Nursing in Mental Health: Supporting Patients with Psychiatric Disorders

Learn how mental health nurses play a pivotal role in the treatment and recovery of mental health patients.

Psychiatric disorders are on the rise globally, presenting a significant public health challenge. Factors such as increased stress, changing lifestyles, and evolving diagnostic criteria have contributed to their growing prevalence. The burden of psychiatric disorders affects individuals, families, and communities on a massive scale, necessitating effective and holistic approaches to treatment and care.

Nursing care is pivotal in mental health treatment due to its multifaceted role. Nurses provide patient-centered care, administer and monitor medications, build therapeutic relationships, and engage in preventive care to mitigate the impact of psychiatric disorders. They also advocate for patients’ needs and educate them and their families about their conditions, fostering a comprehensive approach to mental health treatment.

In this article, we’ll discuss the scope of mental health nursing, dive into understanding the nurse-patient relationship, how to become a psychiatric nurse practitioner, as well as how to assess, diagnose, and treat patients with psychiatric disorders. In addition, we’ll look at medication management, crisis intervention, and future trends in mental health nursing.

The Scope of Mental Health Nursing

Psychiatric nurses play a crucial and multifaceted role within the mental health care system. They are instrumental in delivering holistic care to individuals with psychiatric disorders. These nurses provide patient-centered care, which includes assessing the mental and emotional well-being of their patients, offering emotional support, and creating safe and therapeutic environments for treatment. They are responsible for administering and monitoring medications, ensuring patients receive appropriate treatments and experience minimal side effects. Moreover, psychiatric nurses are pivotal in building strong therapeutic relationships with their patients, fostering trust, and facilitating open communication, which is fundamental for effective treatment. They also engage in preventive care, working to prevent the exacerbation of mental health conditions and reduce the risk of relapse. Advocacy and patient education are additional aspects of their role, as they advocate for patient’s needs and rights while also educating patients and their families about the nature of psychiatric disorders and the importance of adherence to treatment plans.

The history of mental health nursing is deeply intertwined with the historical treatment of individuals with mental illnesses. In the past, patients with psychiatric disorders were often subjected to inhumane and stigmatizing treatments. Over time, the field of mental health nursing has evolved significantly. The origin of the mental hygiene movement was primarily and basically concerned with the improvement of the care of people with mental disorders. It was at a later stage that its program came to include the “milder forms of mental disability” and a greater concern with preventive work. By the mid-20th century, we saw the deinstitutionalization movement, which aimed to move patients from large, overcrowded psychiatric hospitals to community-based care. This shift brought about a transformation in the role of mental health nurses, emphasizing community and outpatient care. In recent years, the field has seen a further evolution with the integration of mental health care into the broader healthcare system. Modern psychiatric nurses are not only found in psychiatric facilities but also in general hospitals, primary care settings, and community health centers, reflecting a more integrated and patient-centered approach to mental health care.

Collaboration with other healthcare professionals is of paramount importance in mental health nursing. Psychiatric nurses often work as part of a multidisciplinary team that includes psychiatrists, psychologists, social workers, occupational therapists, and more. Collaboration ensures that patients receive comprehensive care addressing their physical, mental, and social needs. Psychiatric nurses bring their expertise in patient-centered care, medication management, and therapeutic relationships to the team, while other professionals contribute their specialized knowledge. This collaboration is essential for diagnosing and treating complex cases, especially those involving co-occurring mental and physical health issues. Additionally, it helps in the development of holistic treatment plans and support networks for patients, ultimately improving the quality of care and outcomes for individuals with psychiatric disorders.

How to Become a Psychiatric Nurse Practitioner

Becoming a psychiatric nurse practitioner is a rewarding and challenging career path that requires a combination of education and clinical experience. Here is an overview of the steps to become a psychiatric nurse practitioner:

1. Undergraduate degree: This four-year program provides a strong foundation in nursing practice, including clinical experience.
2. RN licensure: After completing the BSN, graduates must pass the National Council Licensure Examination for Registered Nurses (NCLEX-RN) to become a licensed registered nurse (RN).
3. Gaining practical experience: Gaining hands-on experience as an RN is crucial before commencing a master’s program.
4. Master’s degree in nursing (MSN): Pursue a master’s degree in nursing with a specialization in psychiatric-mental health nursing. This typically takes 2-3 years and includes coursework in advanced nursing practice, pharmacology, psychotherapy, and psychiatric nursing.
5. Clinical hours: As part of the MSN program, complete a significant number of clinical hours (usually 500-600) in psychiatric-mental health settings. This hands-on experience is critical for developing advanced skills.
6. Certification: Obtain national certification as a psychiatric nurse practitioner, which may require passing an exam from an accredited certification body like the American Nurses Credentialing Center (ANCC) or the American Association of Nurse Practitioners (AANP).
7. State licensure: Secure state licensure as a psychiatric nurse practitioner, which involves meeting specific state requirements and regulations.

