*Original post 08/18/2020
Mental health nursing can easily be one of the most exciting and intimidating areas of nursing! There is so much information to cover in this type of course – both in the didactic and clinical setting. Remember to have fun with this rotation because the content is intriguing, and the health care professionals are genuinely concerned with the patient’s well being and success after treatment. So in this article, I’ll go over some tips to set you up for success! First, we’ll take a look at the lecture portion, and then, we’ll dive into clinicals.
When approaching lecture material, breakdown each major mental illness and learn their key characteristics, diagnostic criteria, medical management (medications) and appropriate nursing interventions. As a nurse, it is also imperative to understand both general and specific key points for patient education. Much of mental health nursing involves patient teaching and enhancing the likelihood of compliance with their prescribed treatment regimens, whether that’s pharmacological interventions, non-pharmacological interventions, or a mixture of both. There is often no cure for mental health illnesses, so your goal is to manage the condition during crisis (often the reason why they’re seeking medical attention whether willingly or not) as well as to enhance their ability to live and function independently and as a contributing member to society.
This is also where your knowledge and understanding of medications becomes a major factor. Prior to the start of your clinical rotation, at a minimum, I would learn some of the key medications, their side effects, nursing interventions, dietary restrictions, educational points, and any potential interactions. A few of those key medications, just to get you started, are Sertraline, Trazodone, Lorazepam, Quetiapine, Divalproex, Risperidone, Haloperidol, Alprazolam, and Aripiprazole. If you want to save yourself preparation time and make a long term investment, our Etsy shop offers a set of 30 pocket-sized and laminated psychiatric drug cards. You can click here for more details about that set. We also offer a couple of small sections of our mnemonic cards on the topics of mental health and substance use/abuse if you are a visual learner. Contact me and mention the article for a 10% discount 🙂
Now for some more generalized tips for mental health nursing lecture! Many of the questions you’ll be presented with on exams are in the form of a case study. It would benefit you to find a good review source that presents questions in this case-study format. Ask your professor for the resource they most highly recommend as it may be different from one program to another. One aspect that will not vary, however, is your ability to employ techniques of therapeutic communication. Many test questions will touch on these techniques and they WILL help you in the clinical setting as well. If you’re struggling to understand a condition or really any aspect of mental health nursing, reach out to your professor and clinical instructors sooner rather than later. It shows initiative and maturity to ask for assistance. Plus, you’ll be able to build up your relationship with that instructor (who may serve as an invaluable resource down the road).
If you’re unsure of an answer to an exam question, always approach it from a safety and crisis resolution perspective as the priority. Safety to the patient (self) and others as well as de-escalating the situation are imperative interventions. Begin with least restrictive/invasive measures first and progress to more restrictive and invasive measures only as indicated by the situation. It is always a good idea to know the ins and outs of using both chemical and physical restraints. By this I mean, appropriate use, time limits, nursing interventions during use, required documentation, notification of the provider/obtaining an order, etc.
My final few recommendations? Figure out which way you learn best and incorporate that into your study sessions. If you can’t just read about a condition and understand it clearly, try searching that condition on YouTube. I might suggest adding “mental health nursing” or something similar after the name of the condition to narrow down more credible video sources. Form a study group to help each other understand the material better. This especially comes in handy once clinicals begin, because you all can share your experiences in dealing with/learning about a specific condition. You may be able to reference those scenarios when studying to help retain the material better for an exam. Trust me on this.
Let’s move on to the clinical side of mental health nursing. One of the nerve-wrecking parts of this clinical rotation is the fact that you don’t (and won’t) know what you’re walking into. In light of this fact, I want to help prepare you and set your expectations accordingly. Be prepared for strict rules, simple clothing, and to not be allowed to take much of anything with you to clinical. In fact, I’d take as little with you as possible. This is for your safety and theirs.
