Summary

Nurses working in all settings must understand the difference between mental health and mental illness. Nurses will come across clients in various stages of the mental health continuum in every setting, age group, and community. Gathering both subjective and objective data during the nursing assessments is an important part of nursing practice. A nurse uses therapeutic communication to ask questions and gather subjective data about how the client is feeling in order to determine the effectiveness of the treatment plan. Psychiatric nurses not only assess and provide care for the client’s health-care needs, but are also involved in education, administration, and research. Developing therapeutic nurse-client relationships is a core element of the scope of the psychiatric-mental health nursing practice.

Familiarity with the many risk and protective factors for mental illness is an important part of the nursing process in caring for individuals with potential or diagnosed mental health disorders. While some risk and protective factors are biological and/or genetic, others are caused by psychological and external circumstances and characteristics, such as level of self-esteem, resilience, healthy behaviors, level of activity, social support system, religious/cultural beliefs, substance use, childhood development, and chronic illness.

Nursing assessments must include the use of standardized tools to determine risks and strengths in each client. The nurse-client therapeutic relationship should feature active listening while gathering client data, and the use of critical thinking in order to piece together an appropriate treatment plan.

Stigma is still pervasive in attitudes surrounding those with mental illness. In fact, nearly two-thirds of people with diagnosable mental health disorders do not seek treatment due to the stigma of mental illness (Hegner, 2000). Self-stigma, public stigma, and institutional stigma each affect people in the way they seek treatment and look at themselves in relation to the world around them and influence their ability to function on a daily basis. Prejudice and discrimination can cause barriers to accessing health care, finding safe and affordable living, getting a job, maintaining social relationships, and feeling like a contributing part of society.

Nurses can model acceptance in the care they provide. They can also educate individuals, families, caregivers, and communities about the detrimental effects of stigma and ways to increase positive awareness. Nurses should also take the time to perform self-care because without taking care of themselves, they will not be able to provide the best care for others.

Recovery is an overarching term that covers both physical and mental health. It is continuous but nonlinear in nature. The steps in the recovery process assist the client in making choices to determine their own life course. Acceptance, hope, insight, and taking action have a positive effect on increasing one’s self-esteem. The higher the self-esteem, the healthier a person can become. Learning to rebuild relationships, set boundaries, have gratitude, and focus on the positives all help to maintain wellness through and beyond the recovery journey.

Research is an important nursing role and tool that provides the foundation for evidence-based practice. The main types of empirical research performed are qualitative, quantitative, and sometimes a mixed method. It is imperative to use credible databases and websites to gather the information for a literature search based upon the evidence pyramid. Although evidence-based practice is the basis of good nursing practice, the nurse must evaluate how evidence-based interventions work with specific clients. If the evidence is not applicable to the client being served, it will diminish the chance of a positive outcome. There are several levels of nursing expertise and each one takes on a different kind of research—PICOT, QI, and new research—that lends knowledge to evidence-based practice.