Continuing education is vital for psychiatric nurse practitioners to stay updated with the latest research, treatments, and best practices in mental health care. Specialization allows practitioners to focus on specific populations or disorders, such as child and adolescent psychiatry or substance abuse. Advanced training and certification in these areas can enhance a practitioner’s skills and career opportunities. Explore an in-depth career guide on how to become a Psychiatric Nurse Practitioner to get more detailed information and guidance. And explore the highest-paid nursing jobs for a broader understanding of the career opportunities in the nursing profession.

Understanding the Nurse-Patient Relationship

A therapeutic nurse-patient relationship is the cornerstone of effective mental health nursing. It is characterized by several key elements:

1. Trust: Patients must feel safe and secure in the nurse’s care, knowing that their concerns and personal information will be treated confidentially.
2. Empathy: Psychiatric nurses should demonstrate empathy, showing that they understand what the patient is going through and that they genuinely care about their well-being.
3. Communication Skills: Nurses need to actively listen to patients, ask open-ended questions, and provide clear and honest information. They should use nonverbal cues, such as body language, to convey empathy and understanding.
4. Respect and Non-judgment: Nurses must respect the patient’s individuality and choices. Judgment-free care is essential, as patients may share sensitive and stigmatized information.
5. Boundaries: Establishing and maintaining professional boundaries is vital to ensure a healthy nurse-patient relationship. These boundaries help create a safe environment while preventing potential harm or dependency.

There are many common scenarios that illustrate the importance of these core elements. For example, a nurse working with a patient diagnosed with depression can actively listen to their struggles and feelings of hopelessness. The nurse acknowledges the patient’s emotions and provides encouragement. The patient gradually opens up, knowing the nurse is empathetic and trustworthy. Over time, they work together to develop a treatment plan focused on therapy and medication, fostering improvement in the patient’s condition. A nurse caring for a patient with schizophrenia demonstrates non-judgmental understanding, consistently encouraging medication adherence and discusses potential side effects. By providing clear explanations and addressing the patient’s fears, trust is established. Over time, the patient becomes more comfortable discussing their experiences and adjusting to the treatment plan.

These scenarios exemplify how effective communication, empathy, and trust-building can lead to positive outcomes in mental health nursing. Patients feel respected, heard, and supported, which is essential for their recovery and well-being.

How to Assess and Diagnose Psychiatric Disorders

Below are common assessment process steps for assessing and diagnosing psychiatric disorders.

1. Clinical Interview: The assessment process typically begins with a clinical interview. The nurse conducts a thorough conversation with the patient to gather information about their symptoms, medical history, and psychosocial factors. This helps in understanding the context of the patient’s condition.
2. Observation: Observation plays a significant role in assessing psychiatric disorders. Nurses observe the patient’s behavior, appearance, affect, speech, and thought processes. This can provide valuable insights into their mental state.
3. Standardized Assessments: Nurses may use standardized assessment tools to gather specific information and measure the severity of symptoms. Examples include the Patient Health Questionnaire-9 (PHQ-9) for depression or the Generalized Anxiety Disorder 7 (GAD-7) for anxiety.
4. Collateral Information: Gathering information from family members or significant others can provide additional context and history, especially when patients may have difficulty providing a complete picture themselves.
5. Cultural Considerations: It’s essential to consider the patient’s cultural background and beliefs. Cultural factors can significantly influence the expression of psychiatric symptoms and the perception of mental health issues.

Utilization of Standardized Tools and Techniques

Standardized assessment tools are invaluable in psychiatric nursing as they provide quantifiable data for symptom severity and progression. Examples include the Mini-Mental State Examination (MMSE) for cognitive disorders, the Hamilton Rating Scale for Depression (HAM-D), and the Positive and Negative Syndrome Scale (PANSS) for schizophrenia. These tools help ensure consistency in assessment, improve accuracy in diagnosis, and monitor treatment outcomes.

