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About Psychiatric-Mental Health Nursing


Because mental health is an important aspect of an individual’s total health, every nurse, no matter their work setting, needs a foundational knowledge of managing patients with psychiatric and mental health conditions. Psychiatric-Mental Health Nursing is designed to support a one-semester psychiatric-mental health nursing course offered at both two-year and four-year institutions. Serving a student base of both students specializing in psychiatric nursing and those from other health disciplines, the course integrates evidence-based practices with practical strategies for communication, readying students to build therapeutic relationships with clients and caregivers.

Psychiatric-Mental Health Nursing emphasizes the importance of critical thinking and clinical judgment—skills essential for making informed decisions and providing high-quality care. Embedded throughout the text are opportunities for students to apply the Clinical Judgment Measurement Model to patient cases related to the unit or chapter theme. Ethical practice, client safety, and clinical professionalism are central to the narrative, reflecting the complex landscapes nurses navigate in mental health care. The text is committed to enhancing ethical awareness, patient safety, and clinical competence among nursing students.

Authentic learning experiences are prioritized to ensure a seamless transfer of theoretical knowledge to practical application. Through detailed case studies and real-world scenarios, the text bridges the gap between academic learning and the realities of today’s medical environments, preparing students for impactful careers in mental health nursing.

Psychiatric-Mental Health Nursing invites students to explore the integral role of psychiatric mental health nursing within the broader healthcare spectrum. Students will leave the course equipped with the knowledge and skills necessary to improve the well-being of individuals and communities through dedicated, informed nursing care.

Pedagogical Foundation

Psychiatric-Mental Health Nursing uses a logical, thematic organization that breaks content down into manageable sections. Each unit is designed to foster a deep understanding of the biological, psychological, and social dimensions of mental health. The text helps students make meaningful connections between various psychiatric conditions and the corresponding nursing approaches. The text takes a comprehensive approach, integrating theoretical concepts with practical applications. By focusing on tailored psychiatric interventions and emphasizing patient-centered approaches, Psychiatric-Mental Health Nursing equips students with the knowledge and skills necessary to navigate diverse mental health settings.

Organizational Framework

The table of contents for Psychiatric-Mental Health Nursing presents content in 28 chapters, organized into 6 thematic units.

  • Unit 1 introduces the foundational theories and practices of psychiatric-mental health nursing. It covers the evolution of mental health concepts, various therapeutic theories and their applications, and the latest trends in mental health care, including the integration of research and evidence-based practices.
  • Units 2–6 explore more specialized topics, each dedicated to different facets of psychiatric nursing:
    • Therapeutic Considerations in Mental Health: Discusses the settings, relationships, and interprofessional care crucial for effective mental health treatment.
    • Client Rights and Legal Issues: Explores the legal and ethical frameworks that safeguard client rights and outlines the responsibilities of mental health professionals.
    • Psychiatric Nursing Practice: Focuses on clinical guidelines, practice standards, and specific disorders including mood, anxiety, and personality disorders.
    • Special Populations: Addresses the unique needs of children, adolescents, and older adults within psychiatric care.
    • Mental Health Care in the Community: Examines community-based approaches, current trends, and the broader societal impacts on mental health care. The final chapter focuses on the vital role of critical thinking in psychiatric-mental health nursing. The core of this chapter revolves around the application of clinical judgement through the dissection of an unfolding case study. This practical approach helps students see how theoretical knowledge and critical thinking translate into real world problem-solving.

