Unit 1 Scope and Standards of Psychiatric Nursing Practice

Concept of Mental Health

• In 1999, Surgeon General David Satcher emphasized the importance of mental health.
• Mental health is a multifaceted concept including emotional, psychological, and social well-being.
• Mental health involves how people think, feel, behave, and handle life's difficulties.
• The World Health Organization (WHO) defines mental health as a state where individuals realize their abilities, cope with life stresses, work productively, and contribute to their community.
• WHO uses a life span approach, examining mental health from pre-conception onward.
• Factors influencing mental health change significantly throughout an individual's life.
• Mental health is influenced by numerous interrelated factors.
• Mental health is a dynamic term that changes overtime
• Lack of specific references for Filipinos on mental health, it is often viewed through cultural and spiritual practices.
• Mental Health R&D Program of the Philippine Council for Health Research and Development held discussions on "Spirituality in Philippine Mental Health Research and Practice" in 2022.
• Spirituality and religiosity can affect mental health positively and negatively.
• Spiritual and religious practices can be preventative and help cope with crises.
• These practices can reinforce negative perceptions of mental health issues, hindering access to care.

Concept of Mental Illness

• In 2019, 1 in 8 people globally had a mental disorder, with anxiety and depressive orders being most prevalent.
• By 2020, the number of people affected rose considerably due to COVID-19.
• There was a 26% increase in anxiety disorders and a 28% increase in depressive disorders in 2020.

Mental Health Act

• Mental Health Act of 2018 or Republic Act No. 11036 is a landmark law in the Philippines.
• The Act enhances mental health care and protects individuals' rights.
• Declared mental health a national priority, accessible, affordable, and high quality.
• Mental health care services are integrated into the general healthcare system.
• Individuals have the right to nondiscriminatory care, informed consent, and freedom from discrimination, stigma, and abuse.
• Mental health services are integrated into healthcare levels with community-based care emphasized and training for professionals.
• Mental Health Act encourages mental health promotion and education to raise awareness and reduce stigma.
• Department of Health coordinates efforts with government agencies, non-government organizations, and the private sector for the Act's implementation.
• The Act supports mental health research and development to improve understanding and treatment of mental health conditions.
• Adequate funding for effective implementation of mental health programs and services is mandated by this Act
• System is established to monitor and evaluate services, ensuring quality and effectiveness.

Rights of a client with mental illness

• Include a range of legal and ethical considerations aimed at protecting a patient's dignity, autonomy, and well-being
• Rights include dignity and respect, free from discrimination and stigma.
• Includes informed consent about diagnosis, treatment, risks, and benefits.
• Includes confidentiality except when mandated to prevent harm.
• Includes least restrictive treatment, prioritizing community-based services.
• Includes the right to refuse treatment unless they are a danger, legal procedures need to be followed.
• Includes the right to legal representation for involuntary commitment.
• Includes freedom from abuse and neglect, ensuring secure care.
• Includes access to mental health services: treatment support, rehabilitation, free from discrimination or barriers.
• Includes respect to research and teaching and the right to refuse this.
• Includes right to refuse involvement with students except psychiatric resident.
• Includes the right to provide informed consent for research.
• Includes the right to be informed of research goals and results and the right to alternative treatments.
• The right to withdraw from research at any time.
• Includes the right to make a complaint: raise concerns, or suggest changes.
• Two significant laws enacted for the benefit of patients in the Philippines is:
  • Magna Carta for Disabled Persons
  • Mental Health Act

Legal Psychiatric Nursing Issues

• Legal issues in psychiatric nursing: confidentiality, privacy, informed consent restraints, seclusion, voluntary admission, and involuntary commitment.
• Adhering to legal requirements protects patients rights, ensure ethical, sage, and effective nursing practices

Confidentiality and Right to Privacy:

• Cornerstones for trust
• Maintaining trust between health providers and patients
• Patient records must be secured
• Any discussion of a patient's condition must be conducted in a private setting.
• Nurses discussing a patient's condition publicly can be charged with breach of confidentiality.
• Duty to warn, inform relevant authorities is an exception if patient poses a serious danger to others.
• Patients cannot be searched without probable cause
• Invasion of privacy is a legal issue that can arise
• Physician's order and documented rational should be given

Informed Consent:

• Involves ensuring that patients are fully aware of potential risks, benefits, and alternatives of treatment
• Patient agree with treatment or procedures voluntarily
• Patient lacks capacity for consent due to severe mental illness is obtained from a legal guardian
• Legal proceeding should be followed
• Client is mentally incompetent to make decisions, treatment is necessary to preserve life or prevent serious harm
• When refusing treatment poses a threat to the life or health of another person

Restraints and Seclusion:

• Use of restraints and seclusion in psychiatric settings is a regulated practice
• Restraints and seclusion are only used when absolutely necessary to harm to the patient or others
• Never used for convenience, only for safety measures to avoid accusations of false imprisonment
• Nurse must follow strict protocols, including obtaining a physician's order, and continuously monitoring the patient
• Use of restraints or seclusion must be documented meticulously
• Patient's condition must be re-assessed regularly to ensure the measures are still required

Commitment Issues:

• Involve legal processes related to admitting patients to psychiatric facilities
• Patients can be admitted voluntarily and involuntarily
• Voluntary admission, the patients seek treatment on their own accord and have the right to leave the facility
• Involuntary commitment, the patients can be admitted against their will if they are deemed a harm to themselves or others
• Legal processing requires involving mental health evaluations and court orders
• Includes a legal hearing to uphold the patient's rights while ensuring their safety

