CFMHN Standards 1
CFMHN Standards 1
for Psychiatric-Mental
Health Nursing
3rd Edition
January 2006
Standards of Practice
Y O U R F E D E R AT I O N
Facilitate excellence in psychiatric and mental health nursing by providing our members with educational and networking resources.
Formed in 1988, the Federation pioneered national credentialing in psychiatric and mental health nursing and achieved CNA certification status seven
how to reach us
CFMHN
c/o First Stage Enterprises
1185 Eglinton Avenue East,
Suite 104
Toronto, ON M3C 3C6
Tel: 416-426-7029
Fax: 416-426-7280
E-Mail:
[email protected]
years later.
Because of our efforts, nurses across the country can qualify for the national psychiatric and mental health nursing credential. Nurses with certification
are eligible to use the CPMHN(C) designation after their names and wear the
official CNA certification pin a sign of professional achievement.
www.cfmhn.ca
Standards of Practice
Canadian Standards
for Psychiatric-Mental
Health Nursing
January 2006
Table of Contents
7
Einführung
Standards Development
Purpose of Standards
Current Issues
Beliefs/Values
10
11
12
12
13
13
14
Introduction
Over its long history, Psychiatric-mental health nursing practice in
Canada has enriched the health and well being of Canadians.
Psychiatric-mental health nurses continue to expand their knowledge
and understanding of mental health and mental illness while delivering
competent, safe and ethical care to Canadians. The Canadian Standards
of Psychiatric and Mental Health Nursing (PMHN) provide direction to all
nurses and to the public on acceptable practices of a psychiatric mental
health nurse.
The current document is reflective of the third edition of the Canadian
Standards of Psychiatric and Mental Health Nursing. The document
includes a brief discussion on the Standards development process, purpose of the Standards, current issues, beliefs, the revised practice standards, glossary, and appendix.
The history of psychiatric-mental health nursing provides an important
and informative context to facilitate a full understanding of the standards.
The appendix provides a historical overview.
Standards
Development
Purpose of
Standards
specialty
area
and
Psychiatric-Mental
The third edition expands on the earlier additions
and current issues that affect the practice of psychiatric mental health nursing. In keeping with this
be
Health
held
accountable.
Krankenpflege
(PMHN)
Practice Standards provide a guide for the evaluation of psychiatric and mental health nursing practice within a professional and ethical framework.
Current Issues
ment
of
rapidly
changing
situations,
the
ality).
relationships.
Beliefs/Values
In fostering a legacy of moral and visionary psychiatric mental health nursing leaders.
Standards
Standard I:
Provides Competent Professional Care Through
the Development of a Therapeutic Relationship
A primary goal of psychiatric and mental health nursing is the promotion of
mental health and the prevention or diminution of mental disorder. The
development of a therapeutic relationship is the foundation from which the
psychiatric and mental health nurse can enter into partnerships with clients,
and through the use of the human sciences, and the art of caring, develop
helping relationships (RNAO, 2002b).
The nurse is expected to demonstrate competence in therapeutic relationship by the following:
1. Assesses and clarifies the influences of personal beliefs, values and life
experience on the therapeutic relationship and distinguishes between
social and therapeutic relationships.
2. Works in partnership with the client, family, and relevant others to determine goal directed needs and to establish an environment that is conducive to goal achievement.
3. Uses a range of therapeutic verbal and non-verbal communication skills
that include empathy, active listening, observing, genuineness, and curiosity.
4. Recognizes the influence of culture, class, ethnicity, language, stigma,
and social exclusion on the therapeutic process and negotiates care that
is sensitive to these influences.
10
gration.
1. Collaborating with clients and with other members of the health care team to gather holistic
assessments through observation, examination, interview, and consultation, while being
attentive to issues of confidentiality and pertinent legal statutes.
2. Documenting and analyzing baseline data to
identify health status, potential for wellness,
health care deficits, potential for danger to self
and others; alterations in thought content and/ or
process, affect behaviour, communication and
decision-making abilities; substance use and
dependency; and history of trauma and/or abuse
(emotional, physical, neglect, sexual or verbal).
3. Formulating and documenting a plan of care in
collaboration with the client and with the mental health team, recognizing variability in the
clients ability to participate in the process.
4. Refining and expanding client assessment
Standard II:
Performs/Refines Client
Assessments Through The
Diagnostic and Monitoring
Function
information by assessing and documenting significant change(s) in the clients status, and by
comparing new data with the baseline assessment and client goals.
5. Continuously assessing and anticipating potential needs and risks. Collaborating with the
ceptual model of nursing practice, provides a framework for processing client data and for developing
11
Standard III:
Administers and Monitors
Therapeutic Interventions
ed.
Standard IV:
Effectively Manages Rapidly
Changing Situations
ing care.
2. Provides information to clients and families/ sig-
lation.
