STANDARDS OF PSYCHIATRIC-MENTAL HEALTH NURSING PRACTICE PSYCHIATRIC NURSING

BOLUSO, BRUSAS, CASTANARES, ELIZARDE, FRANCO, REYES, RUIZ, SALVO, SANCHEZ, UMLAS

STANDARDS OF PSYCHIATRIC-MENTAL HEALTH o Mothering role

NURSING PRACTICE • Counselor
• Hildegard Peplau o We do this, but we are not actually yet aware that
o Mother of Psychiatric Nursing we are doing it.
o 1952 Interpersonal Relations Model o Counseling: an act of leading the patient towards
• Maladaptive behavior – may problem with growth a decision, opinion, view, and a concept of his
and development. own. (way different from advising and advising
• Nursing Process – sa conversation palang sa cannot be used in psychiatric nursing); client has
assessment you will see na may problem pa sa “flight freewill.
of ideas”, yung thoughts nag-iiba iba. Ideas may not o Done in psychotherapies whether individual or
relate to each other. Through interactions you can by group.
already do the assessments. o Advising: dictating or telling directly what the
• Everything should be recorded, so if di sya nagwork, person must do/ must not do; no freewill.
through your evaluations and reassessments, you do • Resource Person/Social Agent
something. Sa Metal Hospital they are very o We are acting on behalf of the patient because
aggressive, it is because we do not assess, plan, and there are things that a patient cannot do or even
implement effectively. the family for himself/themselves.
• Utilize therapeutic communication with your patients, o E.g., Referrals, Plan of Care
know when to say something and when to not say • Leader/Ward Manager
something, so that they will cooperate. It is harder to o Leader
establish trust in mentally challenged, schizophrenic ▪ Has the ability to influence the behavior of
patients. the client without dictating; help them lead
to the direction of right decision.
o Ward Manager
▪ Has the ability to make the client’s
environment feel like home, conducive to
recovery of mental health.
• Technician
o Has the ability to manipulate equipment; the
nurse is the number one equipment or
therapeutic tool.

KNOWLEDGE
• Growth and Development
o Growth and Development of Adolescents –
Formal Operational Stage (Piaget’s Cognitive
Development) At this stage, by Erikson, yung
developmental task ninyo, coming in a
relationship is normal.
• Personality Theories
o Theory of Moral development by Kohlberg
o Psychosexual theory by Sigmund Freud –
Three Structures of personality: Id, Ego, and
Super ego should be balanced and play
harmoniously.
▪ Example: In a class during a face-to-face
lecture, the prof is lecturing, yung mind mo
NURSE’S ROLES nagdidictate na nagugutom ka, so ikaw
naman di mo macontrol and you felt hungry
• Stranger
naglalaban tuloy ang superego sasabihin
o Client and nurse remain two different individuals
wag ka kumain, the ego will decide on
– one needing health care and one giving it
morality principle (tama ba o hindi).
professionally.
o Not intimate/friends; professional boundary. • If you are stagnant, you are not able to
transcend to development, that is why
• Teacher
you do introspection and awareness of
o By giving health teachings.
yourself.
• Mother Surrogate
o Psychosocial Development by Erik Erikson
o “Mother Substitute”

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STANDARDS OF PSYCHIATRIC-MENTAL HEALTH NURSING PRACTICE PSYCHIATRIC NURSING
BOLUSO, BRUSAS, CASTANARES, ELIZARDE, FRANCO, REYES, RUIZ, SALVO, SANCHEZ, UMLAS

o Social Learning/Cognitive Theory by Albert o You need to have initiative.

