Chapter 7: The Nursing Process in Psychiatric-Mental Health Nursing

The Nursing Process in Psychiatric-Mental Health Nursing begins with a comprehensive overview of the assessment phase, emphasizing the distinction between primary sources like the patient and secondary sources such as family or medical records, and details the components of the Mental Status Examination (MSE) to objectively evaluate appearance, behavior, speech, affect, thought content, and cognitive function. The text explores the nuances of psychosocial assessment, including the evaluation of spiritual, religious, and cultural factors that influence a patient's worldview and recovery, while stressing the importance of the nurse's self-awareness and professional curiosity to prevent bias. Specific attention is given to age-appropriate assessment strategies, such as using play and observation for children, employing the HEADSSS interview technique to address confidentiality and risk-taking behaviors in adolescents, and accommodating physical or sensory limitations in older adults while screening for comorbidities. The chapter elucidates the construction of nursing diagnoses by combining the problem (unmet need), etiology (probable cause), and defining characteristics (signs and symptoms), and differentiates between actual diagnoses, risk diagnoses for patient safety, and health promotion diagnoses that indicate readiness for growth. Planning is described as a collaborative effort to define measurable, patient-centered outcomes and select interventions that are safe, realistic, and supported by current research. The implementation section distinguishes the scope of practice between the Psychiatric Mental Health Registered Nurse (PMH-RN), responsible for coordination of care, health teaching, pharmacological management, and milieu therapy, and the Advanced Practice Registered Nurse (PMH-APRN), who is qualified for prescriptive authority, psychotherapy, and consultation. Finally, the chapter covers the continuous process of evaluation to determine goal attainment and the legal and ethical imperatives of documentation, comparing narrative charting with structured formats like SOAPIE, and advocating for the use of non-judgmental terminology such as nonadherence instead of noncompliance to maintain a therapeutic nurse-patient relationship.