Mental Health Nursing Care Plans Diagnosis and Interventions
Mental Health Nursing NCLEX Review and Nursing Care Plans
The history of mental illness, developments in treatment, recent concerns in mental health, and the responsibilities of the mental health nurse will all be discussed in this article to provide more ideas about mental health nursing.
Visualizing what it would be like or what nurses do in the field of mental health is a bit challenging, as it is often unfamiliar or strange. Working as a mental health nurse, despite the hurdles, can be a rewarding vocation.
Mental health is a state of emotional, psychological, and social well-being. There is no one-size-fits-all description of mental health, but in general, an individual’s actions and behaviors can tell a lot about his or her mental state.
Every culture of a society has a significant influence on its ideas and values, which has an impact on how mental health is defined. Satisfying interpersonal relationships, effective behavior and coping with the normal stresses of life, positive self-concept, and emotional stability are all indicators of mental health, as it affects how we think, feel, and act.
From childhood and adolescence through maturity, mental health is crucial at all stages of life. Some commonly ignore it, but mental health is an integral part of health.
World Health Organization (WHO) defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” absolutely, there is no health without mental health.
It is imperative to keep in mind that a person’s mental health can fluctuate over a wide range of circumstances. At any one time, an individual’s level of mental health can be affected by a number of social, interpersonal, psychological/biological factors.
- Social/cultural or environmental aspects comprise a sense of community, access to essential resources, intolerance of violence, support of diversity among individuals, environmental mastery, and a positive yet realistic outlook on life.
- Interpersonal. Effective communication, the ability to help others, intimacy, and a balance of separateness and connectivity are all interpersonal or relationship aspects affecting mental health.
- Biological/Psychological. People are more susceptible to mental health issues because of diverse psychological and personality traits, while genetic variables are also a part of biological factors. A person’s biological makeup, autonomy and independence, self-esteem, and capacity for growth are all part of the biological aspects of mental health. This aspect further includes vitality, ability to find meaning in life, emotional resilience or toughness, sense of belonging, reality orientation, and coping or stress management abilities.
Poor mental health and mental illness are not the same things, despite the fact that they are frequently used interchangeably. A person’s mental health can deteriorate without being diagnosed with a mental illness.
A person with a mental illness, on the other hand, can have moments of physical, mental, and social well-being.
According to the American Psychiatric Association (APA, 2000), mental disorder is “a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and is associated with current distress or a significantly increased risk of death, pain, disability, or a significant loss of freedom“.
Mental illness is one of the most common health issues in the United States, according to the Center for Disease Control and Prevention (CDC). However, over half of those who suffer from mental illness do not seek treatment for their conditions.
People frequently avoid or delay obtaining treatment because they are afraid of being discriminated against or losing their employment and livelihoods. Because persons with mental illnesses are still stigmatized, prejudiced, and discriminated against by some.
There is no sole reason for mental illness. The likelihood of mental illness can be influenced by a variety of circumstances, including:
- Trauma or a history of abuse as examples of early negative life events (child abuse, sexual assault, witnessing violence, etc.)
- Other continuous (chronic) medical conditions, such as cancer, diabetes, or stroke
- Biological and chemical imbalances in the brain
- Drugs or alcohol use
- Experiencing feelings of solitude or seclusion
Diagnostic and Statistical Manual of Mental Disorders
The American Psychiatric Association (APA) published the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR). It is widely used by healthcare providers, particularly mental health professionals.
Mental disorders are described in the DSM-IV-TR, featuring precise diagnostic criteria for each based on relevant clinical experience and extensive research. It serves three main purposes:
- To enable the use of standardized terminology and nomenclature for all mental health professionals.
- To distinguish diagnoses apart from each other by identifying particular traits or symptoms.
- To aid in the identification of mental illnesses’ underlying causes
Multiaxial classification in the DSM-IV-TR allows the mental health professionals to identify all of the aspects that contribute to a person’s condition by assessing multiple axes, or domains of information.
- Axis I. Except for mental retardation and personality disorders, Axis I is used to provide information on all major psychiatric disorders. Mood disorders, anxiety disorders, and eating disorders were among the conditions that were classified.
