Registered Mental Nurse Procedures



DESCRIPTION

This is when a patient no longer needs to receive in-patient care and can go home on medication under the authorization of the medical team.

AIMS

  1. Help the patient re-integrate well with the family and community
  2. Continue treatment on out-patient basis
  3. Reduce prolonged stay in the hospital

TYPES

  1. Voluntary Discharge
  2. Involuntary Discharge

DESCRIPTION

This is the process of gathering information about a patient’s physical, mental and social state. These pieces of information could be obtained from the patient, relative(s) or significant others.

AIMS

  1. Gain a better understanding of patient’s problem
  2. Obtain useful information in formulating a nursing diagnosis
  3. Provide effective nursing care to the patient
  4. Give treatment

TYPES

  1. N/A

DESCRIPTION

This is the face to face interaction between the nurse and a patient for the purpose of obtaining or giving information. It is one of the methods/tools used by nurses to assess the feelings, perceptions, thoughts and attitudes of the psychiatric patient. This procedure can also be used to interview the hypoactive patients (e.g. severely depressed, catatonic stuporous patients etc.). These patients demonstrate very slow interaction and thus require extended periods to answer even simple questions. The nurse must understand that the slow responses of these patients is not intentional and he/she should not be frustrated by the slow progress of the interview.

AIMS

  1. Build therapeutic relationship with the patient
  2. Gain a better understanding of patient’s problem
  3. Obtain useful information in formulating a nursing diagnosis
  4. Provide effective nursing care to the patient
  5. Give treatment
  6. Promote healing and rehabilitation

TYPES

  1. Structured
  2. Semi-structured
  3. Unstructured

DESCRIPTION

This is the face to face interaction between the nurse and the patient who frequently has intense, excessive and persistent worry and fear about everyday situation for the purpose of obtaining or giving information. It is one of the methods/tools used by nurses to assess the feelings, perceptions, thoughts and attitudes of the anxious patient and to evaluate care given.

AIMS

  1. Build therapeutic relationship with the patient
  2. Gain a better understanding of patient’s problem
  3. Obtain useful information in formulating a nursing diagnosis
  4. Provide effective nursing care to the patient
  5. Reduce patient’s level of anxiety
  6. Promote healing and rehabilitation

TYPES

  1. N/A

DESCRIPTION

This is an interaction between the nurse and the patient who is either angry or extremely excited for the purpose of obtaining or giving information. It is one of the methods/tools used by nurses to assess the feelings, perceptions, thoughts and attitudes of the aggressive and elated/overactive patient.

AIMS

  1. Build therapeutic relationship with the patient
  2. Gain a better understanding of patient’s problem
  3. Obtain useful information in formulating a nursing diagnosis
  4. Reduce patient’s level of over activity
  5. Promote healing and rehabilitation

TYPES

  1. N/A

DESCRIPTION

This is a clinical assessment process that is used to observe and describe a patient’s psychological functioning at a given point in time. It involves the systematic gathering of the patient’s subjective and objective information.

AIMS

  1. Gather baseline data
  2. Obtain useful information in formulating a diagnosis
  3. Plan effective nursing and medical care
  4. Monitor and evaluate the progress of patient’s response to treatment

TYPES

  1. N/A

DESCRIPTION

This is a process of introducing a patient to the ward environment by the nurse to assist patient familiarise or adapt himself/herself to the ward.

AIMS

  1. Reduce anxiety and promote recovery
  2. Foster cooperation between patients, nursing staff and other health team members
  3. Equip patient with requisite knowledge about the ward routines
  4. Encourage patient to participate in ward routines/activities

TYPES

  1. N/A

DESCRIPTION

This is a process of building a therapeutic relationship with the patient while on admission. It makes the patient feel comfortable in disclosing his/her needs to the nurse and other health team members.

AIMS

  1. Develop mutual trust between patient and nurse
  2. Reduce anxiety and promote recovery
  3. Maintain the dignity of patient
  4. Promote effective communication

TYPES

  1. N/A

DESCRIPTION

This is the act of meeting the daily nutritional requirement of a patient who is less active, withdrawn and retarded. The food served should be a balanced/nutrient dense diet.

