of state boards of nursing licensure examination (NCLEX-RN)
- the six standards of practice defining the critical thinking model known as the nursing process
QSEN- Quality and Safety Education for Nurses
a major national initiative centered on pt safety and quality -the goal is to prepare future nurses with the knowledge, skills and atiitudes (KSA’s) required to enhance quality, care and safety in the health care settings in which they are employed.
QSEN 6 competencies
- pt centered care
- quality improvement
- safety
- Informatics
- Teamwork and collaboration
- Evidence-based practice (EBP)
Goals for a Psychiatric Nursing Assessment
- assess for risk factors affecting the safety of the pt or others
- perform a mental status examination (MSE)
- Assess psychosocial status
- identify mutual goals for treatment
- formulate a plan of care
purpose of Mental Status Exam (MSE)
the purpose of this test is to evaluate current cognitive processes
psychosocial assessment (the most subjective part of the assessment) pts perceptions and recollections of current lifestyle and life
this assessment provides additional info from which to develop a plan of care beyond the MSE, it provides:
- pts chief complaint
- hx fo violet, suicidal, or self mutilating behaviors
- alcohol, substance abuse
- fam psych hx
- personal psych trmt including meds and comple therap
- stressors and coping mechanisms
- quality of activities of daily living
- personal background
- social background including support system
- weakness, strengths, goals for treatment
- racial ethnic, cultural beliefs and practices
- spiritual beliefs or religious practices
Three components of a standard nursing diagnosis
problem -the unmet need
etiology-the probable cause “related to”
supporting data-signs and symptoms “as evidenced by”
Outcomes criteria
these are the optimal goal outcomes that reflect the maximal level of pt health that can realistically be achieved through nursing interventions, the desired change. –stated in attainable/ measurable terms and include a time estimate for attainment.
Nursing Outcomes Classification (NOC)
490 standardized outcomes that provide a mechanism for communicating the effect of nursing interventions on the well-being of pts, families and communities
things to consider when PLANNING care
safe
appropriate
individualized
evidence based
David Sackett’s definition of EBP
“the conscientious, explicit, and judicious us of current best evidence in making decisions about the care of individual patients”
Nursing Interventions Classification (NIC)
research-based standardized listing of 554 interventions that the nurse can use to plan care, and reflects current clinical practice
milieu tharapy
includes orienting pts to their rights and responsibilities, selecting specific activities that meet pts physical and mental health needs, and ensuring that pts are maintained in the least restrictive environment.
4 interventions that can be performed by psychiatric mental health nurse (PMHN) basic education
coordination or care
health teaching and health promotion
milieu therapy
pharmacological, biological and integrative therapies
interventions that only advanced practice psychiatric mental health nurse
prescriptive authority and treatment
psychotherapy