- Axis II. It is used to outline mental retardation and personality disorders, as well as major maladaptive personality traits and defense mechanisms. Some of the conditions of personality disorders include antisocial and histrionic personality disorders. While mental retardation, which has now been referred to as intellectual disability, is characterized by intellectual impairment and deficits in other areas such as self-care and interpersonal skills.
- Axis III. It is used to record current medical conditions that may be significant to understanding or managing a person’s mental illness. These medical conditions influence or worsen Axis I and Axis II disorders. Examples include HIV/AIDS and brain injuries, among others.
- Axis IV. This axis took into account any social or environmental issues that could affect Axis I or Axis II disorders. Unemployment, relocation, divorce, or the death of a loved one are all examples of these situations.
- Axis V. It is where the physicians use Global Assessment of Functioning (GAF) scale from 0 to 100 and give their impression of the client’s overall level of functioning. A greater understanding of how the other four axes interacted and the impact on the individual’s life may be gained from this assessment.
History of Treating Mental Illness
Any illness, according to ancient belief, signaled the gods’ disapproval and was considered as retribution for sins and transgression, therefore persons with mental illnesses were considered as either divine or demonic, depending on how they behaved.
Later, Aristotle attempted to link mental and physical disorders and created his theory that mental disorders were caused by imbalances in happiness, tranquility, rage, and sadness. Bloodletting, starvation, and purging were then used as a treatment to restore balance.
All diseases were blamed on demons again in early Christian times, and the mentally sick were considered as possessed, so priests execute exorcism to expel bad spirits.
During the Renaissance period in England and neighboring European countries, people with mental illness were distinguished from criminals; those thought harmless were permitted to roam the countryside and/or live in rural communities, while the more “dangerous lunatics” were imprisoned, chained, and starved to death.
The poor history of mental illness treatment continued as the Hospital of St. Mary of Bethlehem was officially declared an infirmary for the insane, the first of its kind in 1547. The visitors were privileged to watch and mock the mentally sick, who were treated as animals rather than humans, for a corresponding fee.
The time when mental illness was more understood and treated came in the 1970s. Asylum was formed as a safe haven or shelter for persons who had been lashed, abused, or starved solely because they were mentally ill in institutions. A crusade to improve mental health treatment was started, which then resulted in the opening of 32 state-run hospitals in England, where patients could seek sanctuary.
In the 1850s, Sigmund Freud and other Psychiatrists began the period of scientific study and treatment of mental illnesses. Because of these men, the study of psychiatry, as well as the diagnosis and treatment of mental illness, officially began.
The development of psychotropic medicines or pharmaceuticals used to treat mental disorders marked a significant step forward in the treatment of mental illness around 1950. More pharmacologic interventions were introduced over the next ten years.
Mental Health Nursing
Mental health nursing is a specialized branch of nursing that focuses on the treatment of individuals who have a mental illness to help them recover and live a better life.
It necessitates a wide range of interventions, psychological, and neurobiological skills. In addition to the assessment, diagnosis, care, and treatment of mental health and substance use disorders, it focuses on enhancing well-being through prevention and education.
Mental Health Nurses work in a variety of setting and provide comprehensive care to individuals, families, groups, and societies.
They build strong therapeutic relationships with people of all ages, learning about their lives and issues to make a positive impact on their lives.
Mental Health Nurses also have a deep understanding of mental health disorders and how to assess, diagnose, and treat them to provide specialized care. They usually collaborate with other healthcare professionals to ensure that the patient’s clinical outcomes are as effective as possible.
Mental Health Nursing Diagnosis
Mental Health Nursing Care Plan 1
Impaired Verbal Communication
Nursing Diagnosis: Impaired Verbal Communication secondary to schizophrenia as evidenced by difficulty communicating thoughts verbally, struggle in identifying and maintaining the regular communication pattern, and disorganized thinking.
- The patient will articulate his or her thoughts and feelings in a rational, logical, and goal-oriented manner.