Cultural competence is crucial in psychiatric nursing due to the diversity of patient populations. Understanding the cultural context allows nurses to provide more effective care. For instance, certain cultural norms and beliefs may affect a patient’s willingness to disclose mental health symptoms or accept treatment. Cultural competence involves respecting and acknowledging these differences, adapting communication and treatment plans accordingly, and avoiding stereotyping. It also helps build trust with patients from diverse backgrounds, as they feel their values and identities are respected.

How to Treat Patients with Psychiatric Disorders

The development of individualized treatment plans for patients with mental health disorders is a collaborative and comprehensive process in psychiatric nursing. It typically involves the following steps:

1. Assessment: As previously discussed, a thorough assessment of the patient’s condition, including their symptoms, medical history, and psychosocial factors, is conducted. This assessment helps in understanding the unique needs and challenges of the individual.
2. Diagnosis: Based on the assessment findings, a diagnosis is made. This diagnosis guides the selection of appropriate treatment modalities and interventions.
3. Setting Goals: Together with the patient, treatment goals are established. These goals are specific, measurable, and tailored to the individual’s needs. They may focus on symptom reduction, improved functioning, or enhancing quality of life.
4. Treatment Modalities: A combination of treatment modalities is often used, depending on the diagnosis and individual needs. This can include pharmacological (medication) and non-pharmacological (therapy, lifestyle changes) approaches.
5. Development of a Care Plan: The treatment plan is documented in a care plan. It outlines the specific interventions, the responsibilities of the healthcare team, and the patient’s role in their treatment.
6. Regular Monitoring and Adjustments: The care plan is a dynamic document. It’s regularly reviewed and adjusted as the patient progresses, with the aim of achieving treatment goals.

Treatment Modalities

• Pharmacological Approaches: Medications are commonly used to manage psychiatric disorders. These include antidepressants, antipsychotics, anxiolytics, and mood stabilizers. The choice of medication is based on the specific diagnosis and individual response.
• Psychotherapy: Various forms of psychotherapy, such as cognitive-behavioral therapy (CBT), dialectical-behavior therapy (DBT), and talk therapy, are used to address underlying psychological and emotional factors contributing to the disorder.
• Electroconvulsive Therapy (ECT): ECT is reserved for severe cases of depression and other disorders, such as acute mania and certain schizophrenic syndromes. It involves controlled electrical stimulation of the brain and is often effective when other treatments have failed.
• Hospitalization: In severe cases, hospitalization in a psychiatric facility may be necessary to ensure safety and stabilize the patient.
• Alternative and Complementary Therapies: Some individuals find benefit in alternative therapies like mindfulness meditation, yoga, or art therapy as adjuncts to traditional treatment.

Patient education is essential for treatment adherence and recovery. Patients need to understand their condition, treatment options, potential side effects of medications, and coping strategies. Additionally, family involvement can provide crucial support. Families can help with medication management, offer emotional support, and participate in family therapy sessions, which are especially important in conditions like schizophrenia or bipolar disorder.

Medication Management

Nurses play a critical role in medication management within the context of mental health care. This multifaceted responsibility encompasses medication administration, monitoring, and side effect management. Nurses are responsible for ensuring that patients receive the correct medications in the right doses and at the scheduled times. This requires careful assessment of the patient’s medication regimen, knowledge of the medication’s purpose, and consideration of potential interactions with other drugs. Moreover, nurses actively monitor patients for any changes in their condition, both in terms of symptom improvement and potential adverse effects. They assess for any signs of medication side effects, such as changes in vital signs, mood, or behavior, and communicate these findings to the healthcare team for further evaluation and intervention. Nurses also educate patients about their medications, ensuring they understand the importance of compliance and how to take the drugs safely.

Patient compliance with medication regimens is crucial in mental health treatment. Non-compliance can lead to relapse or exacerbation of symptoms. Nurses play a significant role in patient education, ensuring that individuals understand the need for medication, potential side effects, and the importance of adhering to their treatment plan.

Preventing medication errors is another vital aspect of the nurse’s role. Medication errors can have severe consequences in mental health care, potentially leading to worsening symptoms or harm. Nurses must maintain strict adherence to safety protocols, including verifying the “five rights” of medication administration: the right patient, right medication, right dose, right route, and right time. They must also communicate effectively within the healthcare team and use technology, such as electronic medication administration records, to reduce the risk of errors.