Bandura – we are social beings, and we need to o If you are seeing a patient being combative,
interact, what we do and how we behave is report to staff immediately.
because of the environment that shaped our o Institutions generally only allow us to care for
personality. stable patient but there is still LUCID INTERVAL
▪ We learn by observation. ▪ lucidity is not always present; pag wala,
▪ We learn by modelling (acting it out) – a nagwawala ang patient. DO NOT PANIC.
child who grew up in aggression, the child
o You can report patients that may be in lucid
will grow with aggression.
interval that are too hard to handle.
▪ Bandura conducted a research –
experimental and non-experimental group. o Patients may try to harm you.
• Experimental group – watched a o Always keep an eye on your patient. Let them
violent movie. walk in front of you or alongside you, never let
• Non-experimental group – did not them walk behind you. Never turn your back on
watch anything and wait. your patient.
• After the movie, they gathered the two • Resourceful in Emergency Situation
groups and then Bandura et. al, asked o Somehow related to number 3.
the children to do what they watched. o Referral system – if it is beyond your capability,
• The group who watched the violent you have the accountability to seek help kapag
movie played/acted the violence in the hindi mo na kaya.
movie. o Kapag pinabayaan mo ang patients you still
• Because they were exposed to the have accountability.
movie. So, they observed and
modelled the actions. SKILLS
o As a nurse, dapat you are knowledgeable of • Therapeutic use of self
theories, because all of this is interconnected. o Use introspections. Visit yourself. What are your
• Psychopathology weaknesses?
o From what you learned from the growth and o You need to out-grow your weaknesses. Do
development and personality theory daw something about your weaknesses.
• Treatment Modalities (Psychotherapy) o How can you become therapeutic if you yourself
o Is not applicable to all; depends on the patient’s has a problem.
diagnosis. • Therapeutic techniques of communication
o Theory of Freud: Catharsis – when talking to a o How do you communicate with other people?
patient, he is free to say anything he wants to Even in normal settings.
say; unloading; kung ano lang gusto nya sabihin. o Stimulus response – people will respond to the
▪ How can you be therapeutic kung ikaw stimuli na nakita nya.
mismo may unresolved problems; that is ▪ If you are hostile – expect a hostile
why we started with self-awareness. response.
o Theory of Freud: Free association – related to o Sometimes it is not the word that you said but
catharsis. rather how you say it.
o We cannot function if we lack knowledge from o We have to examine ourselves on how we
these things. communicate with other people.
• Nursing process
ATTITUDE o Assessment
• Composed and Self-Restrained
▪ MSE (Mental Status Examination)
o It is important to do self-reflection at the end of
• Can be seen from communication and
the day.
appearance.
o If you are a nurse, you should be able to control
your temper. • Mental health can be equated to
personal hygiene.
• Able to Face Realities and Challenging Situation
o You cannot address problems in the ward if you o Planning
have problems yourself. o Interventions
• Alert and With Initiative ▪ Depends on the diagnosis of the patient.
o Be vigilant and alert, ▪ Psychotherapy depends on diagnosis.
o Pwede mag away away ang mga patient. Some o Evaluation
patients are very combative. ▪ Gumaling ba or lalong lumala.

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STANDARDS OF PSYCHIATRIC-MENTAL HEALTH NURSING PRACTICE PSYCHIATRIC NURSING
BOLUSO, BRUSAS, CASTANARES, ELIZARDE, FRANCO, REYES, RUIZ, SALVO, SANCHEZ, UMLAS