Nursing Features

To further enhance learning, Psychiatric-Mental Health Nursing includes the following features:

  • Clinical Judgment Measurement Model boxes guide students through the application of the Clinical Judgment Measurement Model in psychiatric nursing. The content explores the critical thinking and decision-making processes necessary to navigate patient care at different points in the process, from recognizing cues to evaluating outcomes.
  • Clinical Safety and Procedures (QSEN) align with the Quality and Safety Education for Nursing competencies by providing detailed explanations of safety protocols and procedures specific to psychiatric nursing. This feature emphasizes the importance of patient safety and quality care and offers checklists, step-by-step, or tips on various safety practices.
  • Cultural Context boxes explore the impact of cultural factors on psychiatric nursing. This feature offers insights into how cultural beliefs, values, and practices can affect the perception and treatment of mental health conditions.
  • Life-Stage Context features address the specific needs and considerations of different life stages in psychiatric care from childhood to older adulthood. This feature provides age-specific insights and tips for adapting psychiatric assessment and interventions according to the developmental state of the patient.
  • Link to Learning features provide a very brief introduction to online resources—videos, interactives, collections, maps, and other engaging resources that are pertinent to students’ exploration of the topic at hand.
  • Psychosocial Considerations explore the social and psychological aspects that affect individuals with mental health conditions. The features examine factors like social support networks, socioeconomic status, and psychological resilience, and their impact on mental health.
  • Real RN Stories feature firsthand accounts from registered nurses in the field of psychiatric-mental health nursing. These stories provide practical insights and real-world experiences that highlight the challenges and rewards of psychiatric nursing.
  • Unfolding Case Studies present a hypothetical client scenario that unfolds in three parts throughout the chapter, with each subsequent part presenting new information on the same client, to help foster clinical judgment. In each part of an unfolding case feature, the scenario is followed by two questions that require students to apply their knowledge of evidence-based care and allow them to practice with questions that mimic the style of Next-Gen NCLEX. The answers to these questions, with explanations, are included in the Answer Key for students at the end of the book.

Pedagogical Features

To support student learning, Psychiatric-Mental Health Nursing includes the following standard elements:

  • Learning Outcomes: Every chapter section begins with a set of clear and concise student learning outcomes. These outcomes are designed to help the instructor decide what content to include or assign and can guide students on what they can expect to learn and be assessed on.
  • Assessments: A variety of assessments allow instructors to confirm core conceptual learning, elicit brief explanations that demonstrate student understanding, and offer more in-depth assignments that enable learners to dive more deeply into a topic or history-study skill.
    • Review Questions test for conceptual apprehension of key concepts.
    • Check Your Understanding Questions require students to explain concepts in words.
    • Reflection Questions and Competency-Based Assessment Questions dive deeply into the material to support longer reflection, group discussion, or written assignments.
    • What Should the Nurse Do? and Critical Thinking About Case Study Questions assess students’ clinical judgment skills using case-based scenarios. Students review either a single case or an unfolding case that reveals information gradually. In response to their observations of the patient, students must decide how to navigate the Clinical Judgment Measurement Model process. This approach challenges them to apply theoretical knowledge to practical situations, determining the most appropriate interventions based on the patient’s specific circumstances.
  • Answers to Questions in the Book: Assessments are intended for homework assignments or classroom discussion; thus, student-facing answers are not provided in the book. Answers and sample answers are provided in the Instructor Answer Guide for instructors to share with students at their discretion, as is standard for such resources.
  • Chapter Summary: Chapter summaries assist both students and instructors by outlining the primary subtopics addressed within the chapter.
  • Key Terms: Key terms are presented in bold text and are followed by an explanation in context. Definitions of key terms are also listed in the end-of-chapter glossary.
  • References: References are listed at the end of each chapter.

