Planning Equipments and Supplies for Nursing Care

Planning equipments and supplies for nursing care: Unit and Hospital INTRODUCTION:Psychiatric hospitals, also known asmental hospitals, arehospitalsspecializing in the treatment of seriousmental disorders. Psychiatric hospitals vary widely in their size and grading. Some hospitals may specialize only in short-term or outpatient therapy for low-riskpatients. Others may specialize in the temporary or permanent care of residents who, as a result of a psychological disorder, require routine assistance, treatment, or a specialized and controlled environment. Patients are often admitted on avoluntary basis, but people who psychiatrists believe may pose a significant danger to themselves or others, may be subject toinvoluntary commitment. HISTORY:Modern psychiatric hospitals evolved from, and eventually replaced the olderlunatic asylums. The development of the modern psychiatric hospital is also the story of the rise of organized, institutionalpsychiatry. While there were earlier institutions that housed the "insane" the arrival ofinstitutionalizationas a solution to the problem of madness was very much an event of the nineteenth century. To illustrate this with one regional example, in England at the beginning of the nineteenth century there were, perhaps, a few thousand "lunatics" housed in a variety of disparate institutions but by 1900 that figure had grown to about 100,000. That this growth coincided with the growth ofalienism, later known as psychiatry, as a medical specialism is not coincidental.In the late 19th and early 20th centuries, terms such as "madness," "lunacy" or "insanity" -- all of which assumed a unitary psychosis -- were split into numerous "mental diseases," of which dementia, praecox, and schizophrenia were the most common in psychiatric institutions. The treatment of inmates in early lunatic asylums was sometimes brutal and focused on containment and restraint.With successive waves of reform, and the introduction of effective evidence-based treatments, modern psychiatric hospitals provide a primary emphasis on treatment, and attempt where possible to help patients control their own lives in the outside world, with the use of a combination ofpsychiatric drugsandpsychotherapy. These treatments can be involuntary. Involuntary treatments are among the many psychiatric practices which are questioned by theAnti-Psychiatric movement. Involuntary treatment is emphatically opposed by the mental patient liberation movement, but this movement does not have any issue with any psychiatric treatment that is consensual, provided that both parties are free to withdraw consent at any time. TYPES: Crisis stabilizationThe crisis stabilization unit is in effect anemergency roomfor psychiatry, frequently dealing with suicidal, violent, or otherwise critical individuals. Open unitsOpen units are psychiatric units that are not as secure as crisis stabilization units. They are not used for acutely suicidal persons; the focus in these units is to make life as normal as possible for patients while continuing treatment to the point where they can be discharged. However, patients are usually still not allowed to hold their own medications in their rooms, because of the risk of an impulsive overdose. While some open units are physically unlocked, other open units still use locked entrances and exits depending on the type of patients admitted. Medium-termAnother type of psychiatric hospital is medium term, which provides care lasting several weeks. Most drugs used for psychiatric purposes take several weeks to take effect, and the main purpose of these hospitals is to monitor the patient for the first few weeks of therapy to ensure the treatment is effective. Juvenile wardsJuvenile wards are sections of psychiatric hospitals or psychiatric wards set aside for children and/or adolescents with mental illness. However, there are a number of institutions specializing only in the treatment of juveniles, particularly when dealing with drug abuse, self-harm, eating disorders, anxiety, depression or other mental illness. Long-term care facilitiesIn the UK long-term care facilities are now being replaced with smaller secure units (some within the hospitals listed above). Modern buildings, modern security and being locally sited to help with reintegration into society once medication has stabilized the conditionare often features of such units. An example of this is the Three Bridges Unit, in the grounds ofHanwell Asylumin West London and the John Munroe Hospital in Staffordshire. However these modern units have the goal of treatment and rehabilitation back into society within a short time-frame (two or three years) and not allforensicpatients' treatment can meet this criterion, so the large hospitals mentioned above often retain this role. These hospitals provide stabilization and rehabilitation for those who are having difficulties such as depression, eating disorders, mental disorders, and so on. Halfway housesOne type of institution for the mentally ill is a community-basedhalfway house. These facilities provide assisted living for patients with mental illnesses for an extended period of time, and often aid in the transition to self-sufficiency. These institutions are considered to be one of the most important parts of a mental health system by manypsychiatrists, although some localities lack sufficient funding. Political imprisonmentIn some countries the mental institution may be used for the incarceration of political prisoners, as a form of punishment. A notable historical example was the use ofpunitive psychiatry in the Soviet UnionandChina. Secure unitsIn theUK, criminal courts or theHome Secretarycan refer people to what are known aspsychiatric secure units, even though for many decades now, the term "criminally insane" is no longer legally or medically recognized. They are hospitals mostly run by theNational Health Service, which undertake psychiatric assessments and can also provide treatment and accommodation in a safe, hospital environment where its patients can be prevented from harming themselves or others. They also run under clearly definedHome Officerules. These secure hospital facilities are divided into three main categories and are referred to as High, Medium and Low Secure. Although it is a phrase often used by newspapers, there is no such classification as "Maximum Secure". Low Secure units are often referred to as "Local Secure" as patients are referred there frequently by local criminal courts for psychiatric assessment before sentencing. Some units have been opened in recent years with the specific purpose of providingTherapeutically Enhanced Treatmentand so form a subcategory to the three main ones.