AIMS

  1. Maintain right amount of patient’s daily nutritional status
  2. Keep patient hydrated
  3. Boost the energy level of patient
  4. Promote recovery

TYPES

  1. N/A

DESCRIPTION

This is the act of meeting the daily nutritional requirement of a hypoactive patient through the gastric/nasogastric tube. It is usually carried out in instances where the psychiatric patient refuses food/unable to swallow safely.

AIMS

  1. Maintain right amount of patient’s daily nutritional status
  2. Keep patient hydrated
  3. Boost the energy level of patient
  4. Promote recovery

TYPES

  1. Gastrotomy feeding
  2. Nasogastric feeding
  3. Nasojejunal feeding

DESCRIPTION

This is the act of meeting the daily nutritional requirement of a hyperactive/overactive patient. The food served should be a balanced/nutrient dense diet since the patient is usually on the run. Although he/she may have good appetite, he/she does not have time to settle and eat even when hungry.

AIMS

  1. Maintain right amount of patient’s daily nutritional status
  2. Keep patient hydrated
  3. Boost the energy level of patient
  4. Promote recovery

TYPES

N/A

DESCRIPTION

This is the act of removing hair from the face of a patient using a shaving device (electronic/disposable).

AIMS

  1. Give patient a well kempt appearance
  2. Boost patient’s confidence
  3. Enhance patient’s body image
  4. Prevent infection
  5. Identify facial abnormalities with ease

TYPES

  1. Dry shaving
  2. Wet shaving

DESCRIPTION

This is the act of removing hair from the armpit and pubic area of a patient using a shaving device (electronic/disposable).

AIMS

  1. Boost patient’s confidence
  2. Enhance patient’s body image
  3. Prevent pediculosis (corporis and pubis) and other infections
  4. Identify any abnormalities with ease

TYPES

  1. N/A

DESCRIPTION

This is the act of washing/cleansing the body of a patient who does not have the physical and mental capability of self-bathing and is confined to bed. Hypoactive patients are usually less active, withdrawn and retarded.

AIMS

  1. Keep patient clean and enhance self-concept
  2. Stimulate blood circulation
  3. Regulate body temperature
  4. Provide comfort, relaxation and induce sleep
  5. Prevent/minimize skin irritation/infection
  6. Aid in physical assessment of the patient

TYPES

  1. N/A

DESCRIPTION

This is the act of helping the hyperactive/overactive patient to wash/clean himself/herself.

AIMS

  1. Keep the patient clean and enhance self-concept
  2. Stimulate blood circulation
  3. Regulate body temperature
  4. Provide comfort, relaxation and induce sleep
  5. Prevent/minimize skin irritation/infection
  6. Aid in physical assessment of the patient

TYPES

  1. N/A

DESCRIPTION

This is the act of helping a patient who lacks the drive to carry out self-care activities.

AIMS

  1. Keep the patient clean and enhance self-concept
  2. Stimulate blood circulation
  3. Regulate body temperature
  4. Provide comfort, relaxation and induce sleep
  5. Prevent/minimize skin irritation/infection
  6. Aid in physical assessment of the patient
  7. Encourage patient resume activity of daily living

TYPES

  1. N/A

DESCRIPTION

This is the act of assisting an excited patient to clean and maintain his/her oral hygiene. Mouth care is an essential activity of daily living.

AIMS

  1. Remove daily dental plaques
  2. Boost self confidence
  3. Boost appetite
  4. Prevent halitosis and other infections
  5. Keep the lips and mucosa soft and clean

TYPES

  1. N/A

DESCRIPTION

The act of shampooing a patient’s hair to get rid of dirt and excess oils and make them feel relaxed on the ward. Hair care is an essential activity of daily living.

AIMS

  1. Stimulate circulation of the scalp
  2. Boost self-image and wellbeing
  3. Prevent infection and promote recovery

TYPES

  1. N/A

DESCRIPTION

The method of ridding the hair of lice on the head (pediculosis capitis). Hair lice is one of the common ectoparasitic infestation of the psychiatric patient that causes a lot of itching and discomfort.

AIMS

  1. 1. Prevent infection and promote recovery
  2. Promote skin integrity
  3. Relieve patient of discomfort

TYPES

  1. N/A

DESCRIPTION

The method of ridding the hair of lice under the armpit (pediculus corporis) and on the pubis (pediculus pubis). Hair lice is one of the common ectoparasitic infestation of the psychiatric patient that causes a lot of itching and discomfort.

