General Principals of Psychiatric Nursing
General principles of Psychiatric Nursing-
These principles are based on the concept that each individual has an intrinsic worth and dignity and has potentialities to grow.
1. Patient is Accepted Exactly as He is -
Accepting means being non-judgmental. Acceptance conveys the feeling of being loved and cared. Acceptance does not mean complete permissiveness but setting of positive behaviours to convey to him the respect as an individual human being
A-Being Non-judgmental and Non-punitive -
The patient's behaviour is not judged as right or wrong, good or bad. Patient is not punished for his undesirable behaviour. All direct (chaining, restraining, putting him in a separate room) and indirect (ignoring his presence or withdrawing attention) methods of punishment must be avoided. A nurse who shows acceptance does not reject the patient even when he behaves contrary to her expectations.
B-Being Sincerely Interested in the Patient
- Being sincerely interested in another individual means considering the other individual's interest
- Studying patient's behaviour pattern
- . Allowing him to make his own choices and decisions as far as possible
- Being aware of his likes and dislikes.
- Being honest with him.
- Taking time and energy to listen to what he is saying.
- Avoiding sensitive subjects and issues.
C-Recognizing and Reflecting on Feelings which Patient may Express -When patient talks, it is not the content that is important to note, but the feeling behind the conversation, which has to be recognized and reflected.
D-Talking with a Purpose The nurse's conversation with a patient must revolve around his needs, wants and interests. Indirect approaches like reflection, open-ended questions, focusing on a point, presenting reality are more effective when the problems are not obvious.
E-Listening Listening is an active process. The nurse should take time and energy to listen to what the patient is saying. She must be a sympathetic listener and show genuine interest.
F- Permitting Patient to Express Strongly-held Feelings Strong emotions bottled up are potentially explosive and dangerous. It is better to permit the patient to express his strong feelings without disapproval or punishment.
2. Use Self-understanding as a Therapeutic Tool-
A psychiatric nurse should have a realistic self concept and should be able to recognize one's Own feelings,attitudes and responses.
3. Consistency is used to Contribute to Patient's Security-
This means that there should be consistency in the attitude of the staff, ward routine and in defining the limitations placed on the patient.
4.Reassurance should be given in a Subtle and Acceptable Manner-
Reassurance is building patient's confidence. To give reassurance, the nurse needs to understand and analyse the situation as to how it appears to the patient.
5. Patient's Behaviour is Changed through Emotional Experience and not by Rational Interpretation -
Advising or rationalizing with patients is not effective in changing behaviour. Role-play and socio-drama are a few avenues of providing corrective emotional experiences to a patient and facilitating insight into his own behaviour.
6. Unnecessary Increase in Patient's Anxiety should be Avoided
- Showing nurse's own anxiety.
- Showing attention to the patient's deficits.
- Making the patient to face repeated failures.
- Placing demands on patient which he obviously cannot meet.
7. Objective Observation of Patient to Understand his Behaviour
Objectivity is an ability to evaluate exactly what the patient wants to say and not mix up one's own feelings, opinion or judgment.
8. Maintain Realistic Nurse-Patient Relationship
Realistic or professional relationship focuses upon the personal and emotional needs of the patient and not on nurse's needs.
9. Avoid Physical and Verbal Force as Much as Possible
10. Nursing Care is Centred on the Patient as a Person and not on the Control of Symptoms
11. All Explanations of Procedures and other Routines are Given According to the Patient's Level of Understanding
12. Many Procedures are Modified but Basic Principles Remain Unaltered-
In psychiatric nursing field, many methods are adapted to individual needs of the patients, but the underlying nursing scientific principles remain the same. Some nursing principles to be kept in mind are: safety, comfort, privacy, maintaining therapeutic effectiveness, economy of time, energy and material.