- The patient will be trained in one or two diversionary techniques to help manage anxiety and improve the ability to think clearly and talk more sensibly.
|Mental Health Nursing Interventions||Rationale|
|Evaluate if the incoherence in speech is recurring or if it occurs suddenly, as in an aggravation of symptoms.||Establishing a baseline makes it easier to set realistic goals, which are the basis for effective care planning.|
|Determine how long the client has been taking psychotic medication.||Antipsychotics in therapeutic doses aid in clear thinking and reduce detachment and looseness of thought.|
|Keep the voice low and speak gently to a feasible extent.||Slow speaking enhances comprehension while a high-pitched/loud tone of voice might raise anxiety levels.|
|Maintain a peaceful, quiet, and free of distractions environment.||Prevent triggering anxiety that could aggravate confusion, as well as hallucinations/delusions.|
|Schedule short, frequent sessions with a client during the day.||Shorter lengths of time are less stressful, and regular meetings allow a client to build trust and feel at ease.|
|Keep directions and explanations as simple as possible, and use clear or plain words when interacting with the client.||Even basic statements may be difficult for the client to comprehend. Misunderstandings and incorporation of those misunderstandings into delusional ideas are lessened by giving basic instructions to the client.|
|Even if spoken words sound nonsensical, look for deeper meaning in what is spoken.||Frequently, the words used by the client are reflective of their emotions.|
|Try to grasp the client’s issues, by using therapeutic procedures such as clarifying feelings when words and thoughts are disorganized. When the client’s words are totally incomprehensible, let the client know.||Pretending to comprehend reduces the client’s trust, while the mental health nurse’s credibility is also lessened.|
|Educate the client on the following therapeutic techniques to deal with anxiety and control voices and disturbing thoughts as soon as ready.|
Concentrate on essential activities
Find a way to replace negative thoughts with positive ones.
Learn to substitute sensible statements for irrational thoughts.
Practice deep breathing exercises regularly.
Do a self-reflection reading exercise.
Speak with a friend, family member, or other persons who can help out if struggling.
|Educating the client on anxiety-relieving techniques can assist in improving verbal communication.|
Mental Health Nursing Care Plan 2
Impaired Social Interaction
Nursing Diagnosis: Impaired Social Interaction secondary to major depressive disorder as evidenced by verbalized discomfort in social situations, avoiding interaction with others, and lacking eye contact.
Desired Outcome: Within one month, the patient will be able to recognize feelings that result in poor social interactions and exhibit improvement in resuming relationships with friends and family members.
|Mental Health Nursing Interventions||Rationale|
|Provide activities that need less focus at first, such as drawing, playing simple board games, among others.||Concentration and memory are both impaired in depressed individuals. Also, participation in activities with no competition is more therapeutic for this client.|
|Engage the client in gross motor activities such as simple stretching and walking exercises that require little concentration.||Performing such activities can assist to relieve stress and improve one’s mood.|
|Involve the client in one-on-one activities when the client is in most depressed condition.||Take advantage of potential communications while reducing anxiety.|
|Gradually engage the client in group activities such as art therapy, dance therapy, or team discussions.||Feelings of isolation are reduced through socialization. Feelings of self-worth can be enhanced by genuine concern for others.|
|Eventually, the client’s social contacts should be expanded.||The client’s self-preoccupation is distracted by interactions with others.|
|Encourage the client and family to join a local self-help organization.||People who share their stories can provide enormous support and insight to the client and the family.|
Mental Health Nursing Care Plan 3
Disturbed Sensory Perception (Auditory/Visual)
Nursing Diagnosis: Disturbed Sensory Perception related to neurologic/biochemical changes and psychological stress as evidenced by frequent blinking of the eyes, auditory distortions, inappropriate responses, and hallucinations.
Desired Outcome: The patient will demonstrate techniques to refrain from responding to hallucinations and identify at least two stressful events that trigger them.