GUIDELINES TO BE FOLLOWED FOR LICENSE TO OPEN OR RUN PSYCHIATRIC HOSPITAL/NURSING HOME:No person shall establish or Maintain Psychiatric Hospital /Psychiatric Nursing Home unless he holds valid license under this act. The following guidelines are to be followed to procure a license in Karnataka State.1. According to Mental Health Act, chapter 1, section 2(G) , the deputy commissioner of districts are nominated as the authority to issue license (government circular no.HFW222 PTD 2001 dated 08/10/2001).2. The application is to be submitted to the concern authority. Form 1- Application for maintaining a psychiatric hospital/ psychiatric nursing home.Form 2- Application for the establishment of psychiatric hospital/psychiatric nursing home.3. License fee as under should be paid.50 bedded Hospital/Nursing Home-Rs.1000/-51-100 bedded Hospital/Nursing Home-Rs.2000/-More than 100 bedded Hospital/Nursing Home Rs. 5000/-4. After receipt of application the licensing authority will make enquire deemed fit to ascertain the suitability. For this vide Govt. Order no. HFW21IME2006, dated 08/01/2007, District wise inspecting officers have been Nominated. Inspections to be carried out through them.a) The Government of India gazette notification dated 31/05/2007 has prescribed the following for every 100 bedded mental health/nursing home.I. A full time qualified Psychiatrist.II. One Mental Health Professional Assistant (Clinical Psychologist or Psychiatric Social Worker)III. Staff Nurses in the ratio of 1:10IV. Attenders in the ratio of 1:5V. Medical Officers having recognized MBBS Degree: Patient of 1:50.5. If licensing authority is satisfied that the psychiatric hospital / nursing home is with the minimum facilities prescribed, license can be sanctioned in the prescribed form, if it is not satisfactory can be rejected with a suitable order .6. Also the Authority which declines the license can give full opportunity for the applicant to tell his /her grievances and give the reasons for each and every aspect for denial of license. RECOMMENDATIONS FOR INPATIENT MENTAL HEALTH UNITS:The information contained in this Design Guide is intended to be applied to locked inpatient mental health facilities, with the goals of promoting safe and recovery-oriented environments. DESIGN RECOMMENDATIONS: FlexibilityThe design of a mental health facility needs to respond to changing workloads, care objectives, and technologies, such as wireless technologies for staff. Spaces should be universally designed to accommodate a range of related functions. Standardization of unit layouts should be developed to reduce care team orientation to different units and to streamline maintenance of each unit. Group spaces in particular need to be designed and grouped to accommodate a range of functions and to accommodate change if possible. Efficiency Support spaces, such as storage and utility rooms, should be designed to be shared where possible to reduce the overall need for space. Minimize unnecessary travel distances for nursing staff to use support space and to reach patient rooms in an inpatient setting. Place most frequently used support areas closest to the central nursing area. Patient NeedsPatient and resident dignity, respect for individuality, and privacy should be maintained without compromising the operational realities of close observation, safety, and security. Patient and resident vulnerability to stress from noise, lack of privacy, poor or inadequate lighting, ventilation and other causes, and the subsequent harmful effect on well being, are well-known and documentedA key architectural objective should be to reduce emphasis on the institutional aspects of care and to surround the patient with furniture, furnishings, and fixtures that are appropriate from a safety standpoint but are more residential in appearance. Proper planning and design should appeal to the spirit and sensibilities of both patients and care providers. A spirit of community should be encouraged. Mental health facilities should be environments of healing that allow the building itself to be part of the therapeutic setting and process. The technical requirements to operate the building should be unobtrusive and integrated in a manner to support this concept. KEY DESIGN CONCEPTS FOR DESIGNING INPATIENT MENTAL HEALTH UNITS INCLUDE: Create a non-institutional, home-like environment through careful attention to external and internal architectural features and interior design elements. Layout should incorporate an open and bright design. Unit configuration should be based on a pod-like design and should be absent of long corridors in order to promote social engagement and interaction with staff and provide for a more domestic and less institutional feel. Layout should be free of blind corners. Portions of the unit, such as the office suite, should be designed to be closed off after hours to reduce the amount of area within the unit required to be supervised by