AIMS

  1. Prevent infection and promote recovery
  2. Promote skin integrity
  3. Relieve patient of discomfort
  4. Promote self esteem

TYPES

  1. N/A

DESCRIPTION

This is the method of maintaining hands and feet hygiene of the psychiatric patient. It involves the trimming and upkeep of patient’s finger and toe nails as well. The hands are easily contaminated and the feet are considered to be the least clean area, therefore it is important for the nurse to maintain hands and feet hygiene of the patient while on admission.

AIMS

  1. Prevent infection
  2. Promote self esteem
  3. Identify any abnormalities
  4. Prevent skin injury to self and others
  5. Improve grooming

TYPES

  1. N/A

DESCRIPTION

The process of moving a patient from one unit/ward to another within the same facility or from one facility to another to improve upon the existing management of the patient. This is usually carried out by the order of the Psychiatrist/Medical Officer.

AIMS

  1. Continue nursing care
  2. Ease congestion on the unit/ward
  3. Promote recovery

TYPES

  1. Intra Transfer (trans-in/out)
  2. Inter Transfer (referral)

DESCRIPTION

This is the act of reporting an in-patient who leaves the ward/hospital unexpectedly without the authority/knowledge of the Nurse(s)/Psychiatrist/Hospital Administrator. Absconding is a major issue of mental health safety concern due to the potential risk of patient harming self or others when he/she leaves the hospital environment without full recovery.

AIMS

  1. Notify nursing staff and other members of the mental health team of patient’s absence
  2. Notify the next of kin/relative(s)
  3. Help trace the whereabouts of patient
  4. Prevent medico-legal issues
  5. Reduce the potential risk of harm to self and others

TYPES

  1. N/A

DESCRIPTION

This is the act of inspecting a patient’s head and hair to identify any abnormalities. The inspection of head and hair is an essential part of physical assessment carried out on the psychiatric patient.

AIMS

  1. Identify any abnormality for possible treatment

TYPES

  1. N/A

DESCRIPTION

This is the process of helping a psychiatric patient with inappropriate perception to gain an awareness of the symptoms and be in touch with reality. It involves the use of a sequence of psychological steps that the nurse can assist the patient use to organize and interpret information from the environment.

AIMS

  1. Help increase awareness of the symptoms to interpret reality
  2. Promote recovery
  3. Prevent patient’s condition from worsening
  4. Avoid the misinterpretation of a message
  5. Prevent injury to self and others

TYPES

  1. N/A

DESCRIPTION

This is the process of teaching the patient and significant others to gain knowledge about his/her medication(s). This is to inform and remind them of proper ways to self-manage care and avoid non-essential re-admissions. Patient’s education on medication, should not be limited only to time of discharge but can also be carried out while the patient is still on admission.

AIMS

  1. Enhance patient’s empowerment and medication adherence
  2. Promote early recovery
  3. Prevent medication errors and minimize complications
  4. Keep patient and significant others aware of side effects of medications and report accordingly

TYPES

  1. N/A

DESCRIPTION

This is the process by which the nurse assists the patient to gain knowledge and understanding of his/her disease process and potential treatment. Through this process, the nurse provides relevant information to the patient which might influence his/her mental health decisions, life choices or general behavoiur. Educating patient on his/her condition should not be limited to only the patient but extended to the patient’s relative(s)/ significant other(s).

AIMS

  1. Promote recovery
  2. Empower patient and inspire him/her to take ownership of his/her care
  3. Prevent and minimize complications
  4. Reduce stigmatization
  5. Prevent/reduce relapse
  6. Reduce the length of stay

TYPES

  1. N/A

DESCRIPTION

This is the process by which the nurse administers/serves medication(s) in a tablet form through the mouth to an overactive patient. The administration of medicine is common but an important clinical procedure to treat and prevent illness.

AIMS

  1. Promote early recovery
  2. Prevent medication errors and minimize complications
  3. Alternative to injections

TYPES

  1. N/A

DESCRIPTION

This is the process by which the nurse administers/serves medication(s) in a tablet form through the mouth to a less active, withdrawn or retarded patient. The administration of a medicine is a common but important clinical procedure to treat and prevent illness.

