MH 3
Nursing Process in Mental Health
Overview of the Nursing Process
The nursing process is a systematic, step-by-step method utilized to provide patient-centered care.
1. Assessment
2. Diagnosis
3. Planning
4. Implementation
5. Evaluation
6. Critical Thinking (often incorporated throughout all steps)The nursing process is employed daily in nursing practice and applicable in everyday life.
It facilitates organized, safe, and effective care.
What is Different in Mental Health Nursing?
Although the same nursing process is employed, mental health nursing includes additional components, particularly during the assessment phase.
Phase 1: Assessment (MOST IMPORTANT IN MENTAL HEALTH)
Additional Mental Health Assessment Components:
Psychosocial History
Cultural Beliefs & Practices
Spiritual/Religious Beliefs
Mental Status Examination (MSE):
- Level of Consciousness
- Appearance
- Behavior
- Cognitive Abilities
- Intellectual Functioning
Standardized Screening Tools:
Mini-Mental State Exam (MMSE)
Glasgow Coma Scale (GCS)
Lifespan Considerations:
Children & Adolescents:
Temperament
Social/Environmental Influences
Developmental Level
Cultural/Religious Factors
Older Adults:
Functional Ability
Economic/Social Status
Geriatric Assessment Tools
Pain Assessment
Environment for Assessment:
Choosing an appropriate setting, including:
- Quiet, private space
- Adequate lighting
- Sitting or standing at patient’s level
- Introducing oneself to the patient
- Asking for name preference
- Utilizing therapeutic touch (if appropriate)
Key Questions to Ask:
Sleep Patterns
Incontinence
Falls
Depression
Dizziness
Energy Levels
Include:
Family/Significant Others (when appropriate)
Summarizing findings
Asking for patient feedback
Phase 2: Nursing Diagnosis
Nursing diagnoses are established based on assessment data.
Utilizes DSM-5 (Diagnostic and Statistical Manual of Mental Disorders).
Purpose of DSM-5:
To identify mental health disorders
To guide assessment
To assist in planning care
To support nursing diagnoses
Phase 3: Planning
Development of patient-centered goals takes place in this phase.
Prioritization based on:
- Safety
- Patient Needs
- Severity of Condition
Phase 4: Implementation
Common Mental Health Interventions:
Counseling/Therapeutic Communication
Promotion of Self-Care
Psychological Interventions
Psychobiological Treatments (Medications)
Cognitive & Behavioral Therapies
Health Promotion & Maintenance
Phase 5: Evaluation
Evaluation phase involves determination of whether established goals were met.
Modify the care plan if needed.
Continuous reassessment is essential.
Critical Thinking in Nursing
Critical thinking is employed throughout all phases of the nursing process.
It helps to:
- Prioritize care
- Make clinical decisions
- Adapt interventions
Patient Problem Statement Components
A complete problem statement consists of:
- Problem (nursing diagnosis)
- Etiology (cause)
- Signs/Symptoms (evidence)
NCLEX-Style Priority Question Concept
Key Strategy:
Look for “PRIORITY” in patient scenarios.
Example Question Focus:
First action during the initial interview?
✅ Correct Priority:
Identify the client’s perception of their mental health status.
❌ Not Priority Initially:
Coordinating services
Teaching
Including family (unless necessary)