staff. Provide ample visual and physical access to nature, which promotes healing. Provide attractive, secure outdoor spaces directly off the unit. In addition to ample courtyard space for patient activities, consideration should be given to incorporating healing gardens. Indoor patient activity areas should have access to natural light and views, as well as appropriate acoustic control. Incorporate wall color, trim, accent colors, and securely-anchored artwork in common areas and patient rooms. Minimize the potential for furnishings, fixtures, and equipment within the unit to be used as a weapon or anchor point for hanging. Develop multiple patient room clusters within the unit to allow for separation of different patient sub-groups. Mental Health Facilities Design Guide December 2010 3-4 Office of Construction & Facilities Management The nursing station should blend in both in scope and design with the therapeutic environment. The nursing station should have direct visibility of all patient wings and activity areas. The station itself should be designed to allow for informal interaction with patients without compromising the confidentiality of patient records. Include an identifiable reception area for greeting patients and their families in a lobby area just outside the unit. In addition to functional benefits, a reception area sends a welcoming message to users. Sufficient signage should be placed to direct patients and families to this area. For additional information and elaboration on principles identified above and throughout this Guide with respect to designing therapeutic, home-like, and safe inpatient mental health units. RISK REDUCTION:The following facility detailing, planning, and design concepts should be integrated into the project to reduce the following risks in mental health facilities: - Elopements: 1. Allowing one way in and out of congregate areas, as allowed by code. 2. Courtyards instead of fenced outdoor areas. 3. Electronic door controls for emergency egress as allowed by code. 4. Simple circulation with no blind spots. 5. Casual observation (visibility from staff offices and work areas that are not directly responsible for observing patients)- Patient Behavioral Incidents:1. Visibility 2. Specify products for the facility that cannot be used as a weapon or used in a suicide attempt. 3. Design appropriate abuse resistance in areas where patients are left alone for periods of time.4. Integrate technology to assist in observing and maintaining security in areas not readily visible to staff.5. Equipment, carts, and other supplies should be adequately stored in locked rooms. Alcoves should not be used for storing or parking of equipment, carts and assistive devices in corridors and other unsecured areas. - Reducing Patient/Staff Injuries: 1. Appropriate accommodations for disabled and bariatric patients. 2. Eliminate balconies, openings, etc. that would allow a patient to jump froman elevated platform.3. Patient rooms and other areas where patient is alone have enough abuse resistance to allow time for an appropriate response team to arrive before a patient harms themselves or is able to exit the space.- Reducing Patient and Staff Stress: 1. Natural light in staff/patient areas. 2. Noise control.3. Open layout, with no unnecessary barriers between staff and patient. 4. Space for both patients and staff is designed so neither feels trapped or vulnerable; overcrowding is avoided. 5. Attractive views of the exterior. 6. Use of natural materials, a soothing color palette and residential character in the interior design of the facility. 7. Familiar and healing environments.8. Patient and staff areas that allow for relaxation and controlling ones social environment (e.g., quiet rooms, staff lounges, secure outdoor space). SPECIFIC REQUIREMENTS FOR PSYCHIATRIC UNIT: Security:The design shall provide the level of security appropriate described in the functional program for the specific type of service or program provided as well as the age level, acuity, and risk of the patients served (e.g., geriatric, acute psychiatric, or forensic for adult, child, and adolescent care). Perimeter security:If it is provided, Perimeter security shall addresses elopement prevention, prevention of contraband smuggling, visitor access control, and exit ingress and egress processes and procedures and meet the following requirements: . (1) A perimeter security system shall be provided that will contain patients within the nursing unit or treatment areas outside the unit until clinical staff and/or hospital security can escort them to an adjacent compartment or an exit stair. (2) The perimeter security system shall be designed to prevent limit contraband smuggling and shall include provisions for monitoring and controlling visitor access and egress. (3) Openings in the perimeter security system (e.g., windows, doors, gates) shall be controlled by locks (manual, electric, or magnetic) when required by the functional program. (4) Use of security cameras or alternate and other security measures consistent with the functional program requirements shall be permitted.