Psychiatric/Mental Health: The Basics

The focus of this psychiatric/mental health nursing is usually around 4 main concepts:

  • therapeutic communication
  • safety
  • medications
  • specific psychiatric disorders

Therapeutic communication:
Communication is vital to the general nursing field, not just in psych, but it is especially important when interacting with a patient in the psychiatric setting. Much of the techniques learned in assessment applies such as reflection, active listening, empathy, etc. However, it is important to first look at the overall patient situation and determine which statement is most appropriate. For example, for a patient who is suicidal, you would want to ask more direct questions even if they seem very blunt such as “have you thought about harming yourself?”

Safety:
Recall that in the model Maslow’s Hierarchy of Needs, the care of the patient follows a stairstep priority list starting with physiological needs, followed by safety, emotional needs, self esteem. In psych, safety is always the priority. Consider interacting with an escalating angry patient. First step would  be to escort other patients away from the angry patient. Think about a patient who just told you he wants to kill himself. First thing would be to remove all objects that he could use to harm himself, such as ropes, bedsheets, even coke cans. Safety of the patient, other patients and nurse is crucial in these settings.

Medications:
Medications aren’t administered by students during the clinical shift, however, it is important for us as nurses to know the ins and outs of psych medications. There are several classes of medications covered in this course:

  • Antidepressants – Selective Serotonin Reuptake Inhibitors (SSRIs), Tricyclics (TCAs), Monoamine Oxidase Inhibitors (MAOIs) and Atypicals
  • Antipsychotics – Conventionals and Atypicals
  • EPS drugs
  • Benzodiazepeines and related anxiolytics
  • Mood Stabilizers – Lithium, antiseizure medications
  • ADHD meds
  • Alzheimer’s agents
  • Herbals
  • Hypnotics
It isn’t enough to simply know what kind of drug it is, but also what is the specific name. Prozac is a SSRI, Geodon is an atypical antipsychotic.  There are several techniques to memorize the different drug names. I’ve seen pictures, acronyms and color coding. Once you know the different names and correlating class of drug, know their mechanism of action. Majority of these drugs work on neurotransmitters in the brain which in turn may produce the therapeutic effect as needed to relieve symptoms. Knowing the side effects is especially important. Some of these medications produce very uncomfortable side effects which may contribute to noncompliance. Teaching patients how to manage the side effects and administering the appropriate treatment is a critical part of medication administration.

Psychiatric Disorders:
There are several different psychiatric disorders covered in this coursed, including:

  • Schizophrenia
  • Anxiety disorders
  • Addictions
  • Depression
  • Bipolar disorder
  • Somatoform, Factitious, Dissociative disorders
  • Cognitive disorders
  • Personality disorders
  • Child/Adolescent disorders
  • Eating disorders

Alongside, there are other topics including death and dying, abuse, crisis intervention, etc. For each of the psych disorders, concentrate on the manifestations of the disorder, medications and relevant treatments, role of the nurse in caring for this particular patient, appropriate diagnoses and outcomes and patient teaching in managing their illness.

Whether you’re interested in working in the field of psychiatric nursing or not, the skills learned in this course may apply to all fields of nursing. Whether you’re working in critical care or general med/surg, there is a high possibility that some patients you meet may have comorbid psychiatric problems. Viewing the patient holistically includes addressing mental health and a efficient nurse is one who is competent in not only the medical, but the emotional and mental aspects of nursing care.

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