Crisis Intervention

Psychiatric nurses are often at the forefront of managing crisis situations in mental health care settings. Their role is multifaceted and critical in ensuring the safety and well-being of individuals experiencing acute mental health crises. One key aspect of their role is the assessment of the crisis, which involves evaluating the patient’s mental state, level of distress, and potential for harm. Nurses must quickly establish rapport, create a safe environment, and actively listen to the patient to understand their needs and concerns. In crisis situations, psychiatric nurses act as both advocates and mediators, collaborating with the healthcare team to develop and implement crisis intervention plans. They employ a range of techniques to de-escalate volatile situations and provide immediate support to individuals in distress. Additionally, psychiatric nurses play a key role in suicide prevention, assessing suicide risk, implementing safety measures, and ensuring that appropriate interventions are in place.

Examples of Crisis Interventions

Crisis interventions employed by psychiatric nurses include techniques to de-escalate tense situations and ensure the safety of patients. Verbal de-escalation involves using calming and empathetic communication to defuse heightened emotions and potentially violent behaviors. Nurses may employ strategies like active listening, offering choices, and using a calm tone to promote cooperation. Physical de-escalation techniques are used when a patient poses an imminent threat to themselves or others. This may involve the physical restraint of a patient, but it should only be used as a last resort and in accordance with legal and ethical standards.

In suicide prevention, nurses assess the risk of self-harm or suicide and take immediate steps to ensure patient safety. This includes removing any potentially harmful objects from the environment, closely monitoring the patient, and instituting one-to-one observation if necessary. Nurses may also coordinate with mental health professionals to develop a safety plan that addresses the patient’s emotional needs and strategies for coping with suicidal thoughts or impulses.

How to Promote Recovery and Resilience

Promoting patient recovery and resilience in mental health nursing involves a holistic approach that encompasses both physical and psychological well-being. Strategies include individualized treatment plans that consider the patient’s unique needs, preferences, and strengths. This might involve a combination of therapy, medication, lifestyle changes, and social support. Supportive relationships with healthcare professionals, peers, and family members are also vital in this process, as they provide emotional support and encouragement.

Setting realistic and achievable goals is a fundamental component of the recovery process in mental health care. Goals should be specific, measurable, and tailored to the individual’s circumstances. Measuring progress against these goals allows patients to see their achievements and provides motivation to continue working toward recovery. It also enables healthcare providers to assess the effectiveness of the treatment plan and make necessary adjustments. The process of setting and achieving small milestones can boost a patient’s self-esteem and sense of competence, reinforcing their belief in their ability to recover and build resilience.

Patient Success Stories

In her article, Breaking The Family Curse: Fighting Stigma And Finding Recovery, Lily Wells struggled with debilitating mood swings and was initially misdiagnosed with depression. She was initially prescribed antidepressants, which temporarily lifted her spirits but soon led to severe manic episodes. However, when she finally sought help from a specialist, she was correctly diagnosed with bipolar 1 disorder, a condition that had gone unrecognized for years. With the right treatment, involving lithium and antidepressants, they finally found relief from the torment of their internal battles. They realized that they were not “crazy” but someone with a medical issue, and for the first time, they began to experience a sense of normalcy and self-acceptance. She has been happily married for 30 years, has three healthy children, and has a thriving professional career.

For over two decades, Maria Kitamura grappled with anxiety and depression, initially hesitating to seek help due to societal expectations of self-reliance and strength. In Learning to Prioritize My Mental Health, she recounts her journey towards healing, which at first involved a brief but unproductive encounter with therapy, followed by years of internalizing her struggles. This led to sporadic outbursts, which deeply impacted her family. Realizing the need for change and understanding that mental health is just as vital as physical well-being, and she eventually embraced therapy as a vital resource, using it to navigate life’s transitions and maintain their emotional well-being.

“Paying a professional to focus on me and listen to my problems felt selfish, like indulging in a spa. But I found myself seeking out therapy again and again — during my children’s adolescent years, career changes, mourning the loss of a parent. Sometimes, I needed medical intervention, sometimes I didn’t. Most of the time, I went to individual counseling, sometimes to a group. The methods may change depending on my situation, but over time, I realized that therapy is necessary as I navigate through transitions in life.”