- Toilet room doors:(a) Where indicated by the patient safety risk assessment, toilet room doors shall be equipped with keyed locks that allow staff to control access to the toilet room. (b) If a swinging door is used, The door to the toilet room shall swing outward or be double acting. (c) Each entry door into a patient toilet room required to provide space for health care providers to transfer patients to the toilet using portable mechanical lifting equipment. (5) Where a toilet room is required: (a) Thresholds shall be designed to facilitate use and to prevent tipping of wheelchairs and other portable wheeled equipment by patients and staff. (b) Grab bars shall be designed to facilitate use (i.e., be graspable) but not be loop able. (6) Where indicated by the psychiatric patient injury and suicide prevention risk assessment, use of alcohol-based hand rubs shall be prohibited in patient toilet rooms. - Patient bathing facilities: (1) A bathtub or shower shall be provided for each six beds not otherwise served by bathing facilities within the patient rooms. (2) Bathing facilities shall be designed and located for patient convenience and privacy. - Patient storage:(1) Each patient shall have within his or her room a separate wardrobe, locker, or closet for storing personal effects. (2) Shelves for folded garments shall be used instead of arrangements for hanging garments. (3) Adequate storage shall be available for a daily change of clothes for seven days. - Outdoor Areas:When outdoor areas are required by the functional program, they shall meet the following requirements: - Fences and walls serving a locked unit shall be designed to: (1) Hinder climbing. (2) Be installed with tamper-resistant hardware. (3) Have a minimum height of 10 feet (3.04 meters) above the outdoor area elevation. (4) Be anchored to withstand the body force of a 350-pound (158.9-kg) person. If provided, gates or doors in the fence or wall shall: (1) Swing out of the outdoor area. (2) Have the hinge installed on the outside of the outdoor area. (3) Be provided with a locking mechanism that has been coordinated with life safety exiting requirements. Trees and bushes shall not be placed adjacent to the fence or wall. Plants selected for use shall not be toxic to patients if consumed. Lights shall not be accessible to patients. Poles supporting lights shall not be capable of being climbed. If provided, security cameras shall not be accessible to patients and cameras shall view the entire outdoor area. If provided, furniture shall be secured to the ground. Furniture shall not be placed in locations where it can be used to climb the fence or wall. Elevated courtyards or outdoor areas located above the ground floor level shall not contain skylights or unprotected walkways or ledges. Comfort/quiet room:If required by the functional program, a comfort/quiet room shall be provided for patients who require less stimulation, but do not require a seclusion room. a) In acute psychiatric hospitals, the number of seclusion treatment rooms shall be permitted to be decreased with the use of comfort/quiet rooms; however, at least one seclusion treatment room shall be provided. b) In long-term psychiatric facilities, provision of comfort/quiet rooms shall be permitted in lieu of seclusion treatment rooms based on the functional program. c) A minimum of 80 square feet per patient/resident shall be provided in a comfort/quiet room. Nourishment area:Food service within the unit may be one or a combination of the following: (1) A nourishment station (2) A kitchenette designed for patient use with staff control of heating and cooking devices (3) A kitchen service within the unit that includes a hand-washing station, storage space, refrigerator, and facilities for meal preparation.Environmental services room. Location of this room either in or immediately accessible to the nursing unit shall be permitted unless otherwise dictated by the functional program. For requirements.- Consultation room(s):(1) Separate consultation room(s), with a minimum floor area of 100 square feet (9.29 square meters) each, shall be provided at a room-to-bed ratio of one consultation room for each 12 psychiatric beds or fewer. (2) The room(s) shall be designed for acoustical and visual privacy and constructed to achieve a level of voice privacy of 50 STC (which in terms of vocal privacy means that some loud or raised speech is heard only by straining, but is not intelligible). (3) The visitor room may serve as a consultation room. Conference room:- A conference and treatment planning room shall be provided for use by the psychiatric unit. This room may be combined with the charting room. Space for group therapy:- This may be combined with the quiet space. (Social spaces) when the unit accommodates no more than 