About the Authors

Senior Contributing Authors

Headshots of three people.
Senior contributing authors: Rebecca Puchkors (left), Jeanne Saunders (middle), David Sharp (right)

Rebecca Puchkors, Baylor University. Professor Puchkors holds a BS and MS in Nursing from the University of Texas at Arlington and is near completion of a Doctor of Nursing Practice at Maryville University of Saint Louis. She is a faculty member at Baylor University and teaches mental health nursing at Louise Herrington School of Nursing. Professor Puchkors has clinical experience in psychiatric-mental health nursing, forensic nursing, legal consultation, education, unit design, and administration. Throughout her nursing career, she has taught nurses and pre-licensure nursing students in hospital and academic settings. She is a member of the American Psychiatric Nurses Association. She has served as faculty for APNA’s Recovery to Practice, Competency-Based Suicide Prevention Course, and Transitions in Practice programs, including curriculum development. She is also a member of the Sigma Theta Tau International Honor Society and the International Association of Forensic Nurses. She is the recipient of the DFW Great 100 Nurses Award and the D Magazine Excellence in Nursing Leadership award and has presented at numerous national conferences on best practices in psychiatric-mental health nursing.

Jeanne Saunders, Daytona State College. Dr. Saunders holds an ASN from J. Sargeant Reynolds Community College, a BSN from VA Commonwealth University, an MSN from University of Phoenix, and a Doctorate in Education – Healthcare Education from Nova Southeastern University. Dr. Saunders has been a nurse for more than 40 years and is certified in the specialty of psychiatric-mental health nursing. She is a Professor of Nursing at Daytona State College where she teaches courses in the Associate Degree Nursing Program that include clinical, lab, online, classroom, and preceptorship components. Dr. Saunders is an Expert Witness for the Florida Board of Nursing, subject matter expert in Trauma Informed Care, volunteer with local mental health agencies, and member of the American Psychiatric Nurses Association (APNA). She has direct care and leadership experience in hospital, long-term care, corrections, community, academic and consultation settings across the consumer lifespan.

David Sharp, Mississippi College. Dr. David Sharp began his nursing career in 1978 in Scotland, working in acute psychiatry, long-term psychiatric care, elderly care, and forensic services. In 1988, he moved into nursing education and has had extensive experience teaching at both undergraduate and graduate levels and continuing education. He developed and delivered the first distance learning degree for Community Psychiatric Nursing in the UK and the inaugural degree-level program for Forensic Nursing aimed at nurses working with offenders in hospitals or the prison system. In 2000, he moved to the United States and has taught courses on mental health issues across four states. As an active member of the American Psychiatric Nurses Association for the past twelve years, he has held leadership roles in the association’s education committees. His work has led to the creation of a toolkit for faculty teaching psychiatry nursing programs and the development of recommendations with the Institute for Safe Environments that seek to reduce the levels of workplace violence across the healthcare sector. David regularly presents at local, national, and international conferences on issues relating to mental health, psychiatric nursing care, and nursing education.

Contributing Authors

Lenore Cortez, Angelo State University

Celeste Dunnington, Shorter University

Victoria Haynes, University of North Dakota School of Medicine and Health Sciences

Kimberly Johnson, Baylor College of Medicine

Laura Logan, Austin State University, DeWitt School of Nursing

Stacy Mikel, Jacksonville State University

Lynn Rew, The University of Texas at Austin

Leigh Waldron, Western Governors University

Pamela Herbig Wall, Rosalind Franklin University


Aeron Adams, University of Wisconsin-Madison

Courtney Albers, University of Louisville

Kimberly Amos, McDowell Technical Community College

Deana Batross, Otterbein University

Jennifer Bell, Ball State University

Stephanie Blundell, University of Massachusetts Global School of Nursing

Gail Burmeister, Charles Drew University School of Nursing

Allison Collins, Grayson College

Lynda Creighton-Wong, University of California, Davis

Janice Call Edmonson, Baylor University

Becky Fields, Roane State Community College

Kelly L. Fink, University Medical Center of Southern Nevada

Katherine Howard, Middlesex College

Debra Lett, Trenholm State Community College

Lynn D. Long, Purdue University Global

Carine M. Luxama, University of Massachusetts Manning College of Nursing & Health Sciences