12
The nurse:
1. Utilizes the therapeutic relationship throughout
the management of rapidly changing situations.
2. Assesses the client using a comprehensive holistic approach for actual or potential health issues,
problems
risk
factors
and
oder
crisis/
emergency/catastrophic situations.
3. Knows resources required to manage actual and
potential crisis/emergency/catastrophic situations and plans access to these resources.
4. Monitors client safety and utilizes continual
assessment to detect early changes in client status, and intervenes accordingly.
ic crisis/emergency/catastrophic interventions as
necessary.
The nurse:
1. In collaboration with the client determines clients
learning needs.
2. Plans, and implements with the client, health promotion education while considering the context
of the clients life experiences. Considers; readiness, culture, literacy, language, preferred learning style and resources available.
3. Engages with the client to explore available
options and resources to build knowledge to
make informed choices related to health needs
and to access the system as needed.
4. Incorporates knowledge of a wide variety of
learning models and principles when creating
learning opportunities for clients.
5. Critiques and provides relevant information, guidance and support to the clients, families and significant others.
6. Documents the teaching/learning process
(assessment, plan, implementation client involvement and evaluation).
7. Determines with the client, the effectiveness of the
educational process and collaboratively develops
or adapts the ways to meet learning needs.
8. Engages in teaching/learning opportunities as
partners with consumers, families and community agencies.
Standard V:
Intervenes Through The
Teaching-Coaching Function
Standard VI:
Monitors and Ensures the
Quality of Health Care Practices
All interactions are potentially teaching/learning situations. The PMH nurse attempts to understand the life
experience of the client and uses this understanding
13
and to respect and affirm the clients right to selfdetermination in a safe and equitable manner. Mental
therapeutic relationship, reflective, ethical, evidencebased practice within complex and dynamic situa-
The nurse:
ment.
Standard VII
14
The nurse:
Glossary
These descriptions apply for the purposes of this document.
client: Individuals, families, groups, populations or communities.
Synonymous terms may be patients, beneficiaries, partners, recipients, consumers. Clients exist in social systems that may influence the onset and
duration of illness and the extent of mental health. (in RNAO, Nursing Best
Practice Guideline: Client Centered Care 2002a).
crisis: An emotional upset, arising from situational, developmental, biological, psychological, socio-cultural, and/or spiritual factors. This state of emotional distress results in a temporary inability to cope by means of ones
usual resources and coping mechanisms. Unless the stressors that precipitated the crisis are alleviated and/or the coping mechanisms are bolstered,
major disorganization may result. It is recognized that a crisis state is subjective and as such may be defined by the client, the family or other members of the community (in RNAO, Nursing Best Practice Guideline, Crisis
Intervention 2002b).
contextual factors: The personal, interpersonal and environmental variables
that comprise a persons unique life experience.
competencies: The integrated knowledge, skills, attitudes and judgements
expected of the PMH nurse (CNA, 2002)
family: Being unique and whomever the person defines as being family. Family
members can include, but are not limited to parents, children, siblings, neighbours, and significant people in the community (RNAOd. 2002).
least restrictive environment: The patient/client has the right to treatment in
an environment that restricts the exercise of free will to the least extent; an
individual cannot be restricted to an institution when he or she can be successfully treated in the community (Boyd, 2005, p.920)
mental disorder: A disorder that is associated with the presence of psychological distress impairment in psychological, social or occupational functioning; or a significantly increased risk for death, pain, disability, or an important
loss of freedom. (Boyd, 2005, p 920)
15
Baylis, 2000)
16
between the nurse and the client(s). Therapeutic relationship is a purposeful, goal directed relationship
that is directed at advancing the best interest and
outcome of the client (RNAO, 2002b).
References
Austin, W., Gallop, R., Harris, D., & Spencer, E. (1996). A domains of practice approach to the standards of psychiatric and mental health nursing. Journal of Psychiatric and Mental Health Nursing, 3,
111-115.
Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing practice. Menlo
Park, CA: Addison-Wesley.
Benner, P., Tanner, C., & Chesla, C. (1996). Expertise in nursing practice. Caring, clinical judgement,
and ethics. New York: Springer.
Boschma G. 2003. The rise of mental health nursing: A history of psychiatric care in Dutch asylums,
1890-1920. Amsterdam: Amsterdam Univ. Press.
Boyd, MA. (2005) Psychiatric Nursing: Contemporary Practice, 3rd Ed. Lippincott Willians and
Wilkins:Philadelphia.
Buchanan J., Harris,D., Greene, A., Newton, L & Austin, W. (1998). The Canadian Standards of
Psychiatric and Mental Health Nursing Practice. Canadian Federation of Mental Health Nurses,
2nd Edition
Canadian Nurses Association [CNA] (2002a). Code of ethics for Registered Nurses. Ottawa, ON:
Author.