12 patients and when at least 225 square feet (20.90 square meters) of enclosed private space is available for group therapy activities. Patient laundry facilities. Patient laundry facilities with an automatic washer and dryer shall be provided. Patient storage facilities:- A staff-controlled secured storage area shall be provided for patients effects that are determined to be potentially harmful (e.g., razors, nail files, cigarette lighters). Child psychiatric unit patient areas shall be separate and distinct from any adult psychiatric unit patient areas Capacity. Maximum room capacity shall be four children. Space requirements:- Patient room areas (with beds or cribs) shall meet the following space requirements: - For single-bed rooms, a minimum of 100 square feet (9.29 square meters).- For multiple-bed rooms, a minimum of 80 square feet (7.43 square meters) per bed and 60 square feet (5.57 square meters) per crib Patient toilet room:- Each patient shall have access to a toilet room, including access via a corridor where permitted by the functional program. 1) The combined area for social activities shall have 35 square feet (3.25 square meters) per patient. 2) The total area for social activities and dining space shall have a minimum of 50 square feet (4.65 square meters) per patient. 3) If a separate dining space is provided, it shall have a minimum of 15 square feet (1.39 square meters) per patient.

ECT AREA:If ECT is included in the functional program, the requirements in this section shall be followed, with the exception noted in below:-Where a psychiatric unit is part of a general hospital, all of the requirements shall be permitted to be accommodated in an operating room in a surgical suite that meets the requirement. Guidelines for issuing licence to Psychiatric Institutions:A. Manner and conditions of maintaining Psychiatric institutions - (Rule 20 of State Mental Health Rules 1990):-a. such Psychiatric Institutions should be located only in the area approved by the local authority;b. such Psychiatric Institutions should be located in the building constructed with the approval of the local authority; c. the building, where such Psychiatric Institution is situated, should have sufficient ventilation and should be free from any pollution which may be detrimental to the patients admitted in such hospital or nursing home;d. such Psychiatric Institutions should have enough beds to accommodate thepatients;e. The nurses and other staff employed in such Psychiatric Institutions should be duly qualified and competent to handle the work assigned to them;f. The supervising officer in charge of such Psychiatric Institutions should be a person duly qualified, having a post-graduate qualification in Psychiatry recognized by the Medical Council of India.B. Minimum facilities required for treatment of in patients (Rule 22 of State Mental Health Rules 1990) (section 10 of the Act)The minimum facilities required for every Psychiatric Institutions for treatment of patients shall be as follows:1. Staff requirements.-a. Psychiatrists: -(i) A psychiatric hospital/psychiatric Nursing Home, Forensic Psychiatric units and Child/Adolescent Psychiatry Clinic &Guidance Units should have at least a full time psychiatrist for every 100 patients and parts there of;(ii) De-Addiction centers should have the service of a Consultant Psychiatrist visiting the hospital, and examining the in patients every day, conducting OP at least two hours twice in a week and will be available on call to attend on emergencies. (iii) General Hospital Psychiatry units/beds should have the service of a Consultant Psychiatrist conducting OPs on the days on which Psychiatric patients are admitted and visiting Psychiatric inpatients in the hospital every alternate day and will be available on call to attend on emergencies. (iv) A Psychiatric Rehabilitation Homes/Centers or other Partial hospitalization units should have a Psychiatrist who will be attending these centers for at least one half day session in a week and will be available on call to attend on emergencies(v) Long term Psychiatric Care Homes should have at least one qualified Psychiatrist visiting the institution at least once fortnightly and review all the patients and will be available on call to attend on emergencies.b. Medical Officers having recognized M.B.B.S Degree.-A psychiatric hospital/psychiatric Nursing Home, De-addiction center, Forensic Psychiatric units and Child/Adolescent Psychiatry Clinic &Guidance Units should have Medical Officers having recognized M.B.B.S Degree in the doctor Patient ratio of 1:50 and round the clock service of one Medical Officer should be available in the facility.c. Clinical Psychologist or Psychiatric Social Worker: -(i) Psychiatric Hospital/Psychiatric Nursing Home, De-Addiction Centre, Forensic Psychiatric Units and Child/Adolescent Psychiatry Clinic &Guidance Units should have at least one full time Clinical Psychologist or Psychiatric Social Worker for every 100 patients and parts there of(ii) In Psychiatric Rehabilitation Homes/Centers or other Partial hospitalization units, service of at least one Clinical Psychologist or one Psychiatric Social Worker during the hours of operation of the institution.