Piggybacking off that topic, safety needs to be first and foremost thought in your mind at all times. Evaluate your surroundings for potential hazards and know your exit route. Not all mental health clients are violent, but it is better to be prepared now than sorry later. Be sure to give the patient adequate personal space; at the same time, be sure to set your own personal boundaries. Some patients such as those experiencing the manic phase of bipolar disorder, for example, may be overly affectionate. Space is a good boundary to establish from the beginning. On the same note, avoid sharing personal information by setting a boundary around your personal life. It is also important to afford the patient their own space. Even though you may be at a facility where the patient is residing there temporarily, consider their room (which may or may not have a door) a private area for which you need permission to enter. Of course circumstances of harm to self and others are a reason to breach this privacy, but try to afford this to them as much as possible.
When having a discussion with a client, be sure to refrain from reacting through facial expressions or passing judgment. Maintain a poker face even though the client tells you, for example, that they eat their hair and cannot stop (that’s a real condition by the way and it’s called trichophagia). It is also important, when talking with a client, to establish a goal or expectation for the conversation so you can limit its duration and redirect if needed. Maintain a positive attitude during your discussion, being clear and transparent with your intentions. Keep your guard up and be weary of any requests the patient makes, no matter how small or seemingly insignificant. Before fulfilling any requests, clear it with a nurse on duty, the unit charge nurse, and/or your clinical instructor. Students can be seen as easy, susceptible targets toward getting something they need or want.
Remember to utilize those tips for therapeutic communication you should be learning in the didactic portion of your course. It is incredibly important to make sure you are not being sympathetic toward the patient. Rather, when appropriate, be empathetic. I strongly encourage you to sit in on group sessions and counselings as much as possible to enhance your mental health nursing clinical experience. If the patient you’re following has a solo counseling session, ask if they would be comfortable in allowing you to attend the session with them. These experiences are invaluable, and from my experience, most of the clients are not shy about their condition or feelings and typically allow you to attend if you inquire.
***WARNING! This next section discusses suicide in terms of mental health nursing.***
Suicide can seem like a taboo subject, and for good reason, however in this scenario it needs to be addressed. In my experience, many of these clients have either seriously thought about suicide, have a plan (whether active or passive), or have already attempted. Suicide risk assessment is a crucial part of any patient assessment, regardless of if they have a mental health condition or not. It is even more imperative if they have a mental health condition and/or a history of suicidal ideation. Be blunt in asking and follow a logical thought process throughout your inquiry. Closed-ended questions are appropriate here and should be followed by open-ended questions.
- First, you may start off by asking something like, “Within the past three months, have you had thoughts of harming yourself or wish you were no longer alive?”
- If the answer is a “yes,” you may try saying “Tell me more about those thoughts.”
- You should also follow up with a question asking, “Are you having these thoughts of self harm or suicide currently?”
- If the response to this question is a yes, it prompts you to immediately follow up by asking the closed-ended question of if they have a plan to harm themselves or end their life.
- If they say yes, they have a plan, your duty is to obtain as many details as possible about their plan to determine the likelihood for “success”. Ask, “What is the plan you have made?” If, for example, they plan to use a gun they have at home to commit suicide, then the risk is not as immediate as other alternatives. Their current status is admitted to a mental health care facility where their personal belongings have been stored away. The patient does not have access to a gun at the moment. You will still address the suicidal ideations, but the threat is not as imminent as the client expressing that their plan is to hang themselves during the night with their own sheet. This alternative is both plausible and accessible for the patient and presents as an immediate risk for which interventions need to occur ASAP.
- Attempt to de-escalate the patient and determine if there are any factors that can be improved to help them change their mind. Always seek the assistance of the mental health nurse, charge nurse, clinical instructor, and/or health care provider when suicidal ideation is expressed by the patient.
That last section was a bit heavy, so let’s end on a more positive note. Lastly, BE BOLD! You are in charge of your learning experience more than you may think. Seek out opportunities for learning and to be more involved. Not only will you have a better time, it can also open your eyes to the area of mental health nursing! It will also help enhance your understanding and incorporation of the materials you’re learning in the didactic portion of the course which can improve your ability to answer questions correctly. Keep an open mind as you head into this semester of your program and seize every opportunity afforded to you.