She learned that seeking professional help is not a sign of weakness but a necessary part of self-care. Let’s dive into what self-care means and how it applies to nurses working in the mental health arena.

Self-Care Tips for Mental Health Nurses

Self-care is of paramount importance for nurses working in the mental health field. The nature of the work can be emotionally demanding and stressful, making self-care crucial for maintaining mental well-being and providing effective patient care. When nurses prioritize self-care, they are better equipped to cope with the challenges of the job, reduce burnout, and offer compassionate and empathetic care to patients.

Tips and Resources for Self-Care

1. Set Boundaries: Establish clear boundaries between work and personal life to prevent emotional exhaustion. Avoid taking work-related stress home.
2. Mindfulness and Relaxation Techniques: Practice mindfulness, meditation, or deep-breathing exercises to reduce stress and improve mental clarity.
3. Physical Activity: Regular exercise is an excellent stress reliever. It releases endorphins and helps maintain physical health.
4. Healthy Eating: A balanced diet can have a significant impact on mental well-being. Avoid excessive caffeine and sugar and prioritize nutritious foods.
5. Peer Support: Connect with colleagues and seek support from peers who understand the challenges of the mental health field.
6. Professional Support: Utilize employee assistance programs, counseling services, or support groups for healthcare professionals when needed.
7. Time Off: Take breaks and use your vacation days to recharge. Overworking can lead to burnout.
8. Stay Informed: Stay updated on the latest research, techniques, and best practices in mental health care to enhance your knowledge and confidence in your role.

Nurses need to remember that self-care is not a luxury but a necessity to sustain well-being and provide the best care to their patients. Resources such as counseling services, employee assistance programs, and professional organizations in mental health nursing can offer additional support and guidance in maintaining your mental health.

The Future of Mental Health Nursing

Mental health nursing is an evolving field, with several emerging trends and advancements that are reshaping the way care is delivered. These include:

1. Telepsychiatry: The use of telepsychiatry has surged, enabling mental health nurses to reach patients in remote or underserved areas and increasing access to care. Telepsychiatry also offers the potential for improved monitoring and follow-up, as well as reducing the stigma associated with seeking in-person mental health services.
2. Personalized Medicine: Advances in genetics and neuroscience are contributing to the development of personalized treatment plans. By understanding an individual’s genetic and neurobiological makeup, mental health nurses can tailor interventions, including medication and therapy, to be more effective and have fewer side effects.
3. Digital Health and Apps: There is a growing range of mental health apps and digital tools that complement traditional treatments. These apps offer support for self-management, mood tracking, and even cognitive-behavioral therapy (CBT) exercises, allowing patients to take a more active role in their care.
4. Integrated Care: Mental health nursing is increasingly integrated with primary care and other medical specialties, recognizing the interconnectedness of mental and physical health. This integrated approach offers more comprehensive and holistic care, addressing both mental and physical health needs.
5. Crisis Intervention Training: With the increasing awareness of mental health crises, many mental health nurses are receiving specialized training in crisis intervention techniques. This helps them effectively manage critical situations and de-escalate potential crises.
6. Cultural Competence: Mental health nursing is placing a stronger emphasis on cultural competence, ensuring that care is tailored to diverse patient populations and addressing disparities in mental health care.

Pursue a Career in Nursing Today!

Nursing plays a crucial role in supporting patients with psychiatric disorders. Psychiatric nurses provide patient-centered care, administer and monitor medications, build therapeutic relationships, engage in preventive care, and offer advocacy and education. They are instrumental in ensuring the well-being and recovery of individuals facing mental health challenges. Moreover, a holistic approach to mental health care considers not only the symptoms of psychiatric disorders but also the broader context of a patient’s life. It recognizes that mental health is interconnected with physical, emotional, and social well-being. Psychiatric nurses employ a range of interventions, from medication management to therapy and lifestyle changes, to address the diverse needs of patients, fostering comprehensive and effective care.

Mental health nursing is a dynamic field that continually evolves with new research and treatments. To provide the best care, nurses should engage in ongoing research and professional development. Staying up to date with the latest advancements in mental health care is vital for improving patient outcomes and enhancing the quality of mental health nursing practice.

For individuals interested in pursuing a career in nursing, Brookline College offers a Bachelor of Science in Nursing (BSN) program and a Accelerated Bachelor of Science in Nursing Program Track. These programs provide a strong foundation for those aspiring to become skilled and compassionate mental health nurses.