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Standards and Documentation in Psychiatric Nursing Practice

Oct 03, 202410 min read

Structure Criteria and Standards

Qualifications of a Psychiatric-Mental Health Nurse (PMHN)

  1. Personal Requirements: a unique skill set for handling mental illness including being knowledgeable, having good basic nursing skills, problem-solving skills, patience, the therapeutic use of self and importantly, exceptional communication skills which comprises much of the work of a psychiatric nurse (talking, listening). The nurse must understand the that a patient and their family will experience with mental illness, and have the ability to deal with that stress in a calm but authoritative manner.
  2. Professional Requirements: a BSN, RN, MSN, or a Doctor of Nursing Practice (DNP).

Functions of a PMHN

(mn. ARISE) Assess, Respond to, and Intervene for the patient’s needs, Safeguard the right of the patient, and Evaluate the effectiveness of interventions.

  1. In the Hospital: working with psychiatrists, psychologists, advanced practice nurses, registered nurses, licensed practical nurses, aides, and orderlies. This involves record-keeping and team meetings to coordinate care. The psychiatric nurse comforts frightened or sad patients and answers patients’ questions. They often administer medications.
  2. In the Community: “Visiting Psychiatric Nurses” take on de-institutionalized patients who need help taking medications or who are at risk of decompensating (losing normal functioning). They administer medications, assess functioning, and answers questions.
  3. At the Clinic or Doctor’s Office: working with one or two doctors in a small practice or clinic; providing patient education. They take patient histories and updates records. The psychiatric nurse dispenses medications prescribed by the doctor.
  4. Advanced Level: Psychiatric or Mental Health Nurse Practitioner: with an MSN and specialized training, they may prescribe medications and practice independently. They frequently have private practices. In some institutions, they may grant admitting privileges (the master-level nurse is able to decide whether a person is in danger of harming themselves or others).

Roles of a PMHN

  1. Mothering Role: all “motherly” activities, such as bathing, feeding, dressing, comforting, etc.
  2. Technician Role: the performance of all nursing procedures such as bed baths, serving food, administering medications, etc.
  3. Socializing Agent: helping the client learn to behave in social situations and utilizing ward group activities.
  4. Teacher: setting examples, orienting client to ward policies, giving health teaching, etc.
  5. Counselor: works specifically on the client’s presenting problem or behavior pattern creating difficulty.
  6. Ward manager: provides a therapeutic milieu for the client.

Physical Facilities and Equipment

  1. Psychiatric Hospitals, in addition to inpatient nursing units, include associated diagnostic and treatment areas, as well as necessary dietetic, supply, housekeeping, and administrative spaces common to all hospitals.
  2. Psychiatric and Neuro-Psychiatric Nursing Units of General Hospitals
  3. Facilities for the Psychiatric Medically Infirm
  4. Neuropsychiatric Units
  5. (Inpatient and Outpatient) Alcohol and Drug Addiction Treatment Facilities
  6. Mental Health Clinics
  7. Day Hospitals
  8. Day Treatment Centers

Process and Outcome Criteria and Standards

The minimum acceptable level of performance and the legal and professional obligations required for a Registered Psychiatric Nurse across all practice settings, domains, and roles.

Therapeutic Relationships

The Registered Psychiatric Nurse establishes collaborative, professional, interpersonal, and therapeutic relationships with clients.

  1. Continually applies the therapeutic use of self within professional practice.
  2. Recognizes and addresses power imbalances in therapeutic relationships.
  3. Ensures client needs to remain as the focus of the therapeutic relationship.
  4. Does not exploit the vulnerability of persons encountered through their practice.
  5. Will not engage in any sexual behavior while in a therapeutic relationship with a client, with or without consent.
  6. Will not enter into a close personal or intimate relationship with a client or a former client who has received psychotherapeutic treatment from the Registered Psychiatric Nurse.
  7. Uses professional judgment, effective communication and interpersonal skills, and practice with integrity to establish, maintain, and terminate the therapeutic relationship.
  8. Recognizes and addresses transference, counter-transference, and their impact on the therapeutic relationship.
  9. Applies critical thinking and professional judgment in therapeutic relationships.
  10. Establishes and negotiates boundaries in therapeutic relationships.
  11. Practices according to the principles of informed consent and confidentiality.
  12. Will make their best efforts to find suitable alternatives to treating their own family or friends.
  13. Develops partnerships using a client-centered, integrated, and holistic approach.

Competent, Evidence-Informed Practice

The Registered Psychiatric Nurse continually acquires and integrates evidence informed knowledge and builds on psychiatric nursing education and lifelong learning.

  1. Applies evidence-informed knowledge, skill, critical thinking, and professional judgment to assess, plan, implement, and evaluate in the practice of psychiatric nursing.
  2. Incorporates evidence-informed knowledge to promote safety and quality in psychiatric nursing practice.
  3. Uses communication skills effectively.
  4. Integrates cultural competence and cultural safety into their practice with diverse clients.
  5. Recognizes potential risks and hazards, and implements interventions to promote a safe environment.
  6. Integrates infection prevention and control principles in providing psychiatric nursing care.
  7. Documents the application of the clinical decision-making process in a responsible, accountable and ethical manner.
  8. Applies documentation principles to ensure effective written/electronic communication.
  9. Remains up-to-date in current knowledge relevant to their practice.
  10. Incorporates knowledge of therapeutic modalities and conceptual models of psychiatric nursing.
  11. Coordinates client care and/or health services throughout the continuum of care.
  12. Establishes, maintains, and coordinates a plan of care based on a comprehensive psychiatric nursing assessment.

Professional Responsibility and Accountability

The Registered Psychiatric Nurse is accountable and responsible for safe, competent, and ethical psychiatric nursing practice that meets the standards of the profession an legislated requirements.

