Psychiatry reform occurred not only in the US but in Europe as well. As a result, psychiatric units in general hospitals were established both here and abroad. 2. Principles of psychiatric nursing also changed. In the US and Germany, guidelines emphasized the goal of a patient's self-sufficiency rather than dependency on staff and institutions. 3. Psychiatric staff nurses in Germany receive additional and continued education, whereas academic advancement and specialization prepares the nurse specialist in the US. 4. The daily routine on a German psychiatric unit includes preadmission interviews, more liberal passes and outings for patients, overlapping shifts, and an emphasis on "supervision."