Principles of psychiatric care by suresh aadi8888

PRINCIPLES AND CONCEPTS OF
MENTAL HEALTH NURSING:-
MR SURESH KUMAR SHARMA
RNRM, ACCN, MSN PSYCHIATRY 1suresh sharma-
sharmasuru.aadi@gmail.com

WELCOME
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General principles
of psychiatric care
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Principles:
Is rule that guides one's actions.
Principles of psychiatric care:
1-patient should be accepted as he
is.
Means of showing acceptance:
1) Be non- judgmental and non-punitive
2) Show interest in the patient as person
3) Recognize and reflect on feelings which the patient
express.
4) Talk with a purpose.
5) Permit patient to express strongly held feelings.
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2- Self understanding should be used
as a therapeutic tool.
Self understanding methods:
1)Exchange personal experience freely and frankly
with colleagues
2)Discuss own personal reaction with an
experienced person.
3)Participate in group conference regarding patient
care.
4)Keeping reflecting on why you feel or act way you
do.
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3-Consistency is used to contribute
to patient's security..
Consistency means:
Having certain routine pattern that dose
not change from one day to the other ..
**fear of unknown produce anxiety,
consistency helps in knowing what to
expect.
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4)Reassurance must be given in
suitable and acceptable manner.
How to give reassurance:
1)Be truly interested in patient problems.
2)Pay attention to the matters that are
important to the patient.
3)Listen to personal problems.
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4) Agree that the patient has a problem
and think along with him to solve it.
5) Provide patient with acceptable
outlets of anxiety.
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5) Patient's behavior is changed
through emotional experience and
not by use of reason.
 Advising and rationalizing is not
effective
 Modify the behaviour by corrective
emotional experience and clearing
insight. e.g role play
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6)Unnecessary increase of the
patient's anxiety should be
avoided.
– Showing nurse’s own anxiety
– Showing attention to the patients deficit
– Placing demand which patient cant complete
– Direct contradiction with patients psychotic
ideas
– Passing comments 10suresh sharma-

7-Observation of mentally ill patient is
directed toward the why of his
behavior.
*objectivity is an essential component of
observation
What do we mean by objectivity?
Objectivity is an ability to evaluate exactly
the patient's behavior without mixing one's
own feelings ,opinion or judgment.
Empathy versus sympathy 11suresh sharma-

8)Maintain a professional
relationship
– Focus on patients emotional needs
– Nurse self concept and empathy.
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• 9)Verbal and physical force must
be avoided if possible.
–Nurse should predictable
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10)Care should be centered on the
patient as person and not on the
control of symptoms.
– Same symptoms may be different
need
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11)Discussion of personal relationship and
personal values should be initiated only by
the patient
12) Many procedure are modified but basic
principles remain unaltered.
– Keep in mind
• Safety, comfort, privacy, therapeutic effectiveness,
economy of time, energy and material.
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Problems in applying principles
 Nurse discomfort
 Lack of objectivity
 Halo
 Horn error
 Leniency/strictness
 Central tendency
 Recent behavior bias
 Personal bias
 Manipulating the evaluation
 Nurse anxiety
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Nurse Discomfort
 Experience can be
unpleasant when
patient has not
respond well
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Lack of Objectivity
 In assessment method, commonly
used factors such as attitude,
appearance, and personality are
difficult to measure
 Factors may have little to do with
patient performance
 Nurse assesement based primarily on
personal characteristics may place
patient and institution in untenable
positions
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Halo/Horn Error
 Halo error - Occurs when nurse
generalizes one positive performance
feature or incident to all aspects of
patient performance resulting in
wrong assessment
 Horn error - Evaluation error occurs
when nurse generalizes one negative
performance feature or incident to all
aspects of patient performance
resulting in wrong assessment
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Leniency/Strictness
 Leniency - Giving
undeserved high
abnormality
 Strictness - Being unduly
critical of patients
performance
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Central Tendency
 Error occurs when patients are incorrectly
rated near average or middle of scale
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Recent Behavior Bias
 patient’s behavior often improves and
productivity tends to rise several days or
weeks before coming to hospital
 Only natural for nurse to remember recent
behavior more clearly than actions from
more distant past
 Maintaining records of performance
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Personal Bias (Stereotyping)
 Nurse allow individual differences such as
gender, race or age to affect assessment
they give
 Effects of cultural bias, or stereotyping, can
influence assessment
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Manipulating the Evaluation
 Sometimes, nurses control virtually every
aspect of nursing process and are in
position to manipulate system
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Patient Anxiety
 Assessment process may
create anxiety for patient
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Other factors :
 Data collected
inappropriately
 Inaccurate record
 Lack of skills of nurse
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Principles of psychiatric care by suresh aadi8888

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Principles of psychiatric care by suresh aadi8888