Definition
Admission of a client in a psychiatric unit refers to the process of allowing and facilitating a patient to stay in the hospital for observation, investigation, or treatment of mental health conditions. This process is guided by legal frameworks, such as mental health acts, and involves ensuring the patient’s safety, addressing their health needs, and providing a supportive environment.
Aims of admission
- To orient and educate the caretakers about the rules and regulations and ward routines.
- To introduce the staff members whom they can approach in time of need.
- To maintain a safe environment in the client’s unit for him, his relatives and his belongings.
- To render care to meet the health needs of patients.
Types of Admission
Admissions to mental health hospitals can generally be categorized into voluntary and involuntary types, depending on the patient’s condition and circumstances:
1. Voluntary Admission
- Patients willingly seek treatment and agree to hospitalization.
- They must have the capacity to understand their decision and consent to care.
- Voluntary patients can typically leave the hospital at their discretion, unless their condition poses a risk to themselves or others.
2. Involuntary Admission
- Patients are admitted against their will under legal provisions, such as the Mental Health Act.
- This type of admission is often necessary when patients are unable to make decisions due to their mental state or pose a danger to themselves or others.
- Involuntary admissions may involve court orders or assessments by mental health professionals.
3. Supported Admission
- For individuals who lack the capacity to make decisions about their care, a nominated representative or legal guardian provides consent.
- This type of admission is common for minors or patients with severe cognitive impairments.
4. Acute Hospitalization
- Patients experiencing severe symptoms, such as psychosis, mania, or suicidal ideation, are admitted for urgent care.
- The goal is to stabilize the patient and ensure their safety.
5. Specialized Wards
- Patients may be admitted to specific units based on their condition, such as eating disorder units, forensic units, or psychiatric intensive care units.
- These wards provide tailored care for unique mental health needs.
Procedure
| Nursing actions | Rationale | |
| 1 | Upon completion of the admission order, assign a bed or room to the client considering his/her need for close monitoring. | Provides for rest and relaxation. Clients with suicidal tendency, aggressive behavior or psychotic behavior are placed near to the nurses’ station. |
| 2 | Orient the client and his family to ward routines, policies and procedures. | Learns about ward activities, meal time, visiting hours and therapy timings. |
| 3 | Plan and meet the client’s emotional and biological needs. | Improves client’s emotional and physical status. |
| 4 | Establish and maintain trusting and therapeutic relationship. | Encourages cooperation of patient in his therapy and verbalization of feelings. |
| 5 | Carry out a complete physical examination. | Excludes any physical condition. |
| 6 | Carry out a mental status examination, and process recording. | Informs the therapeutic team of necessary observations made. |
| 7 | Assist with needed investigations. | Helps to evaluate the health status. |
| 8 | Provide explanation and assist with prescribed therapies. | Therapies help to improve the mental health status. |
| 9 | Encourage client to engage in activities, he can do. | Diverts the mind from unwanted thoughts. |
| 10 | Document all relevant data, care, activities, therapy, and observations in the nurses’ notes. | Provides for communication among health team members. |
Special considerations
- Conduct a thorough risk assessment to identify potential harm to the patient or others.
- Remove any dangerous objects from the patient’s belongings to prevent self-harm or injury.
- Ensure the environment is secure and supportive, with close monitoring for patients at risk of suicide or aggression.
- Verify the patient’s decision-making capacity for voluntary admission.
- For involuntary admissions, ensure compliance with legal frameworks, such as mental health acts, and obtain necessary documentation.
- Respect the patient’s privacy and confidentiality throughout the admission process.
- Perform a physical and mental health evaluation to identify underlying conditions and immediate needs.
- Use standardized tools like suicide risk assessments or mental status examinations to guide care planning.
- Orient the patient and their family to the unit’s routines, policies, and available resources.
- Establish a therapeutic relationship to encourage cooperation and emotional expression.
- Tailor the care plan to address the patient’s specific needs, such as medication management, therapy, or crisis intervention.
- Collaborate with interdisciplinary teams to ensure holistic care.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- R.Sreevani, A Guide to Mental Health & Psychiatric Nursing, 6th Edition, 2024, Jaypee Publishers, ISBN 978-9366161686
- Sheila L. Videbeck, Psychiatric Nursing, Seventh Edition , 2017, Wolters Kluwer Publications, ISBN: 978- 1496355911
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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