MENTAL HEALTH NURSING

Dr. K.Lalitha
Professor
Department of Nursing, NIMHANS,
Bangalore

PRINCIPLES OF PSYCHIATRIC
NURSING

Every one has basic needs

Principles are general for
Physically ill and mentally ill.
Has intrinsic worth and dignity
Has potentiality to grow

1. ACCEPT THE PATIENT AS HE IS

Conveys the feeling of being loved

and cared.
Unlearning of sick behavior is less
threatening
Does not mean complete
permissiveness
Set positive behaviour to gain
respect.

1.1 BE NON-JUDGMENTAL AND NON-PUNITIVE

Behaviours are neither judged not

punished.

Direct and indirect punishments

are avoided.

1.2 SHOW INTEREST IN THE PATIENT AS A

PERSON

Studying patients behaviour

pattern
Making the patient aware in a subtle
manner that you are interest in him
Seeking out a patient
Using time spent with him on those
things he is interested in.

Being aware of his likes and

dislikes
Explain when his demands cannot
be met
Dealing with his comments,
complaints and expression of
approval realistically
Accepting his fears as real to him
Avoid sensitive subjects and

1.3 RECOGNIZE AND REFLECT ON

FEELINGS
WHICH PATIENT MAY EXPRESS

Identifying strong negative feelings

(Anger, Worthlessness).
Content of talk is not important
Reflects the understanding of his
feelings

1.4 TALK WITH A PURPOSE

Find out Needs, wants and

interests
of him
Use reflections, open-end
questions
and focusing
Avoid evaluative, hostile, probing
responses

1.5 LISTEN

An active process
Third ear is required
Give brief, non-directive comments
and interest.

1.6 PERMIT PATIENT TO EXPRESS STRONGLY

HELD FEELINGS

Strong emotions re dangerous.

Let him express anxiety, fear
hostility, hatred or anger.
Be a listener without disapproval
and punishing.

2. USE SELF-UNDERSTANDING AS A
THERAPEUTIC TOOL

Why one becomes the way.

Exchange personal experience with
colleagues
Discuss with experienced persons
Participate in group conference
Introspect on why we feel or act
the way we do.

3. USE CONSISTENT BEHAVIOUR TO

INCREASE
PATIENTS EMOTIONAL SECURITY

Reflect consistency in attitudes,

ward routine and defining the
limitation
Demonstrate consistency through
Convey acceptance
Maintain from nurse to nurse, shift
to shift

Limit permissiveness (Homicidal,

suicidal, Hyper-active and
Suspicious)
Allow patient to feel as he does,
but limit his behaviour.
Plan for reinforcing positive
behaviour
Dont attempt to win patients
liking

4. GIVE REASSURANCE TO PATIENTS IN SUBTLE

AND ACCEPTABLE MANNER

Reassurance is building patients confidence

Empathize with the patient to reassure.
Avoid false promises
Reassure by
Showing interest
Attending to the matters that are most
important to the patients
Allowing him to be sick, as he needs to be
Being aware and accepting how he really feels.

Giving unconditional services

Being with the patient physically
Listening to his problems without
surprise or disapproval
Agreeing with his problems and
thinking along with him to solve
them.
Providing outlet for his anxieties.

5. CHANGE PATIENTS BEHAVIOUS

THROUGH EMOTIONAL EXPERIENCE &
NOT BE RATIONAL INTERPRETATION

Focus on feeling and not on

intellectual aspects
Telling and advising is of no use
Role-play, socio-drams and
transactional analysis- to provide
corrective emotional experience
Help him in self-understanding
Insight development is painful

6. AVOID UNNECESSARY
INCREASE IN
PATIENTS ANXIETY
Anxiety is a feeling of
apprehension
Increase in apathy may be due to,
i. Contradicting psychotic ideas.
ii. Demanding the patients to
complete the set tasks that he
cannot obviously meet.
iii. Making him to face repeated
failure

iv. Using big sentences,

professional terms while talking

to him.
v. Careless conversation within
patients hearing about his
personal life.
vi. Calling attention to patients
defects
vii. Being insincere.

viii. Giving no orientation about the

wards,
about his co-patients about ward
staff,
policies, routines and procedure.
ix. Threats, passing sharp commands
and
showing indifference.
x. Asking questions about family,
work,

7. DEMONSTRATE OBJECTIVE
OBSERVATION

Objectivity is evaluating exactly.

Improve objectivity through introspection.
Lack of objectivity is due to
i.
Nurses emotional needs take precedence
ii.
Defending or Justifying herself
iii.
Demanding that patient should treat her in a
certain way
iv.
Evaluating the patients behaviour right or
wrong

Identify personal limitations and cause

for faults in objectivity.

8. MAINTAIN REALISTIC NURSE-PATIENT RELATIONSHIP

Focus: Personal and emotional needs of

patients.
Relationship is planned with
therapeutic orientation.
Analyze the interaction with patients.
Identify patients demands and actual
needs
It is an interpersonal process to bring
adaptive ness, integration in patients.

9. AVOID PHYSICAL AND VERBAL FORCE AS

MUCH AS POSSIBLE

Force results in psychological trauma for few.

Some patients welcome punishment
While using physical restrains
Do it quickly, firmly with help
Dont show anger or annoyance
Tell the reason for tying and how long
Attend to his needs as usual
After releasing restraints, never remind him
Predict patients behavior in advance.

10. PROVIDE NURSING CARE TO THE

PATIENT AS A
PERSON AND NOT ON CONTROL OF
SYMPTOMS OF
THE DISEASE THAT HE HAS

Every behaviour is caused

Symptoms are reflections of his
problems
Analyze symptoms find the
cause and reveal to the patient.

11.EXPLAIN ROUTINES AND

PROCEDURES AT
PATIENTS LEVELS OF
UNDERSTANDING

Respect patients rights.

Explanation reduces anxiety
Explanation depends on patients
span of attention, level of anxiety
and ability to decide.

12. MANY PROCEDURES ARE

MODIFIED BUT
BASIC PRINCIPLES REMAIN
UNALTERED
Nursing principles
Safety
Comfort
Individuality
Privacy
Maintaining therapeutic effectiveness
Fine workmanship

THANK YOU