(iii) Long term care homes should have the services of one Clinical Psychologist or One Psychiatric Social Worker and they should attend half-day duty in every week.d. Staff Nurse.-(i) Psychiatric Hospital/Psychiatric Nursing Home, De-Addiction Centre, Forensic Psychiatric Units and Child/Adolescent Psychiatry Clinic &Guidance Units should have one staff nurse for every 10 beds and round the clock service of at least one staff nurse should be made available in each ward.(ii) Psychiatric Rehabilitation Homes/Centers or other Partial hospitalization units should have one Staff Nurse for every 15 beds and service of at least one staff nurse should be made available round the clock. (iii) Long term Psychiatric Care Homes should have one staff nurse for every 15 beds.e. Attenders.-(i) ANMs, Nursing Assistants, Hospital Attendant Gr I & II will be treated as Attenders for licensing purpose.(ii) Psychiatric Hospital/Psychiatric Nursing Home, De-Addiction Centre, ForensicPsychiatric Units, and Child/Adolescent Psychiatry Clinic& Guidance Unit, Psychiatric Rehabilitation Homes/Centers or other Partial hospitalization units should have one Attender for every 10 patients/beds (iii) Long term care homes should have one Attender for every 15 beds. (iv) In the case of institutions where patients are admitted only with bystanders, the minimum number of attenders shall not be insisted (v) Service of a watcher should be provided round the clock at the entrance of the Psychiatric institutionf. Further staff requirements.-Further staff requirements for the different types of the institutions shall be Provided as per guideline issued by the State Mental Health Authority, in this regard from time to time.

2. Physical features.- a) The plinth area of the building, housing a Psychiatric Hospital/Psychiatric Nursing Home or other Mental Health Care centers, shall ordinarily occupy only half of the land area of the plot in which it is located. In situations where there is genuinedifficulty to provide this much of open land area, 10% to 30% of the total carpet area prescribed for patients shall be provided as additional living area, depending on the quantum in shortage of open land area.b) The open land area or the additional living area shall be easily accessible to the in patients.c) There should be proper drainage system and facility for waste disposal.d) Each patient should be provided with an area of 60 sq. feet as dormitory and further 30 Sq. feet as living room cum dining room area e) There should be one bath room and one toilet each for every eight male patients and for every six female patients.f) The floor area for dormitory, living room and dining room mentioned above are exclusively for the use of the patients. Additional floor area for the use of the staff has to be provided separately, to meet standard requirements.g) There should be adequate ventilation and supply of safe drinking water and the patients should have access to drinking water round the clock. h) There should be proper compound wall to ensure the protection of the patients.i) Cots, beds, pillows and adequate number of bed sheets and pillow covers should beprovided to all inmates in the Psychiatric institutions and separate dining rooms should be available for male and female inmates. j) A register should be maintained with watcher and, the name, purpose and time of visit of all the visitors should be entered in the register for psychiatric hospital and nursing home. In the case of GH with Psychiatry ward/beds this register should be kept by the ward staff. k) There should be separate dining room for male and female inmates. l) A written booklet showing the details of, facilities and privileges available in the institution is to be maintained.m) The details of the staff working in the institution and facilities available have to be displayed in a notice board in a prominent place in the institution.

(3) Support / facilities:-(i) The minimum support /facilities for Psychiatric Hospitals/Psychiatric Nursing Homes specialized Psychiatric Hospitals/Specialized Psychiatric Nursing Home like De- addiction centers, Forensic Psychiatric Units and Child/Adolescent Psychiatric Centre should be as under:(a) Provision for emergency care for outpatients and for handling medical emergencies for outpatients and inpatients.(b) A well-equipped modified electro convulsive therapy unit (optional);(c) Psycho diagnostic facilities(d) Provision for recreational/rehabilitation activities; and(e) Facilities for regular out patient care.(ii) Rehabilitation Centre or other Partial Hospitalization Units and long term Care Homes should have provision for Recreation and Rehabilitation activities.

