Class Notes: Psychiatric Nursing
1. Introduction to Psychiatric Nursing
• Definition: A specialized field of nursing focused on the care of individuals with mental
health disorders.
• Goals:
o Promote mental health
o Prevent mental illness
o Restore mental health and function
• Settings: Psychiatric hospitals, community mental health centers, outpatient clinics,
correctional facilities
2. Roles of a Psychiatric Nurse
• Care Provider: Assess, plan, implement, and evaluate care
• Counselor: Provide therapeutic communication and support
• Advocate: Ensure patient rights are respected
• Educator: Teach patients and families about mental health
• Manager: Coordinate care with the multidisciplinary team
3. Principles of Psychiatric Nursing
• Acceptance and respect for patients
• Use of self as a therapeutic tool
• Individualized care
• Maintaining confidentiality
• Providing a safe and structured environment
• Non-judgmental and empathetic attitude
4. The Nurse-Patient Relationship
Phases:
1. Pre-interaction Phase
o Review patient history
2. Orientation Phase
o Build trust, define roles, set goals
3. Working Phase
o Explore stressors, develop coping strategies
4. Termination Phase
o Evaluate progress, plan for discharge
5. Therapeutic Communication
• Techniques:
o Active listening
o Open-ended questions
o Reflecting
o Clarifying
o Silence
• Barriers:
o Giving advice
o False reassurance
o Judging
o Changing the subject
6. Common Psychiatric Disorders and Nursing Care
A. Schizophrenia
• Symptoms: Delusions, hallucinations, disorganized thinking
• Nursing Care: Medication adherence, reality orientation, safety
B. Mood Disorders
• Depression: Monitor for suicidal ideation, encourage expression
• Bipolar Disorder: Manage mood swings, set limits during mania
C. Anxiety Disorders
• Types: GAD, panic disorder, phobias, OCD
• Care: Relaxation techniques, CBT support, medication compliance
D. Personality Disorders
• Traits: Maladaptive behavior, difficulty in relationships
• Focus: Set firm boundaries, consistent approach
E. Substance Use Disorders
• Signs of intoxication/withdrawal
• Support recovery, prevent relapse, refer to support programs (e.g., AA)
7. Psychiatric Emergencies
• Suicide: Risk assessment, safety plan, one-to-one observation
• Violence/Aggression: De-escalation techniques, ensure safety
• Acute psychosis: Medication, calming environment, reassurance
8. Mental Health Assessment
• Components:
o History (medical, psychiatric, family)
o Mental Status Examination (MSE)
▪ Appearance, behavior
▪ Speech, mood, affect
▪ Thought content and process
▪ Perception (e.g., hallucinations)
▪ Cognition and insight
9. Legal and Ethical Aspects
• Patient Rights: Informed consent, confidentiality, treatment refusal
• Legal Terms:
o Involuntary admission
o Competency vs. guardianship
o Restraints (physical/chemical): Use as a last resort, under guidelines
10. Therapies in Psychiatric Nursing
A. Biological Therapies
• Psychotropic medications (antidepressants, antipsychotics, mood stabilizers, anxiolytics)
• ECT (Electroconvulsive therapy): Used for severe depression, catatonia
B. Psychosocial Therapies
• Cognitive Behavioral Therapy (CBT)
• Family therapy
• Group therapy
• Milieu therapy (therapeutic environment)
11. Community Psychiatric Nursing
• Focuses on rehabilitation and reintegration
• Promotes continuity of care
• Addresses stigma and social inclusion
• Home visits, crisis intervention, day care programs
12. Documentation in Psychiatric Nursing
• Objective, accurate, timely
• Include behavior, interventions, patient responses
• Use of standardized tools (e.g., BPRS, GAF scale)
13. Recent Trends in Psychiatric Nursing
• Telepsychiatry
• Trauma-informed care
• Holistic and integrative approaches (yoga, mindfulness)
• Focus on mental health promotion and early intervention
