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What Does a Psychiatric/Mental Health Nurse Do?
If you are a nursing student or even a seasoned registered nurse, you may be wondering what does a mental health nurse do. Perhaps you have not had your psychiatric nursing clinical yet or maybe it’s been years since you were in nursing school. While mental health nursing shares some similarities with medical-surgical nursing care, there are many differences as well.
I have worked in a mental health hospital for 6 years, either as a staff registered nurse or as a registered nursing professor educating students in the psychiatric clinical setting. I have experience working in a stand-alone psychiatric hospital and in a psychiatric unit of a medical hospital, in addition to an outpatient psychiatric clinic that serves a variety of mental health needs. Each of these facilities has some differences, but overall the goal is the same. Read on for more information about what a psychiatric/mental health nurse does.
Psychiatric Nursing Assessment
When a psychiatric nurse is assessing a mentally ill person, he/she does the basic nursing assessment plus some additional assessment techniques. The focus is quite a bit different. These are some of the differences:
- Establishing rapport with the patient is priority. If the patient does not trust the nurse, it is unlikely the nurse will get thorough, accurate information.
- Have a positive initial impression of the patient. If the psychiatric nurse goes into the interview believing the patient is bad or unpleasant, the patient may sense this and become guarded.
- A complete physical exam is accompanied by a mental status exam (see below)
- A psychosocial exam is conducted (see below)
- The patient sets the pace of the assessment, rather than the registered nurse completing the assessment as quickly as possible
- Using therapeutic communication is key. We want the patient to feel comfortable and to provide us with accurate, thorough explanations
- Maintaining open body language is invaluable
- Eye contact is very important, rather than focusing on your documents
- Patient comfort is a priority. It is likely the patient is not prone in a hospital bed, so seating must be arranged for therapeutic communication.
- Much of the focus is on functional abilities, such as: is the patient able to work? To take care of his/her children? To clean their home?
- A psychiatric nurse always assesses for the potential for danger (E.g. Is the patient suicidal, homicidal, or psychotic, or self-mutilating?)
- Alcohol and substance abuse is thoroughly explored. The use of substances can exacerbate and worsen mental illness. Scales like CIWA are used to assess the patient.
- Self concept, esteem, and developmental issues are addressed.
- The mental health nurse needs to know how the patient perceives the problem.
- The mental health nurse may need to verify the data with others, such as the police or significant others. People who are suffering from various forms of mental illness may not provide reliable data.
In mental health nursing, a full physical exam is included to help rule out any medical causes of psychiatric issues. Sometimes behavior changes can be related to something as minor as a urinary tract infection to something as severe as a brain tumor. All the psychiatry in the world will not fix these problems, so it is important to rule out medical problems before focusing on psychiatric diagnoses.
Also, according to Maslow’s Hierarchy of Needs and various other theories, the psychiatric nurse knows that we must address basic physiological needs before we focus on the psychiatric needs. For example, a patient who has been sitting in the emergency department for 12 hours with nothing to eat should have something to eat before we ask him/her 100 different questions. Likewise, if a psychiatric patient is having chest pain or shortness of breath, we must address those issues first.
Mental Status Exam
Explanation or Description
Dress, hygiene, body posture and body language
Unusual behaviors, fidgeting, pacing
Rate (pressured, rapid, slow, etc.), volume (excessively loud, whispering), and disturbances (repeating words or phrases, mutism, lisps, etc.)
Depressed, elated, angry
Disorders of the form of thought
Delusions, obsessions, flight of ideas, etc.
Short and long-term recall, insight, judgment
Ideas of harming self or others
Explanation or Description
Previous psychiatric hospitalizations
Is this a new or recurrent problem?
Friends, family, loved ones, interactions
Any change in libido, number of sexual partners, etc.
Educational level must be assessed as it relates to both cognition and the education the mental health nurse and other staff provide
High stress jobs, joblessness
Interests and abilities
Any change in motivation or interest; also, interests and abilities can be used to help the patient develop adaptive coping skills
Alcohol and/or drug use
The use of alcohol and/or drugs can either exacerbate or mask psychiatric symptoms. Many people self-medicate to cope with mental illness.
How does the patient usually handle stress or hard times?
Is the patient religious? Believe in a higher power? Have a sense of meaning in life or a connectedness with the world or universe?
Nursing Diagnoses in Mental Health Nursing
Nursing diagnoses are written the same in mental health as they are in medical nursing care. The focus will vary, depending on the diagnosis and patient needs, but the nurse still must include the problem statement, the causative factors, and the evidence for the diagnosis. A sample mental health nursing diagnosis looks like this:
Chronic low self esteem (problem statement) related to history of child abuse by father (probable cause) as evidenced by patient statements of “No one loves me. I’m not worth being here” (evidence)
Nursing Interventions in Mental Health Nursing
Nursing interventions in mental health nursing may be different at times from medical nursing interventions. For example, rather than applying O2 2L per NC, the psychiatric nurse might ask the patient to make a list of 5 things they are good at. Psychiatric nursing interventions focus on:
- Health teaching and promotion
- Milieu therapy (the environment, room lighting, furniture spacing, communication techniques, etc.)
- Dietary needs
- Exercise needs
- Medical or surgical procedures (e.g. electroconvulsive therapy)
- Integrative therapy (e.g. pet therapy, therapeutic massage)
This is a brief overview of some of the differences between medical-surgical nursing and psychiatric/mental health nursing. This topic is broad and deep, but this introduction can give you an idea about what a mental health nurse does and how the focus of care is different. If you have any questions or comments, please feel free to leave them below. I always love to discuss my favorite topic in more detail! Thank you for reading and while you are here, feel free to check out some of my other articles on psychiatric nursing and mental illness.
© 2013 Leah Wells-Marshburn