1. 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.

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

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

4. 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

5. 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

6. 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

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

8. 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

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

10. 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

11. 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