Name
Chamberlain University
NR-326: Mental Health Nursing
Prof. Name
Date
A disheveled appearance, rapid speech, grandiose thinking, and avoidance of eye contact are often linked to worsening mental health conditions. While irregular heart rate is clinically significant, it does not directly suggest mental health deterioration.
Clients with major depressive disorder often display self-care deficits, particularly in hygiene, along with hopelessness and low self-esteem. They are less likely to present with disturbed sensory perception (hallucinations), disturbed thought processes (delusions), or ineffective impulse control, which are more commonly associated with bipolar disorder.
Mental health nurses frequently use validated survey tools to evaluate changes in emotional state, behavior, and symptom severity. While medical tools such as stethoscopes, electrocardiograms, and reflex hammers may be employed, they do not provide data specific to mental health.
The primary aim of nursing in mental health is to help clients adapt to environmental stressors. This process may require altering thoughts, emotions, and behaviors to align with cultural and social expectations. Nurses also play a vital role in crisis intervention and management during acute mental health episodes.
Building a trusting nurse-client relationship early is critical for safety and recovery. Through this relationship, nurses promote, restore, and maintain optimal mental health in themselves and their clients.
Developing a professional identity begins with self-awareness. Nurses must recognize how their own feelings, thoughts, and behaviors affect patient care. Personality assessments assist in this development, while tools like depression scales and lifestyle interventions (e.g., exercise, diet) serve different purposes.
Mental health assessments emphasize psychosocial, emotional, cognitive, and behavioral symptoms rather than physical findings.
| Symptom/Behavior | Examples and Notes |
|---|---|
| Perceptual disturbances | Hearing voices, visual hallucinations, rejecting facts |
| Poor hygiene | Infrequent bathing, unkempt appearance, untreated skin issues |
| Eye contact | Avoidance may indicate disorder or reflect cultural background |
| Inappropriate behavior | Aggression, shouting, sexual remarks, unwanted touching |
| Substance misuse | Use of alcohol, illicit substances, or prescription misuse |
| Suicidal ideation | Passive or active thoughts, with or without a plan |
| Self-harm/violence | Cutting, physical aggression toward others |
| Self-defeating behavior | Engaging in repeated negative outcomes |
| Legal issues | Frequent involvement with law enforcement |
| Survey tool score changes | Reflects worsening or improvement of mental state |
Baseline assessments are crucial for detecting changes over time. For instance, worsening depression may be observed through social withdrawal, neglect of hygiene, and reduced food intake.
Nursing diagnoses enable tailored interventions, set goals, and promote professional autonomy.
| Diagnosis | Typical Indicators |
|---|---|
| Labile emotional control / Impaired mood | Frequent mood swings |
| Ineffective impulse control | Risk-taking behaviors |
| Hopelessness | Depression-related symptoms |
| Disturbed personal identity | Indicators of personality disorders |
| Disturbed body image / Chronic low esteem | Passive behaviors, anorexia |
| Ineffective/defensive coping | Anger, aggression |
| Self-mutilation | Cutting or self-harm |
| Disturbed sensory perception | Hallucinations |
| Disturbed thought processes | Delusions |
| Self-care deficit | Neglect of hygiene |
Dysfunctional family dynamics
Ineffective interpersonal relationships
Post-trauma syndrome
Post-rape syndrome
Relocation stress
Aggressive coping styles
Anorexia-related low self-esteem
Validated tools help measure symptom severity and provide objective data.
| Tool | Purpose |
|---|---|
| GAD-7 | Screens for generalized anxiety disorder |
| SPIN | Evaluates social phobia |
| ASRM | Mania self-rating scale |
| BEST | Tracks borderline symptom severity |
| SBQ-R | Suicide risk assessment |
| SAD PERSONS | Suicide risk screening (adapted for adults/children) |
| COWS | Opioid withdrawal measurement |
| CAGE / CAGE-AID | Screening for alcohol and substance misuse |
A client undergoing opioid withdrawal received a COWS score of 28. The nurse documented:
“The client scored 28 on the COWS assessment. Alprazolam administered orally per provider orders.”
Key interventions include:
Crisis intervention and aggression management
Medication administration (scheduled and PRN)
Therapeutic communication techniques (e.g., reframing, reassurance)
Environmental adjustments (reducing stimuli, isolating if required)
Interdisciplinary collaboration
Encouraging participation in constructive activities
Removing clients from unsafe environments
De-escalation is often most effective when the client is relocated to a personal space, reducing confrontation.
A crisis is a sudden, short-lived event that overwhelms coping mechanisms and disrupts equilibrium. It may result in personal growth or psychological harm. Those with pre-existing mental health vulnerabilities are at heightened risk, and crises may exacerbate prior conditions.
| Phase | Description | Example |
|---|---|---|
| Phase 1 | Event seen as crisis, anxiety increases, problem-solving begins | Evan lost his job, updated resume, and began job searching |
| Phase 2 | Coping fails, anxiety worsens, daily functioning declines | Rachel’s dog died; she stopped sleeping, eating, and working |
| Phase 3 | Seeks support, tries new coping strategies | Doug, after losing his home to a tornado, asked his brother for help |
| Phase 4 | Crisis unresolved, panic and disorientation arise | Phyllis, homeless and hungry, was found confused in a grocery store |
Perception of the Event – Interpretation determines severity.
Available Support – Family, social, and financial support systems increase resilience.
Coping Mechanisms – Past experiences, education, and self-awareness shape outcomes.
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.).
Townsend, M. C., & Morgan, K. I. (2018). Psychiatric mental health nursing: Concepts of care in evidence-based practice (9th ed.). F.A. Davis.
Varcarolis, E. M. (2021). Foundations of psychiatric mental health nursing: A clinical approach (8th ed.). Elsevier.
