Psychiatric Mental Health Nursing

Therapeutic communication

Encourages expression, reflection, clarifying feelings; patient-centered.

Nontherapeutic communication

Blocks expression; giving advice, false reassurance, changing subject.

Active listening

Nurse focuses fully; verbal + nonverbal cues; follows patient's lead.

Passive listening

Nurse sits quietly; does not build relationship; shows boredom.

Orientation phase

Build trust, set boundaries, explain purpose.

Working phase

Identify problems, problem-solve.

Resolution phase

Closing relationship once goals met.

Withholding phase

Nurse seen as withholding care.

Avoidance phase

Patient avoids nurse; perceives rudeness.

End phase

Relationship ends with frustration.

Transference

Patient projects feelings from past relationships onto nurse.

Countertransference

Nurse projects personal feelings onto patient.

Rapport

Harmony, trust.

Empathy

Understanding patient feelings.

Professional boundaries

No social relationships; cautious self-disclosure.

Autonomy

Patient makes own decisions.

Beneficence

Doing good.

Nonmaleficence

Do no harm.

Justice

Fair treatment.

Fidelity

Loyalty to patient.

Veracity

Tell the truth.

Paternalism

Provider makes decisions "for good of patient."

Least restrictive care

Use lowest level of restriction possible.

Involuntary admission

Danger to self, others, or unable to care for self.

Confidentiality

Protect patient info.

Physiological needs first

Airway, safety, medical stability before psychosocial.

Safety reporting

Duty to report harm, abuse, suicidal/homicidal intent.

Culture

Shared beliefs, values, behaviors; dynamic and changing.

Acculturation

Adapting to new culture.

Linguistic competence

Communicating effectively across languages.

Cultural competence

Respectful care aligned with cultural beliefs.

Appearance (MSE)

Grooming, hygiene.

Behavior (MSE)

Movements, agitation.

Speech (MSE)

Rate, tone.

Mood vs Affect (MSE)

Mood = stated; Affect = observed.

Thought process (MSE)

Logical? Tangential?

Thought content (MSE)

Delusions? SI/HI?

Perception (MSE)

Hallucinations.

Cognition (MSE)

Orientation, memory.

Insight/Judgment (MSE)

Awareness of illness; decision-making.

Serotonin

Mood, sleep, appetite; low = depression.

Dopamine

Reward, movement; low = Parkinson's/ADHD; high = schizophrenia.

GABA

Calming; low = anxiety.

Acetylcholine

Memory; low = Alzheimer's.

Norepinephrine

Fight/flight; low = low energy, poor focus.

Histamine

CNS neurotransmitter; abnormal in Alzheimer's/Parkinson's.

SSRIs

Increase serotonin; first-line; slow onset; suicide risk early.

SNRIs

Increase serotonin + norepinephrine.

Bupropion

Increase NE + dopamine; seizure risk.

TCAs

Cardiotoxic; ECG monitoring.

MAOIs

Tyramine restriction; hypertensive crisis risk.

Typical antipsychotics

More extrapyramidal symptoms (EPS).

Atypical antipsychotics

Metabolic syndrome risk.

Dystonia

Muscle spasms.

Akathisia

Restlessness.

Pseudoparkinsonism

Tremor, rigidity.

Tardive dyskinesia

Permanent mouth/tongue movements.

Lithium

Mania; toxicity signs: tremor, confusion, GI upset.

Anticonvulsants

Valproate, carbamazepine, lamotrigine; monitor for rash (SJS), liver issues.

Benzodiazepines

Fast; addictive; enhances GABA.

Buspirone

Slow onset; non-addictive.

Stimulants

ADHD; increase catecholamines; appetite suppression.

Milieu therapy

Structured environment promoting safety, healing.

Psychoeducation group

Teaching.

Supportive therapy group

Emotional support.

Task groups

Complete a task.

Self-help group

Peer-led.

Hope (Recovery)

Foundation of recovery.

Person-driven recovery

Patient leads goals.

Holistic recovery

Whole-person care.

Peer support recovery

Community + allies.

Biological assessment

Sleep, nutrition, meds.

Psychological assessment

Coping, triggers, SI/HI.

Social assessment

Support systems, home.

Direct questioning

Ask directly about suicide/homicide.

Past attempts

Strongest predictor of future suicide risk.

Intent

Evaluate plans and means for suicide/homicide.

NANDA

Standard nursing diagnoses.

Outcomes

Measurable change from nursing care.

Biological interventions

Sleep, hydration, meds.

Psychological interventions

CBT, counseling.

Social interventions

Milieu, safety, community.