(4)Provision for treating out patients (section 14 of Mental Health Act) a) Psychiatric Hospitals/Psychiatric Nursing Homes should have outpatient section open at least for three hours per day for six days in a week. b) Specialized Psychiatric Centers like De-addiction centers; Child/Adolescent Psychiatric Centers should have an outpatient section working for at least two hour twice in a week. c) General Hospital Psychiatry units, should have Out Patient services on every alternate days (Minimum 3 days in a week) for at least three hours d) Rehabilitation Centers or other partial hospitalization units should have two hour outpatient section once in a week.e) Outpatient section in all these centers should be manned by a Psychiatrist and the presence of a Clinical Psychologist/Psychiatric Social Worker and (Psychiatric) Nurse are to be ensured as far as possible.f) All admissions should be made through the Outpatient section as far as possible When admissions are made out-side of the outpatient section, the psychiatrist inCharge shall record on the patients case record, the reasons for resorting to such a procedure

(5) Further Amenities.-Further amenities for the patients shall be provided as per guide lines issued in this regard by the State Mental Health Authority from time to time.

C. Maintenance of records (Rule-24 of State Mental Health Rules 1990) :- Every institution shall maintain the records of the treatment of patient in Form VI of State Mental Health Rules 1990.

D. Other provisions: (i) General Hospital with Psychiatry Units/beds.:- All the provisions in this Guidelines applicable for Psychiatric Hospitals/Psychiatric Nursing Homes except that for the service of full time Psychiatrists will be applicable for General Hospital with Psychiatry units/beds also.(ii) Minimum number of Staff Nurses and Attenders required:- For Psychiatric Hospital/Psychiatric Nursing Home, De-Addiction Centre, Forensic Psychiatric Units, Child/Adolescent Psychiatry Clinic & Guidance unit and Psychiatric Rehabilitation Centersminimum number of Staff Nurses and Attenders required will be 3 each irrespective of the number of beds in the institution.(iii) In the absence of qualified Clinical Psychologists service of trained Psychologists will be considered for issuing license to private psychiatric institutions. This is a temporary arrangement which will be continued till the shortage of qualified Clinical Psychologists is over.(iv) In the absence of qualified Psychiatric Social Workers service of trained Medical Social workerswill be considered for issuing license to private psychiatric institutions. This is a temporary arrangement which will be continued till the shortage of qualified Psychiatric Social Workers is over.

THE STANDARDS OF PSYCHIATRIC NURSING PRACTICE:The Standards of Psychiatric Nursing Practice describes, in broad terms, the expected level of performance of all Registered Psychiatric Nurses. There are four (4) Standards of Psychiatric Nursing Practice. A standard may be defined as a benchmark of achievement that is based on a desired level of excellence. The standards provide a guide to the knowledge, skills, values, judgment, and attitudes that are needed to practice safely. They reflect a desired and achievable level of performance against which actual performance can be compared. Their main purpose is to promote, guide, and direct professional psychiatric nursing practice.Under each standard of practice there are a number of indicators that help determine how to meet the standard of practice. An indicator is a statement that helps illustrate how the standards can be met. The indicators are representative but not comprehensive for each standard.STANDARD 1: THERAPEUTIC INTERPERSONAL RELATIONSHIPS:-Registered Psychiatric Nurses establish professional, interpersonal, and therapeutic relationships with individual, groups, families, and communities.Indicators:A Registered Psychiatric Nurse: Acts as role model for positive professional, interpersonal, and therapeutic relationships. Uses professional judgment and practices with personal integrity to initiate, maintain, and terminate professional, interpersonal, and therapeutic relationships. Consistently applies processes of self-awareness within professional practice. Collaborates and advocates with individuals, families, groups, and communities. Creates therapeutic environments in diverse practice settings. Creates partnerships in professional, interpersonal, and therapeutic relationships. Recognizes and addresses power imbalances in professional, interpersonal, and therapeutic relationships.STANDARD 2: APPLICATION AND INTEGRATION OF THEORY-BASED KNOWLEDGERegistered Psychiatric Nurses apply and integrate theory-based knowledge relevant to professional practice derived from psychiatric nursing education and continued life-long learning.Indicators:A Registered Psychiatric Nurse: Uses theory-based knowledge in psychiatric