  1. Maintains current registration and licensure.
  2. Practices in accordance with all relevant legislation and regulation including the Standards of Psychiatric Nursing Practice.
  3. Exercises professional judgment when agency policies and procedures are unclear or absent.
  4. Assumes responsibility and accountability for continuing competence, and for meeting continuing competence requirements.
  5. Seeks out the necessary resources using skill and professional judgment to address personal and professional limitations.
  6. Recognizes the competencies and limitations of colleagues and/or students when assigning responsibilities.
  7. Responds to and/or reports unsafe practice, professional incompetence, professional misconduct, and incapacity or fitness-to-practice issues to the appropriate authority.
  8. Complies with any legal duty to warn and report, including abuse or potential harm to the public.
  9. Self-reports to the regulatory body conditions that compromise their fitness to practice.
  10. Uses technology, electronic communication, and social media responsibly and professionally.

Leadership and Collaboration in Quality Psychiatric Nursing practice

Professional Ethical Practice

The Registered Psychiatric Nurse understands, upholds, and incorporates the profession’s Code of Ethics into their professional practice.

  1. Practices with honesty, integrity and respect, and demonstrating the ethics, standards, principles, guidelines and values of the profession.
  2. Applies the Code of Ethics in all areas of their practice.
  3. Identifies the effect of their own values, beliefs and experiences in relationships with clients, recognizes potential conflicts, and takes action to prevent or resolve them.
  4. Applies ethical and legal considerations in maintaining confidentiality in all forms of communication.
  5. Supports the human, legal, and moral rights of clients, including the right to make informed decisions and the right to live at risk.

Related Laws in Mental Health

Philippine Mental Health Law (R.A. 11036)

The law proposes a mental health policy that aims to:

  • Enhance the delivery of integrated mental health services.
  • Promote mental health services.
  • Provide accessible mental health care, especially to the impoverished and those at high risk. Mental health services are proposed to be accessible from large-scale hospitals, down to the barangay level.
  • Promote and protect the rights of the individuals utilizing psychiatric, neurologic and psychosocial health services.
  • Appropriating funds for these purposes.

Patients’ Bill of Rights

Also read: The Patients’ Bill of Rights. It is a document that provides patients with information on how they can reasonable expect to be treated during the course of their hospital stay. These documents, in almost all cases, not legally binding. (?)

  1. Right to Appropriate Medical Care and Humane Treatment
  2. Right to Informed Consent
  3. Right to Privacy and Confidentiality
  4. Right to Information
  5. Right to Choose Health Care Provider and Facility
  6. Right to Self-Determination
  7. Right to Religious Belief
  8. Right to Medical Records
  9. Right to Leave
  10. Right to Refuse Participation in Medical Research
  11. Right to Correspondence and to Receive Visitors
  12. Right to be Informed of His Rights and Obligations as a Patient
  13. Right to Fair Treatment: treated with respect and dignity, have their privacy protected, receive services appropriate for their age and culture, and understand treatment options and alternatives.

Magna Carta of Women (R.A. 9710)

Under the Magna Carta of Women, it outlines the women’s human rights law that seeks to eliminate discrimination against women by recognizing, protecting, fulfilling, and promoting the rights of Filipino women, especially of those in the marginalized sector.

Magna Carta of Disabled Persons (R.A. 7277 of 1992)

Under the Magna Carta of Disabled Persons is an act for the provision for the rehabilitation, self-development, and self-reliance of disabled persons and their integration into the mainstream of society and for other purposes.

Magna Carta of Health Workers (R.A. 7305)

Under the Magna Carta of Public Health Workers, the government health workers who are “exposed to great danger, contagion, radiation, volcanic activity/eruption, or occupational risks or perils to life” are entitled to hazard pay/allowance.

The following are common legal psychiatric nursing issues:

  1. Tort Law is the area of law that covers most civil suits. Generally, every claim that arises in civil court, with the exception of contractual disputes, falls under tort law. The concept of this area of law is to redress a wrong done to a person and provide relief from the wrongful acts of others, usually by awarding monetary damages as compensation. The original intent of tort is to provide full compensation for proved harms. Torts can be split between three categories:
    • Negligent Torts: encompasses harm done to people generally through the failure of another to exercise a certain level of care, usually defined as a reasonable standard of care.
    • Intentional Torts: when an individual intentionally engages in actions that effectively cause injury or damage to another person.
    • Strict Liability Torts: also known as an absolute liability, these are tort cases where responsibility can be placed on an individual without proof of negligence or fault.
  2. Commitment Issues:
    • Legal and Ethical Context of Psychiatric Nursing Care: psychiatry and the law reflects tension between individual rights and social needs. They deal with human behavior, relationships, controlling socially undesirable behaviors, and together analyze whether the care of psychiatric patients is therapeutic, custodial, repressive, or punitive. Differences also exist between the law and psychiatry, where the law focuses on consequences and enforcement of a system of rules to encourage orderly functioning among groups while psychiatry is concerned with the meaning of behavior and the life satisfaction of the individual. The legal and ethical context of care is important for all psychiatric nurses because it focuses concern on the rights of patients and the quality of care they receive. Psychiatric nurses must become familiar with the laws of the state or country they are practicing in, as it enhances the freedom of both the nurse and the patient, informs ethical decision making, and ultimately results in better care.
    • Ethical Standards in Psychiatric Nursing Care: psychiatric nurses may encounter complex ethical situations, and are held to the highest standards of ethical accountability in their clinical practice.
  3. Independent and Collaborative Interventions: collaborative care intervention should maintain the client’s health care rights and focus on improving the psychologic and/or social aspects of a patient’s health.

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