The standards of practice for psychiatric-mental health nursing

• Guides nursing actions in providing holistic, patient-centered care
• Standards are detailed in Psychiatric-Mental Health Nursing: Scope and Standards of Practice, 2nd Edition

Standards of Practice

• Assessment: PMH nurse gathers and integrates health information relevant to the consumer.
• Diagnosis: The PMH nurse evaluates assessment data to identify diagnoses, issues and key areas for care and treatment including the risk level
• Outcomes Identification: The PMH nurse determines the anticipated outcomes and healthcare consumer's objectives for a plan tailored to the individual or the specific situation.
• Planning: The PMH nurse formulates a plan.
• Implementation: The PMH nurse carries out the designated plan.
• Coordination of care: The PMH nurse oversees coordination of this care.
• Health teaching and health promotion- utilize tactics to enhance wellness.
• Consultation: Advanced Practice nurse offers guidance to fellow clinicians to bolster skills in delivering healthcare services, and drives impactful change.
• Prescriptive Authority and treatment: Advanced Practice nurse employs prescriptive privileges, protocols, referrals, intervention and therapies.
• Pharmacological, Biological and Integrative Therapies: Advanced Practice nurse blends pharmacology, biology and complementary treatments with clinical expertise.
• Milieu Therapy: Creates and upholds secure, healing environment geared towards recovery in partnership with patients, their families, and fellow health providers.
• Therapeutic relationship and counseling: Utilizes therapeutic bond and counseling techniques to enhance coping, and restorating skills.
• Psychotherapy: Advanced Practice nurse conducts individual, couple, group, family therapy and supports the patient and family.
• Evaluation: Assesses goals, an ongoing process that treatment is effective, and how patients is meeting needs, while continuously optimized.

Legal and Ethical Contexts of Psychiatric Nursing

• Nurses in psychiatric care encounter complex situations, requiring them to uphold high ethical and legal standards.
• Ethics is the study of right and wrong, guides personal behavior and decisions based on moral principles
• Laws are formal rules created and enforced by governments to maintain order, protect rights, and ensure justice.
• Nurses must understand their professional code of ethics (ICN, 2021).

Ethical Principles:

• Autonomy: Respecting individuals as rational agents able to determine their own destinies.
• Beneficence: An obligation to promote patient well-being. Sometimes, duties like respecting autonomy yield to protecting them from harm.
• Non-maleficence: Preventing more harm. Nurses must carefully weigh the interventions and strive to minimize harm.
• Justice: Often termed as "Justice as fairness" (Rawls, 1985). Advocates for equal treatment in health regardless of race, gender, and wealth.
• Veracity: Healthcare provider tells truth and refrains from deceiving or misleading patients (Aiken, 2004). Be transparent and provide accurate information.

Emergence of Psychiatric Nursing Specialization

• Florence Nightingale initiated holistic patient care prioritizing self-care and independence.
• 1882, Psychiatric nursing evolved with specialized training for nurses, pioneered by Linda Richards.
• Effie Jane Taylor established psychiatric nursing at Johns Hopkins University in 1913.

Advancements in Treatment and Care:

• In early 20th century, mental health advanced.
• 1920, Harriet Bailey's first psychiatric-mental health textual emphasized procedural care.
• Post 1950, milieu management emphasized therapeutic environments.
• 1954, Antipsychotic meds like chlorpromazine changed care for ill, involving community-based support while keep patient.
• Therapy's growth challenged psychiatric nurses.
• 1953, Interpersonal models emerged, linking personality to interactions and unmet needs.
• 1990s, mental health care shifted to somatic interventions.
• 1992, Interpersonal models shaped nursing, with Hildegard Peplau highlighting the nurse's counselling role.

Contemporary Psychiatric-Mental Health Nursing:

• Described as a specialized nursing area.
• Committed to promoting mental health assessment, diagnosis, and treatment of disorders (2013).
• A key part of the practice is using oneself therapeutically, based on scientific studies and research.

Historical Development of Psychiatric-Mental Health Nursing

• Nursing profession advanced mirroring advancements in healthcare.

Early Beginnings:

• 1890s to post WWII, nurses cared for mentally ill in custodial sanitariums.
• Not focusing on patient engagement.
• Dorothea Dix, a 19th century school teacher advocated for state hospital
• Impacted mental health care reform

Defining Mental Illness:

• According to the American Psychiatric Association (2022), mental disorders are health conditions involving changes in emotion, thinking, or behavior.
• Associated distress and problems functions
• WHO states that mental disorders comprise a broad range of problem
• Characterized by combination range of perception, emotions, behavior, and relationships with others.
• Defining mental illness universally is challenging due cultural influences.
• Horwitz believes that the concept of relative acknowledges that norms defining "normal" cultural bound.
• "Abnormal" behaviors are culturally bound.
• Often viewed as indicative of the family's overall state.
• Shame and secrecy stemming from super natural beliefs and social stigma.
• Stigma deters individuals from seeking professional mental health services, derogatory terms.
• Rivera Antonio, 2017

Explore fundamental principles that guide healthcare practices. This includes autonomy, beneficence, non-maleficence, and justice. Discover how these influence moral behavior, patient rights, and holistic care.