▪ When you do your evaluation, you have to o Inilalagay mo yung sarili mo sa kalagayan ng
record it also. pasyente
o Documentation of NPI (Nurse-Patient o We have the ability to feel and understand the
Interaction) emotions that other people are feeling.
▪ Everything that you do to your patient • Respect
should be documented. o Always understand that your patient is not in the
▪ Should something happen to your patient, proper disposition, wala sa tamang pag-iisip, do
not laugh about their situation.
they can file a case in court.
• Trust
▪ Any intervention that has not been
o You learn to trust other people, in the same
documented means it never happened. manner that you get the trust of others,
▪ Sign your name. especially your patient.
▪ Mental institutions are very particular sa • Regardless of the context, length of the interaction
charts. No alterations allowed. and whether the nurse is the primary or secondary
▪ Students are no longer allowed to chart. care provider, these components are always present.
o Process recording
▪ Will be discussed more as we go on. THERAPEUTIC NURSE-PATIENT RELATIONSHIP
▪ Everything that you observed from the
patient on your one-on-one should be PERSONAL QUALITIES OF THE NURSE
recorded. • Personal Qualities of the Nurse
o Self-awareness; Recognition; Acceptance
NURSE-PATIENT RELATIONSHIP ▪ The Johari Window
• Primary mode of nursing process in psychiatric o Open – Known to others, known to
nursing self.
o Kahit saang ward NPR is always done. o Hidden – NOT known to others, known
to self.
TYPES OF NURSE-PATIENT RELATIONSHIP o Blind – Known to others, NOT known
• Therapeutic NPR to self.
o Majority of our patient are not trusting. o Unknown – NOT known to others,
o Prepare food in front of your patient because NOT known to self.
they are very suspicious. o The sizes of the quadrants can
o They have delusion or persecution and change, especially the OPEN
hallucinations that is why they are very quadrant. It can change based on the
suspicious. person’s desire to be known to others.
o Kumbaga naestablish niyo na yung
• Social Relationship
trust, kaya nakakapagshare ka na ng
o Friendship
mga bagay na hindi mo kaya i-disclose
o Companionship
before.
o Social, casual interaction
o You will not be able to discover
o You have to analyze what the patient is saying
yourself if you do not try to interact with
and use your judgement in your conversations.
other people.
o Find out the purpose of your interaction with the
o Self-growth (from life experiences)
patient.
o Focus on Client.
o For example: The patient says, “May papatay sa
o Professional Caring: Altruism & Empathy
akin.” Hindi mo sasakyan yung hallucinations
o Psychodynamic Nurse (Peplau: SKA)
niya, rather you would confirm and validate kung
o Ethics, Legal, and Moral Responsibility
totoo yung sinasabi ng patient mo.
▪ Works effectively with a team
• Therapeutic NPR is not intimate relationship.
▪ Confidentiality (3 limits)
o Emotional involvement
▪ Privacy and dignity
o Physical involvement
▪ Use of Touch
▪ Student concerns:
5 KEY COMPONENTS OF THERAPEUTIC NPR
• What if no one will talk to me?
• Professional Intimacy • What if I say the wrong thing?
• Power • What if I cannot think of anything to
• Empathy say?
o Iniintindi natin yung kalagayan ng pasyente • How can I ask personal questions
without prying?

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STANDARDS OF PSYCHIATRIC-MENTAL HEALTH NURSING PRACTICE PSYCHIATRIC NURSING
BOLUSO, BRUSAS, CASTANARES, ELIZARDE, FRANCO, REYES, RUIZ, SALVO, SANCHEZ, UMLAS

PHASES OF THE RELATIONSHIP

• Pre-interaction; Pre-orientation phase
o Get to know your patient – read the charts.
• Introductory; Orientation phase
o The clinical instructor would assign your patient;
introduce yourself to your patient.
o “I am ______, from Pamantasan ng Lungsod ng
Maynila, your student nurse for this today up until
this period ______.”
o Kailangan iinform yung client kung hanggang
kalian mo lang sila mahahandle as patient, para
pagdating ng termination phase hindi na sila
mabibigla.
• Working phase
o Carrying out the orders and interventions
needed for the patient.
• Termination phase
o Culmination of the rotation

THERAPEUTIC IMPASSES
• Resistance
• Transference
o Lahat ng mga hinaing ng mga pasyente ibabato
nila sayo
o They will “transfer” their concerns to you
o You have to do your self-assessment, so you
have your weapon in facing this transference.
o If you are not self-aware, hindi mo maaabsorb
Mabuti yung concerns ng patient and hindi
magiging therapeutic yung conversation niyo.
• Countertransference
• Boundary violations
o Kailangan meron kayong goal setting dito, kung
ano yung mga limits na kailangan ninyong i-
impose, and rules na dapat i-set para-aware
yung patient na meron pala silang dapat sundin.
o Example: Sa psych ward, sasabihin ko sa
patients na before sila magkaroon ng interaction
with the students dapat nakapag-morning care
na sila. Nakapagsipilyo na, nakapaghilamos na.
o If they violate the rules, you have to tell them na
merong consequences (not necessarily
punishment) pero sabihin ng maayos, and
ipaintindi kasi there is a tendency na mas mag-
escalate yung emotions nung patient.