nursing practice. Synthesizes and applies recognized theories or frameworks to engage in innovative problem solving. Provides theoretical and/or evidence-based rationale for psychiatric nursing practice. Applies theory to psychiatric nursing decisions and interventions. Applies theory-based knowledge, skill, and judgment to assess, plan, implement, and evaluate the practice of psychiatric nursing. Applies critical thinking in the problem solving process. Applies communication theory to ensure effective verbal and written communication. Applies documentation principles to ensure effective written communication. Remains current in knowledge relevant to the professional practice setting. Engages in life-long learning.STANDARD 3: PROFESSIONAL RESPONSIBILITYRegistered Psychiatric Nurses are accountable to the public for safe, competent, and ethical psychiatric nursing practice.Indicators:A) Registered Psychiatric Nurse: Practices in accordance with the Code of Ethics, Standards of Psychiatric Nursing Practice, and relevant legislation. Assumes responsibility and accountability for own practice. Recognizes personal and professional limitations and consults and refers appropriately. Creates and maintains professional boundaries. Integrates cultural safety into psychiatric nursing practice. Recognizes and reports unprofessional and/or unethical conduct. Assumes responsibility and accountability for continuing competence.STANDARD 4: PROFESSIONAL ETHICS:Registered Psychiatric Nurses understand, promote, and uphold the ethical values of the profession.Indicators:A) Registered Psychiatric Nurse: Practices and conducts ones self in a manner that reflects positively on the profession. Promotes and adheres to the professional Code of Ethics. Uses ethical principles to guide psychiatric nursing practice. Applies the elements of confidentiality and consent in psychiatric nursing practice. Recognizes the power imbalance in the therapeutic relationship and mitigates the risks of exploiting that power. Supports the rights of clients to make informed decisions. Maintains boundaries between professional and personal relationships.ANA Standards for Psychiatric Nursing Practice:-Standard I -Assessment The RN collects client data.Standard II - Diagnosis The RN analyzes assessment data and determines a nursing diagnosis.Standard III - Outcome Identification The RN identifies expected outcomes individualized to the client.Standard IV - Planning The RN develops a plan of care that is negotiated among the client, nurse, family and health care team and prescribes evidence based interventions to attain expected outcomes.Standard V-Implementation The RN implements the interventions identified in the plan of care.Standard Va -Counseling The RN uses counseling interventions to assist clients in improving or regaining their previous coping abilities, fostering mental health, and preventing mental illness and disability.Standard Vb - Milieu Therapy The RN provides, structures and maintains a therapeutic environment in collaboration with the client and other health care professionals.Standard Vc - Promotion of Self-Care Activities The RN structures interventions around the client's ADL's to foster self-care and mental and physical well-being.Standard Vd -Psychobiological InterventionsThe RN uses knowledge of psychobiological interventions and applies clinical skills to restore the client's health and prevent further disability.Standard Ve - Health Teaching The RN, through health teaching, assists clients in achieving satisfying, productive, and healthy patterns of living.Standard Vf - Case Management The RN provides case management to coordinate comprehensive health services and to ensure continuity of care.Standard Vg - Health Promotion and Health Maintenance The RN employs strategies and interventions to promote and maintain health and prevent mental illness.DOCUMENTATION:The facility shall maintain a record for each person admitted to a psychiatric clinic. The record shall include the following:(1)Patient identifying information(2)Referral source.(3)Presenting problems.(4)Appropriately signed consent forms.(5)Medical, social, and developmental history.(6)Diagnosis and evaluation.(7)Treatment plan.(8)Treatment progress notes for each contact.(9)Medication orders.(10)Discharge summary.(11)Referrals to other agencies, when indicated.(b)Records shall also be maintained as follows:(1)Legible and permanent.(2)Reviewed periodically as to quality by the facility or clinical director as appropriate.(3)Maintained in a uniform manner so that information can be provided in a prompt, efficient, accurate manner and so that data is accessible for administrative and professional purposes. (4)Signed and dated by the staff member writing in the record.(c) Confidentiality of mental health records.(d)All case records shall be kept in locked and protected locations to which only authorized personnel shall be permitted access.