Standards of Care

Standard of care refers to the degree of care that a reasonably prudent and competent mental health nurse would exercise under similar circumstances.

It is a benchmark against which nursing actions are judged. These standards include both clinical competence and ethical conduct, reflecting the nature of caring for individuals with mental health conditions.

They were enunciated by the American Nurses Association (ANA) in 1973.

• Professional Organizations: Bodies such as the American Nurses Association (ANA) or country-specific nursing councils publish detailed standards of psychiatric-mental health nursing practice. These are often the primary source.
• Legislation and Regulations: Laws like the Mental Treatment Act, Nurse Practice Acts, and patient rights legislation set legal mandates that directly influence nursing standards.
• Institutional Policies and Procedures: Each healthcare facility develops its own policies and procedures, which must align with professional and legal standards and guide staff behavior within that specific environment.
• Accrediting Bodies: Organizations that accredit healthcare institutions (e.g., The Joint Commission) set standards that influence care delivery and quality.
• Published Literature and Research: Evidence-based practice guidelines, nursing textbooks, and peer-reviewed research contribute to defining optimal care.
• Expert Consensus and Case Law: The opinions of expert witnesses in legal cases and previous court rulings (case law) can establish or clarify standards of care.

Underlying all standards of care are fundamental ethical and philosophical principles that are particularly salient in mental health:

• Patient Safety: Paramount in all care, especially concerning risks like suicide, self-harm, or aggression.
• Therapeutic Relationship: The development of a trusting, empathetic, and professional relationship is central to effective mental health nursing.
• Autonomy: Respecting the patient's right to make decisions about their care, even when their capacity may be impaired, and supporting them to regain decision-making abilities.
• Beneficence: Acting in the best interest of the patient, aiming to do good.
• Non-Maleficence: The duty to do no harm.
• Justice: Ensuring fair and equitable access to care, regardless of background or diagnosis.
• Fidelity: Being faithful to promises and commitments made to patients.
• Confidentiality: Protecting sensitive patient information, which is especially critical given the stigma often associated with mental illness.

The practice of psychiatric nursing is influenced by law, particularly initial concern for the rights of patients and the quality of care they receive.

• The client’s right to refuse a particular treatment, protection from confinement, intentional torts, informed consent, confidentiality and Promotion of research in mental health nursing.
• The nurse contributes to nursing and the mental health field through innovations in theory and practice and participation in research.
• Cost-effective nursing care: Studies need to be conducted to find out the viability in terms of cost involved in training a nurse and the quality of output in terms of nursing care rendered by her.
• Focus of care: A psychiatric nurse has to focus care on certain target groups like the elderly, children, women, youth, mentally retarded and chronic mentally ill.
• Record keeping are a few legal issues in which the nurse has to participate and gain quality knowledge.

The purpose of Standards of Psychiatric and Mental Health Nursing practice is to fulfill the profession’s obligation to provide a means of improving the quality of care. The standards presented here are revision of the standards enunciated by the Division on Psychiatric and Mental Health Nursing Practice in 1973.

The nurse applies appropriate theory that is scientifically sound as basis for decisions regarding nursing practice. Psychiatric and mental health nursing is characterized by the application of relevant theories to explain phenomena of concern to nurses and to provide a basis for intervention.

The nurse continuously collects data that are comprehensive, accurate and systematic. Effective interviewing, behavioral observation, physical and mental health assessment enable the nurse to reach sound conclusions and plan appropriate interventions with the client.

The nurse utilizes nursing diagnosis and/or standard classification of mental disorders to express conclusions supported by recorded assessment data and current scientific premises.

Nursing logic basis for providing care rests on the recognition and identification of those actual or potential health problems that are within the scope of nursing practice.

The nurse develops a nursing care plan with specific goals and interventions delineating nursing actions unique to each client’s needs.

The nursing care plan is used to guide therapeutic intervention and effectively achieve the desired outcomes.

The nurse intervenes as guided by the nursing care plan to implement nursing actions that promote, maintain or restore physical and mental health, prevent illness and effect rehabilitation.

• (a) Psychotherapeutic interventions: The nurse uses psychotherapeutic interventions to assist clients in regaining or improving their previous coping abilities and to prevent further disability.
• (b) Health teaching: The nurse assists clients, families and groups to achieve satisfying and productive patterns of living through health teaching.
• (c) Activities of daily living: The nurse uses the activities of daily living in a goal directed way to foster adequate self-care and physical and mental well-being of clients.
• (d) Somatic therapies: The nurse uses knowledge of somatic therapies and applies related clinical skills in working with clients.
• (e) Therapeutic environment: The nurse provides structures and maintains a therapeutic environment in collaboration with the client and other health care providers.

The nurse evaluates client responses to nursing actions in order to revise the database, nursing diagnosis and nursing care plan.

The nurse participates in peer review and other means of evaluation to assure quality of nursing care provided for clients.

The nurse collaborates with other health care providers in assessing, planning, implementing and evaluating programs and other mental health activities.

The nurse participates with other members of the community in assessing, planning, implementing and evaluating mental health services and community systems that include the promotion of the brand continuum of primary, secondary and tertiary prevention of mental illness.

The nurse contributes to nursing and the mental health field through innovations in theory and practice and participation in research.

Adherence to these standards is fundamental to quality mental health nursing. It:

• Minimizes Liability: By practicing within accepted standards, nurses significantly reduce their risk of negligence or malpractice claims.
• Promotes Quality Outcomes: Consistent application of evidence-based standards leads to improved patient safety, more effective treatments, and better overall patient experiences and outcomes.
• Enhances Professional Credibility: Upholding high standards reinforces the professionalism and trustworthiness of mental health nursing.
• Guides Professional Development: Standards highlight areas for ongoing education, skill development, and specialization within mental health nursing.