AIMS

  1. Promote early recovery
  2. Prevent medication errors and minimize complications

TYPES

  1. N/A

DESCRIPTION

This is the process by which the nurse administers/serves medication(s) in a liquid form through the mouth to an overactive patient. This is a common but important clinical procedure to treat and prevent illness.

AIMS

  1. Promote early recovery
  2. Prevent medication errors and minimize complications
  3. As an alternative to injections

TYPES

  1. N/A

DESCRIPTION

This is the process by which the nurse administers/serves medication(s) in a liquid form through the mouth to a less active, withdrawn or retarded patient.

AIMS

  1. Promote early recovery
  2. Prevent medication errors and minimize complications

TYPES

  1. N/A

DESCRIPTION

This is a form of psychotherapy in which a number of patients come together for discussion session to assist them improve their behavoiur and wellbeing by sharing their experiences and adopting appropriate behavoiur patterns. Group therapy is usually carried out under the guidance of a nurse/therapist. NB: Group therapy sessions should not be more than one (1) hour

AIMS

  1. 1. Assessment of patient
  2. 2. Improve communication skills both interpersonal and external
  3. 3. Build patient’s confidence and self esteem
  4. 4. Promote socialization/social skills
  5. 5. Enable patient practice and learn new positive skills and behaviours
  6. 6. Promote recovery

TYPES

  1. Open Session
  2. Closed Session

DESCRIPTION

This is a social therapy that uses leisure activities and other activity based approaches to assess and address the needs of the patient. It is to improve his/her psychological, physical health and wellbeing. This is usually facilitated by the nurse and interventions such as arts and crafts, playing of “ludo”, “oware”, cards, dance, video games, gardening etc. are used to help the patient.

AIMS

  1. Help patient reduce depression, stress and anxiety
  2. Help patient recover basic physical and mental abilities
  3. Build confidence, social skills and socialize effectively
  4. Promote self esteem
  5. Improve circulation and help patient relax

TYPES

  1. Indoor recreational activities
  2. Outdoor recreational activities

DESCRIPTION

This is a type of psychotherapy that is designed to help with issues that specifically affect families’ mental health and functioning. This include but not limited to marital issues, financial problems, conflict between parents and children, the impact of substance abuse or a mental illness on the entire family. This therapy basically involves the nurse, patient, family members and the relevant mental health team members.

AIMS

  1. Promote problem solving by understanding the family dynamics
  2. Facilitate cohesion and improve communication
  3. Create a better functional home environment
  4. Reduce stigmatization
  5. Help handle special family situations

TYPES

  1. N/A

DESCRIPTION

This is a psychotherapeutic process by which one person with skills and ability helps another who has problems by purposeful interaction in an accepting and understanding atmosphere. This therapy basically involves the nurse, patient and the relevant mental health team members. In counselling, one should desist from giving advice but rather guide patient to explore and decide on what is best for him/her

AIMS

  1. Establish a healthy relationship
  2. Help reduce anxiety and tension
  3. Encourage client to examine the available alternatives and decide on appropriate choices useful for problem solving
  4. Assist patient to gain insight and understanding of his/her condition

TYPES

  1. N/A

DESCRIPTION

This is a process carried out by nurses to assist patients adapt and familiarise themselves to the hospital environment. This can be done when the patient is settled or in his/her lucid interval.

AIMS

  1. Reduce anxiety and promote recovery
  2. Foster cooperation between patient, nursing staff and other members of the health team
  3. Equip patient with requisite knowledge about the hospital routines/activities
  4. Help patient know his/her way around the hospital environment

TYPES

  1. N/A

DESCRIPTION

This is a behavioral management intervention where a team of nursing staff place aggressive or violent patient under control where necessary. This is to prevent serious harm to himself/herself or others. Restrain should be used within the shortest possible time when all other interventions (de-escalation, crisis management strategies etc.) have failed to keep the patient and others safe.

AIMS

  1. Protect the patient from harming himself/herself and others
  2. Maintain a safe working environment
  3. Prevent patients from causing damage to property

TYPES

  1. Physical restraint
  2. Chemical restraint
  3. Environmental restraint

DESCRIPTION

This is the process whereby the nurse arranges and helps patient(s) to select and undertake O.T. activities. Occupational Therapy is any mental or physical activity that is medically prescribed or professionally guided to enhance patient’s vocational skills e.g. painting, sewing, farming, sculpturing etc., for the specific purpose of contributing to the recovery of the patient. It is given as an adjunct treatment to other forms of therapy for psychiatric patient(s). It can be done at the ward, the O.T. department or patient’s home.

