Nursing Practice in the Clinical Setting Chapter 2: Nursing Practice in the Clinical Setting Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Psychiatric Mental Health Nursing Leaders Florence Nightingale - holistic view Linda Richards - first psychiatric nurse Hildegard Peplau - “mother of psychiatric nursing”

Nurse Pioneers Help mold and set foundations, conceptual, theoretic, and clinical frameworks of psychiatric mental health nursing

Psychiatric Mental Health Nursing Is a dynamic profession that has seen dramatic clinical advances and role changes over the past several decades Follows the trend toward Evidenced Based Practice (EBP) and integrated patient care

Therapeutic Alliance A bond that exists between nurse and patient Plays a significant role in the patient’s well being Guided by standards and objectives Focuses on patient centered needs, issues, and short- and long-term goals

Therapeutic Alliance Serves To Allow open discussion of needs and problems free from judgment and criticism Assist with insight into problems, expectations, abilities, and support systems Learn and practice new skills in a safe environment Effect life changes Heal mental and emotional wounds Promote growth

Stages of the Nurse-Patient Relationship Pre-orientation Orientation-rapport Working Termination

Principles of the Nurse-Patient Relationship Relationship is therapeutic rather than social Focus on patient’s needs and problems Relationship is purposeful and goal directed Objective rather than subjective Time-limited versus open-ended

Fears Fear in the psychiatric setting Fear of the patients Fear of failure Fear based on personal experience

Additional Clinical Principles Accept the patient’s feelings; not necessarily all their behaviors Avoid false reassurances, clichés, and global statements Avoid giving advice Avoid rescue fantasy

Additional Clinical Principles, cont’d Avoid heroics Use simple, concrete, and direct language Consider the clinical setting the patient’s laboratory Encourage patients to take responsibility for their actions, decisions, choices, and lives when capable