Canadian Nurses Association [CNA] (2002b). Achieving excellence in professional practice: A guide
to developing and revising standards. Ottawa, ON: Author.
Canadian Nurses Association (2002c). Discussion guide for the unique contribution of the Registered
Nurse. Ottawa, ON: Author.
Health Canada, (2002) A report on mental illness in Canada: Ottawa, ON: Author.
Health Canada, Mental Health Promotion Unit, Mental Health Promotion: Promoting Mental Health
Means Promoting the Best of Ourselves Frequently Asked Questions.
http://www.hc.gc.cahppb/mentalhealth/mhp/cfaq.html
Ontario Ministry of Health and Long-term Care (1999) Making it happen: Operational framework for
the delivery of mental health services and supports. Toronto, Ontario: Queens Printer for Ontario.
Registered Nurses Association of Ontario. [RNAO] (2002a). Best practice guideline: Client Centered
Care. Toronto, ON: Author.
Registered Nurses Association of Ontario. [RNAO] (2002b). Best practice guideline: Crisis intervention. Toronto, ON: Author. (May be retrieved from
http://www.rnao.org/bestpractices/completed_guidelines/BPG_Guide_C2_crisis.asp
Registered Nurses Association of Ontario. [RNAO] (2002c). Best practice guideline: Establishing therapeutic relationships. Toronto, ON: Author. (May be retrieved from http://www.rnao.org/bestpractices/completed_guidelines/BPG_Guide_C2_TR.asp)
Registered Nurses Association of Ontario. [RNAO] (2002d). Best practice guideline: Supporting and
strengthing families through expected and unexpected life events.Toronto, ON: Author.
Society for Education and Research in Psychiatric-Mental Health Nursing [SERPN] (1996).
Educational preparation for psychiatric-mental health nursing practice. Pensacola, FL: Author.
Stephens, T (1999). Mental Health of the Canadian Population: A Comprehensive Analysis,Chronic
Diseases in Canada, 20, No. 3.
Tiplisky V. 2002. Parting at the crossroads: The development of education for psychiatric nursing in
three Canadian provinces, 1909-1955. PhD thesis, University of Manitoba.
Varvoe(Varcoe in text), C., Rodney, P., & McCormick, J. (2003). Health care relationships in context:
An analysis of three ethnographies. Qualitative Health Research, 13 (7), pp. 957-973.
Webster, G., & Baylis, F. (2000). Moral residue. In S.B. Rubin & L. Zoloth (Eds.) Margin or error: The
ethics of making mistakes in the practice of medicine. Pp 217-232. Hagerstown, MD: University
Publishing Group.
Wright, M., & Leahey, M. (2000). Nurses and families: A guide to assessment and intervention (3rd
ed.). Philadelphia, PA: F.A. Davis.
17
Appendix
History of Canadas Psychiatric
Mental Health Nursing*
(Boschma, 2003 & Tipliski, 2002)
Until the late nineteenth century, people with mental illness were usually cared
for by their families. From that time, institutional care for the person with mental
illness considered as dangerous to be at large, became available as provinces
passed legislation for the formal admission of this group, and asylum care
became the responsibility of the state. Provinces established asylums headed
by physicians titled medical superintendents, and staffed by lay attendants.
Early in the twentieth century, several asylums in Ontario, Nova Scotia and
Quebec initiated specialized mental nurse training schools, modeled closely on
general hospital schools. Under the leadership of general nursing, mental hospital graduate nurses eventually became eligible for general nurse registration in
those provinces. Asylum training schools appeared some time later in western
Canadian asylums as well, but those graduates generally were not eligible for
provincial nurse registration, eventually leading to a separate registration system.
Public funding for Canadas mental hospitals remained a challenge, and problems of limited resources and overcrowding soon made the institutions difficult
to manage, resulting in a poor reputation. Under the influence of the mental
hygiene movement which emerged in the 1920s, ideas about care of the person with mental illness shifted, and gradually more emphasis was placed upon
prevention of mental illness and promotion of mental health among the general
population. Following World War Two, the health care system rapidly expanded, new psychotropic medications became available, and care of the mentally
ill became more diversified. Large mental hospitals remained, but general hospitals created psychiatric departments and outpatient clinics, and services
expanded. Beginning in the mid-1960s, the focus of mental health care slowly
shifted from institutional to community-based care, and a wider range of professional services became available. There was a significant decrease in the number of patients cared for in the provincial hospitals.
Throughout the postwar years and transition to community care, psychiatric
mental health nursing remained central to the care of the person with mental illness, however, the role of nurses and their education also changed. In all
provinces, psychiatric mental health nursing is now a component of generic
nursing education programs, preparing graduates for positions in this nursing
specialty as part of the profession of nursing. Today psychiatric mental health
nurses are an integral part of multidisciplinary teams, providing a wide range of
inpatient and community mental health care services in partnership with consumers and their families.
18