Vanessa Miller, University of California, San Francisco

Jan Olson, Concordia University

Jessica Peckham, Duke University Health System and Harvard Medical School

Antonia M. Scialdo, Palm Beach State College

Lori Taylor, South University

Aaron Tomberlin, Central Piedmont Community College

Antoinette Towle, Southern Connecticut State University

Susan K. Tucker, Gadsden State Community College

Nancy Lynn Whitehead, Milwaukee Area Technical College

Additional Resources

Student and Instructor Resources

We have compiled additional resources for both students and instructors, including Getting Started Guides, an instructor’s answer guide, test bank, and image slides. Instructor resources require a verified instructor account, which you can apply for when you log in or create your account on Take advantage of these resources to supplement your OpenStax book.

Instructor’s answer guide. Each component of the instructor’s guide is designed to provide maximum guidance for delivering the content in an interesting and dynamic manner.

Test bank. With more than 1,100 assessments, instructors can customize tests to support a variety of course objectives. The test bank includes review questions (multiple-choice, identification, fill-in-the-blank, true/false), short answer questions, and long answer questions to assess students on a variety of levels. The test bank is available in Word format.

PowerPoint lecture slides. The PowerPoint slides provide learning objectives, images and descriptions, feature focuses, and discussion questions as a starting place for instructors to build their lectures.

Academic Integrity

Academic integrity builds trust, understanding, equity, and genuine learning. While students may encounter significant challenges in their courses and their lives, doing their own work and maintaining a high degree of authenticity will result in meaningful outcomes that will extend far beyond their college career. Faculty, administrators, resource providers, and students should work together to maintain a fair and positive experience.

We realize that students benefit when academic integrity ground rules are established early in the course. To that end, OpenStax has created an interactive to aid with academic integrity discussions in your course.

A graphic divides nine items into three categories. The items "Your Original Work" and "Quoting & Crediting Another's Work" are in the "Approved" category. The items "Checking Your Answers Online", "Group Work", "Reusing Past Original Work", and "Sharing Answers" are in the "Ask Instructor" category. The items "Getting Others to Do Your Work", "Posting Questions & Answers" and "Plagiarizing Work" are in the "Not Approved" Category.
Visit our academic integrity slider. Click and drag icons along the continuum to align these practices with your institution and course policies. You may then include the graphic on your syllabus, present it in your first course meeting, or create a handout for students. (attribution: Copyright Rice University, OpenStax, under CC BY 4.0 license)

At OpenStax we are also developing resources supporting authentic learning experiences and assessment. Please visit this book’s page for updates. For an in-depth review of academic integrity strategies, we highly recommend visiting the International Center of Academic Integrity (ICAI) website at

Community Hubs

OpenStax partners with the Institute for the Study of Knowledge Management in Education (ISKME) to offer Community Hubs on OER Commons—a platform for instructors to share community-created resources that support OpenStax books, free of charge. Through our Community Hubs, instructors can upload their own materials or download resources to use in their own courses, including additional ancillaries, teaching material, multimedia, and relevant course content. We encourage instructors to join the hubs for the subjects most relevant to your teaching and research as an opportunity both to enrich your courses and to engage with other faculty. To reach the Community Hubs, visit

Technology partners

As allies in making high-quality learning materials accessible, our technology partners offer optional low-cost tools that are integrated with OpenStax books. To access the technology options for your text, visit your book page on

Special Thanks

The Division of Digital Learning at the Texas Higher Education Coordinating Board (THECB) has a history of dedicated research initiatives, services, and programs that have advanced open education in Texas by providing support, advocacy, and resources to Texas institutions in their OER efforts. The Division maintains a diverse OER portfolio including OERTX, a digital library and community space for open education work. The leadership and collaboration of the Division of Digital Learning staff made the OER Nursing Essentials (ONE) project possible, throughout research, planning, and development phases of the eight-textbook series.

This work was supported in whole or in part by the THECB. The opinions and conclusions expressed in this document are those of the author(s) and do not necessarily represent the opinions or policies of the THECB.


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