AIMS

  1. Promote self confidence
  2. Promote socialization
  3. Promote rehabilitation
  4. Promote recovery

TYPES

  1. N/A

DESCRIPTION

This is the process of assisting a psychiatric patient who cannot tell what is real from what is imagined to gain an awareness of the symptoms and be in touch with reality. It involves the use of a sequence of psychological steps that the nurse can use to aid a patient to organize and interpret reality. This patient usually has unshakeable beliefs in something untrue despite the availability of clear evidence to the contrary.

AIMS

  1. Help increase awareness of the symptoms to interpret reality
  2. Prevent patient’s condition from worsening
  3. Promote recovery

TYPES

  1. N/A

DESCRIPTION

This is a process where a nurse prepares a room in a manner appropriate for confinement and care of an acutely disturbed patient. Seclusion is the involuntary confinement of a patient alone in a room or area from which the patient is physically prevented from leaving. This is indicated for: destructive patient, situation of increasing agitation by environmental stimuli and control undesirable behaviour. It is essential that a patient in seclusion is closely observed and given proper care. This must be prescribed by the Doctor/Psychiatrist. Do not leave a patient in seclusion for more than twenty (20) minutes without observation or talking to him/her. Take patient out of seclusion room if he/she becomes more disturbed and ensure that at least two (2) nurses are available when the seclusion door is opened.

AIMS

  1. Protect the patient from harming him/herself and others
  2. Maintain a safe working environment for the health team
  3. Prevent patient from causing damage to property

TYPES

  1. N/A

DESCRIPTION

Electro-Convulsive Therapy is both psychological and physical treatment prescribed by the psychiatrist. The nurse initiates and prepares the patient for the procedure to ensure that he/she undergoes a safe ECT and avoid complications. ECT is often prescribed when other treatments are unsuccessful. ECT is indicated for severe depression, catatonic schizophrenia, post-partum psychosis etc.

AIMS

  1. Reduce fear and anxiety
  2. Ensure patient’s safety
  3. Treatment purposes
  4. Enhance recovery

TYPES

  1. N/A

DESCRIPTION

These are activities organized and coordinated by the nurse to ensure the safety of the patient during the administration of ECT to prevent its complication and control side effects.

AIMS

  1. Prevent any injuries
  2. Ensure patient’s safety
  3. Prevent complications

TYPES

  1. N/A

DESCRIPTION

These are activities organized and coordinated by the nurse to ensure the safety of the patient following the administration of ECT to prevent its complication and control side effects.

AIMS

  1. Control side effects
  2. Prevent and manage complications if any
  3. Monitor the progress of recovery

TYPES

  1. N/A

DESCRIPTION

This is the process of organizing the environment of a psychogeriatric patient by the nurse to minimize accident and other physical injuries. The psychogeriatric patient in addition to his/her cognitive impairment, also has physical problems (e.g. unsteady gait, poor eye sight, hearing defect etc.) which make him/her susceptible to accidents and injuries.

AIMS

  1. Prevent accident and injury
  2. Encourage activity
  3. Provide comfort

TYPES

  1. N/A

DESCRIPTION

Admission is an act of allowing the patient/client to stay in the health facility for effective clinical management and rehabilitation.

AIMS

  1. Prevent the patient from causing harm to himself/herself, others and properties
  2. Assessment, diagnosis and treatment
  3. Assist patient to perform activities of daily living

TYPES

  1. Voluntary Admission
  2. Involuntary Admission

DESCRIPTION

This is the act of helping the less active, withdrawn and retarded patient to clean and maintain his/her oral hygiene. The hypoactive patient usually does not see the need to maintain his/her oral hygiene even though mouth care is an essential activity of daily living.

AIMS

  1. Remove daily dental plaques
  2. Boost self confidence
  3. Boost appetite
  4. Prevent halitosis and other infections
  5. Keep the lips and mucosa soft and clean
  6. Encourage patient to resume daily activities

TYPES

  1. N/A