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General Principles of Psychiatric Nursing - Coggle Diagram
General Principles of Psychiatric Nursing
Patient Needs to Be Accepted Exactly As He Is:
Concept: Unconditional positive regard. Respect the patient's dignity and right to their own behavior without judgment, punishment, or approval of unhealthy actions.
How to Show Acceptance:
Show interest (listen, seek them out, recognize changes/feelings).
Recognize and reflect feelings.
Talk with a purposeful, patient-centered focus.
Allow expression of strong feelings (anger, fear) in a safe, non-destructive way.
Self-Understanding is Used as a Therapeutic Tool:
Concept: The nurse's self-awareness is crucial. Understanding one's own feelings, biases, and reactions prevents projecting them onto the patient.
Participating in group conferences.
Measures to Increase Self-Awareness:
Self-reflection/journaling.
Discussing reactions with colleagues/supervisors.
Consistency is Used to Contribute to Patient's Security
Concept: Predictable routines and staff attitudes reduce anxiety and build trust in insecure patients.
Areas for Consistency:
Staff Attitudes: Unified approach to acceptance, reassurance, and limit-setting.
Ward Routine: Clear, explained schedules for meals, activities, etc.
Defining Limitations: Clear, consistent, and calmly enforced rules for unacceptable behavior.
Reassurance Must Be Given in a Subtle and Acceptable Manner:
Concept: Reassurance is indirect, genuine, and based on true interest, not empty promises.
How to Show Reassurance:
Be genuinely interested.
Pay attention to what's important to the patient.
Sit with a silent patient (therapeutic presence).
Accept the patient's feelings.
Listen without judgment.
Avoid: Direct, false reassurance (e.g., "You'll be fine," "There's nothing to worry about").
Patient's Behavior is Changed Through Emotional Experience, Not by Reason:
Concept: You cannot reason someone out of a mental illness. Challenging beliefs increases defensiveness.
Method: Facilitate corrective emotional experiences (e.g., helping a patient feel safe and understood so they can explore new ways of behaving).
Unnecessary Increase of the Patient's Anxiety Should Be Avoided:
Concept: Anxiety is a core problem; the nurse's role is to reduce it, not exacerbate it.
Anxiety-Inducing Situations to Avoid:
Contradicting psychotic ideas.
Using jargon or having careless conversations.
Making unrealistic demands.
Creating situations where the patient fails.
Displaying the nurse's own anxiety.
Highlighting the patient's defects.
Being insincere or dishonest.
Observation is Directed Toward the "Why" Behind the Behavior:
Concept: All behavior has meaning. The nurse must be a detective, asking "What is the patient trying to accomplish?" or "What need is this behavior meeting?"
Objectivity: Essential for accurate observation. It means evaluating behavior without mixing in one's own feelings or judgments.
Maintain a Professional Nurse-Patient Relationship:
Concept: The relationship is for the benefit of the patient, not the nurse. It has boundaries that protect both parties.
Verbal and Physical Force Must Be Avoided If Possible:
Concept: Force is traumatic. Skilled nursing can often prevent the need for it through prediction and de-escalation.
If Force is Necessary (e.g., restraints):
Act quickly, firmly, and with adequate staff.
Do not show anger.
Explain the reason calmly.
Do not treat it as punishment.
Never remind the patient of the incident afterward.
Nursing Care is Centered on the Patient as a Person, Not on the Control of Symptoms:
Concept: See the person behind the illness. Holistic care addresses the patient's needs, not just the suppression of symptoms.
Routine and Procedures Should Be Explained at the Patient's Level of Understanding:
Concept: Explanation reduces anxiety and promotes cooperation
Many Procedures are Modified According to Patient's Needs:
Concept: Flexibility is key, but basic principles of safety and therapy remain unchanged.
Discussion of Personal Relationships and Values Should Be Initiated Only by the Patient:
Concept: Let the patient lead the conversation, especially on sensitive topics like family, to avoid provoking anxiety or guilt.
The Environment Should Promote Social Participation:
Concept: The ward should be a therapeutic community—a pleasant, homelike environment that encourages positive social interaction among patients, staff, and visitors.