|Mental Health Nursing Interventions||Rationale|
|Acknowledge that the client’s voices are real, but clarify that only the client can hear them. Use the terms “your voices” or “voices that you hear” to refer to the voices.||The client’s doubts regarding the voices’ existence could be alleviated if the nurse confirms that they cannot be heard by anyone.|
|Watch out for signs of increased apprehension, anxiety, or restlessness.||The client could have hallucinatory activity, which can be extremely terrifying, and the client may act on the hallucinations by assaulting themselves or others.|
|Assist the client in determining when the hallucinations are most intense and terrifying.||It enables both the nurse and the client in determining which situations and periods are the most stressful and frightening to the client.|
|Take necessary safeguards by following the unit protocols as a guide if voices are telling the client to harm himself or others.||Individuals frequently follow hallucinatory directions to harm themselves or others. Early detection and intervention can save lives.|
|When clients begin to hallucinate, stay with them and repeatedly tell them to tell the voices they hear to go away.||When given repeated instructions, the client may learn to ignore them, especially in a relationship based on trust.|
|Reduce the amount of noise and activity in the environment as much as feasible.||It aids in the relaxation of the client and reduces the risk of hallucinations due to anxiety.|
|When appropriate, intervene with restraints and stat medicines as ordered by the physician.||Prevent escalating anxiety by intervening as soon as possible. Use medications or physical restraints as directed by the unit if the client is already out of control.|
|Make sure that conversations are focused on real-life issues. Assist the client in focusing on a single concept at a time.||There may be confusion and disorganization in the client’s thinking. This intervention aids in the client’s ability to focus and comprehend real-world situations.|
|Collaborate with the client to determine which activities help to alleviate anxiety and keep them away from a hallucinatory state.||If a client’s stress causes them to experience hallucinations, they may be more motivated to pursue distraction strategies or ways to get out of a stressful situation.|
|Include the client in real-life activities such as card games, writing, drawing, basic arts and crafts, and music listening.||To help divert from voices and reduce the potential of acting on hallucinations, channeling the client’s energies to appropriate tasks is therapeutic.|
Mental Health Nursing Care Plan 4
Nursing Diagnosis: Ineffective coping secondary to anxiety and panic disorders as evidenced by an inability to meet basic needs and role expectations, inadequate problem solving, and ritualistic behavior.
Desired Outcome: The patient will demonstrate the ability to cope effectively and how to maintain anxiety at a manageable level.
|Mental Health Nursing Interventions||Rationale|
|Assess the level of anxiety and analyze the circumstances that lead to ritualistic behavior and anxiety.||The first step in educating a client to prevent the anxiety from getting worse is to help them recognize the triggers.|
|Begin by meeting the client’s dependent needs as they arise.||The client will be more anxious and burdened if all channels for dependency are abruptly and entirely eliminated.|
|Encourage self-reliance and recognize independent behaviors through positive reinforcement.||It boosts self-esteem and inspires individuals to do appropriate actions more often.|
|Allow plenty of time for rituals at the start of the treatment. Don’t judge or express disagreement of the behavior.||Denying a client the opportunity to engage in this behavior can lead to a panic attack.|
|As the client gets more active in unit activities, slowly reduce the amount of time given for ritualistic behavior.||Anxiety is minimized when the client is able to replace ritualistic behaviors with more adaptive ones.|
|Promote and help the client’s efforts to learn more about the behavior’s meaning and purpose.||It is possible that the client is unconscious of the link between obsessive behaviors and emotional issues. Before any change can occur, it is necessary to recognize and accept the problems.|
Mental Health Nursing Care Plan 5
Interrupted Family Processes
Nursing Diagnosis: Interrupted Family Processes secondary to Bipolar Disorder as evidenced by changes in communication patterns, the crisis in the family, and changes in participation in decision making and problem-solving.
Desired Outcome: The family members and/or significant others will demonstrate awareness of what bipolar disorder is, how it is treated, and the importance of medication and treatment adherence.
|Mental Health Nursing Interventions||Rationale|
|Spend time with the client’s family on the first or second day of hospitalization to understand their concerns, such as: |
More information about the illness
Information on compliance, adverse or toxic effects of lithium and other anti-manic drugs
Knowledge of local bipolar support organizations and how they can assist families going through a difficult time.
|When family members begin to act strangely, out of control, and even aggressively during an acute manic episode, it causes a lot of chaos and confusion in the family. The family must be aware of what can and cannot be done for the condition, and where to seek support for their concerns.|
|Allow the family members and/or significant others to raise questions and concerns about the patient’s mental health status and its appropriate day-to-day management.||Giving the opportunity to the significant others to speak up or vent out concerns is important in creating a stronger support system for the patient.|
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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