Principles of psychiatric nursing

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Principles of Psychiatric Nursing

Transcript of Principles of psychiatric nursing

Page 1: Principles of psychiatric nursing

Principles of Psychiatric Nursing

Page 2: Principles of psychiatric nursing

The basic principles in Psychiatric Nursing are as follows:

1. Accepting patients as exactly as they are

2. Maintaining contact with reality3. Seeking validation from patient4. Self-understanding used as a

therapeutic tool5. Nurse’s personal contribution6. Influence of expectations of

behavior7. Consistency and patient

security

8. Reassurance9. Changes in patient behavior through emotional experience10. Avoiding increased patient anxiety11. Consideration of reason for behavior12. Necessity of Motor and Sensory stimulation13. Realistic nurse patient relationship

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1. Accepting patients as exactly as they are:

• The goal is to convey to the patient as a respect for him/ her as an individual human being who possesses worth and dignity.

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Acceptance is conveyed through many avenues of approach such as:

1. Non-judgmental and non-punitive relationship with patient.

• A patient's behavior is no more right or wrong, good or bad.

• You can feel shocked from his or her behavior but do not make the patient feel that he has insulted and must be punished.

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A non-punitive approach: do not punish neither directly nor indirectly for his expressions of behavior.

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The means of punishment consists of measures such as:

a. Avoiding a patient except when something must be done for him.b. Telling him something un-pleasantc. Calling attention to his defects by talking to him.d. Reducing him to a diagnosis.e. Failing to explain what is being done to him.f. Laughing at his fears.

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g. Expecting him to know and behave as though hospital routine were more important than him.

h. Demanding that he respects doctors and nurses, and showing him annoyance and disapproval face.

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Showing interest in the patient as a person and not as a case or clinical problem.

• reading patient's chart by the nurse• studying textbooks for increased

understanding of the development of the behavior pattern

• using time spent with him on those things which he is interested

• nurses awareness of patient's likes and dislikes

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• Attain patient's requests and if not explain to them the reason for not meeting it

• Listen carefully to client’s complaints and expressions

• accept patient's fears as a real to him

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Recognizing the feelings patients do express:

• the nurse must focus his/her attention upon understanding what the feeling means to the patients

e.g: " I'd like to break someone's neck, means that he is angry. • use of open-end question. it does not direct

the patient's answer in any specific direction. E.g "Would you care to tell me about it?"

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Talking provides a means of keeping acceptance of patients.

• The conversation should center on the patient, on his needs, wants and on his interests, not on the nurse's

• Nurse can use Understanding approach, reflection and open-end questions

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Listening to Patients

• Listening requires hearing, proper interpretation and selective responsiveness.

• Nurse can encouraging patients to talk through non-directive comments and through interests in what the patient is saying.

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Permitting patients to express emotions.

• Anxiety, fear, hostility, hate and anger should be expected, tolerated and allowed expression but without physiologic or physical danger to themselves and others.

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2. Maintaining contact with reality

• clients tend to see reality as they want it to be rather than what it is.

• There must not be support for the unrealistic ideas, assumptions or behavior. Reality must be called to the patient's attention.

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3. Seeking Validation from patient

• It is the meaning of feelings and behavior from the patients point of view thus the nurse has to check against the nurse's interpretation of

how he sees things. ?

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4. Self- understanding used as a therapeutic tool

• The nurse should feels some security about her ability to respond appropriately to patient behavior by understanding her behavior and attitude towards mental illness first

• The nurse can participate in group conferences about patient care.

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5. Nurse's personal contribution

• Self-understanding of how nurse really feels is so important and stereotyped behavior response to situations and patients is potentially dangerous.

• The inconsistency between feelings and actions lessens the nurse's effectiveness in a relationship

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6. Influence of expectations of behavior

• It is important to see the potential for growth in every patient this makes the nurse to be active as a resources person.

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7. Consistency and patient security

• The nurse has to be consistent in attitude, behavior, feelings and routine in the psychiatric hospital to help the patient to reduce the number of decisions he is called upon to make

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8. Reassurance

• Reassurance can best be given to patient by:a. Attention to matters that are important to him/her.

b. Allowing patient to be as sick as he needs to bec. Complete awareness and acceptance of how the patient actually feels.

d. Doing things without asking anything of the patient in return, such as improved behavior or a show of appreciation.

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9. Changes in patient behavior through emotional experience

• Help patient to go through experience and develop their own feelings toward subject

• This involves the use of acceptance, discriminating listening, focus of relationships upon the patient, and involvement with the patient.

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10. Avoiding increased patient anxiety

• Demands upon the patient that he obviously cannot meet. e.g. to insist that a depressed patient cheer-up, that an over active patient sits down and keeps quiet. Failure causes anxiety to patient

• Careless conversations• Focusing attention on patient's defects, failing

abilities

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• Insincerity• Threats, by sharp commands• Avoid topics/situations that increase patient's

anxiety• Avoid exposing the patient's failing ability• Avoid focusing attention on patient's

weaknesses

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11. Consideration of reason for behavior

• Viewing patient's behavior objectively is important in understanding why the patient behaves in a specific way.

• Objectivity is the ability to evaluate a situation of the patient's behavior, on the basis of what is actually happening rather than on the basis of one's personal feelings

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12. Necessity of Motor and Sensory Stimulation

• Opportunity must be given to psychiatric patients on exercises, games or mental tasks to increase the sense of achievement

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13. Realistic nurse patient relationship

• It has to be therapeutic relationship and limitations within the relationships

• It is to protect the patient from demanding more than possibly he can receive

• It has a beginning, it develops once a relationship is established and it has an end. A relationship based on mutual respect and trust will tolerate mistakes and the strains and stresses of termination.

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Thank You