Mental health is an essential aspect of overall health and involves a person’s psychological, emotional, and social well-being. It affects the way a person feels, thinks, and acts, and determines how a person relates to others, handles stress, and makes decisions.
In this article:
- Overview
- Nursing Process
- Nursing Care Plans
- Disturbed Thought Processes
- Ineffective Coping
- Risk for Self-Mutilation
- Risk for Suicide
Overview
Mental health problems or illnesses can arise anytime throughout a person’s life. Various factors give rise to mental health illnesses including biological factors like genes, environmental factors such as toxins, alcohol, and drugs, family history of mental health illnesses, and life experiences like abuse or trauma.
Signs and symptoms of mental health problems include:
- Sadness
- Inability to concentrate
- Excessive fear
- Excessive guilt
- Withdrawal from society
- Extreme mood changes
- Detachment from reality
- Inability to cope with problems
- Trouble relating to other people or situations
Fortunately, discussions surrounding mental health are becoming more common and resources are readily available to manage mental health disorders.
Nursing Process
Physical assessments, laboratory tests like thyroid tests and drug or alcohol screening, and psychological evaluations are conducted to help diagnose or rule out mental health problems.
While it can be difficult to determine the type of mental health problem a person has, an accurate diagnosis will help guide the most appropriate treatment for the patient.
Medications like antidepressants, mood stabilizers, and antipsychotic drugs are prescribed to help improve symptoms. Psychotherapy, brain-stimulation treatments, and inpatient treatment programs may also be indicated.
Nurses, regardless of specialty, care for patients who display signs of or are at risk of developing mental health problems. Nurses are instrumental in the assessment, management, education, and collaboration of a patient’s mental health.
Nursing Care Plans
Once the nurse identifies nursing diagnoses related to mental health conditions, nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section, you will find nursing care plan examples related to mental health conditions.
Chronic Low Self-esteem
Chronic low self-esteem refers to a long-standing negative perception of self-worth and personal abilities. Low self-esteem may be experienced by patients with various mental health disorders such as anxiety disorders, eating disorders, major depressive disorders, and alcohol and drug abuse.
Nursing Diagnosis: Chronic Low Self-esteem
Related to:
- Disturbed body image
- Fear of rejection
- Inadequate social support
- Ineffective communication skills
- Insufficient approval from others
- Low self-efficacy
- Abandonment
- Domestic abuse
As evidenced by:
- Depressive symptoms
- Excessive shame or guilt
- Constant seeking of reassurance
- Hopelessness
- Insomnia
- Loneliness
- Passive behavior
- Overly-conforming behaviors
- Reduced eye contact
- Rejects positive feedback
- Reports repeated failures
- Self-negating verbalizations
Expected outcomes:
- Patient will verbalize an increased sense of self-worth.
- Patient will demonstrate behaviors of improved self-esteem such as eye contact, appropriate physical appearance, posture, and participation in conversations.
Assessment:
1. Assess the patient’s past and current achievements.
This shows the patient a more realistic view of his or her strengths and capabilities. Patients with mental health conditions may lose sight of their past accomplishments and tend to exhibit low self-esteem.
2. Assess how the patient views themselves.
Assess for negative self-talk and exaggerated feelings of one’s self. The goal isn’t to reject the patient’s feelings but to gain insight into their view of themself.
3. Assess support systems.
A lack of support can contribute to poor self-worth. A present support system that is degrading or harmful to the patient’s self-esteem may require intervention.
4. Assess for suicidal ideation.
Patients with chronic low self-esteem may have suicidal thoughts or a plan. Ask directly if the patient is thinking of killing or harming themselves.
Interventions:
1. Focus on what can be controlled.
A chronic sense of failure may need to be overcome. The patient may feel that their every action or entire life is a failure. Attempt to have the patient focus only on what can be controlled, and that what may be deemed a “failure” does not have to be tied with one’s sense of self.
2. Apply active listening and open-ended questions.
Therapeutic communication is an important aspect of providing care and support to patients suffering from mental health problems. Communication methods like active listening and using open-ended questions enable the patient to verbalize interests, worries, concerns, and thoughts without interruption.
3. Provide positive feedback and reinforcement.
Continuous positive feedback and support promote the patient’s self-esteem and self-worth. In time, the patient will hopefully begin to believe and be a source of their own positive feedback.
4. Teach the patient to recognize and shut down negative self-talk.
Recognition of negative thoughts enables the patient to develop new ways of coping. The patient can be taught to replace negative ideas and beliefs with positive affirmations.
Disturbed Thought Processes
Mental health problems affect a person’s mood, thoughts, and behavior. Certain mental health disorders may result in disturbed thought processes where the patient experiences alterations in cognition, perception, reasoning, and problem-solving, interfering with their daily life.
Nursing Diagnosis: Disturbed Thought Processes
Related to:
- Altered self-concept
- Cognitive dysfunction
- Low self-esteem
- Psychological barriers
- Anxiety
- Fear
- Stressors
- Substance misuse
- Unaddressed trauma
- Social Isolation
As evidenced by:
- Absence of eye contact
- Inaccurate interpretation of stimuli (external or internal)
- Decreased willingness to participate in social interactions
- Difficulty comprehending communication
- Inappropriate social behavior
- Cognitive dissonance
- Inappropriate verbalization
- Speech abnormalities
- Hallucinations/delusions
- Distractibility
- Suspiciousness
Expected outcomes:
- Patient will maintain reality orientation and communicate and interact with other people according to social norms.
- Patient will recognize and implement strategies to manage hallucinations/delusions.
Assessment:
1. Assess the patient’s past medical history and identify factors present.
Proper assessment of the patient’s medical history and factors contributing to the patient’s condition is important to help plan the best treatment regimen. Conditions such as dementia, anoxic brain injuries, and schizophrenia may cause disturbed thought processes and all have very different treatments.
2. Assess and review laboratory values.
Mental health problems can be caused by biochemical imbalances. Abnormal laboratory values like hypokalemia, anemia, signs of infection, or metabolic alkalosis can indicate causative factors of the patient’s condition.
3. Assess the patient’s cognitive ability.
This will help determine the patient’s ability to participate in the plan of care and treatment regimen.
Interventions:
1. Reorient the patient to person, place, and time as necessary.
When a patient is unable to maintain reality orientation, it can cause anxiety or worsening confusion. Consistent reorientation allows the patient to develop a sense of control and builds a trusting relationship with the healthcare provider.
2. Provide safety measures as needed.
It is always important to consider the patient’s safety at all times since mental health problems can affect the patient’s reactions to external stimuli. Safety measures include side rails, close supervision, or seizure precautions as indicated.
3. Schedule structured tasks with adequate rest periods.
This will help provide adequate stimulation and appropriate treatment interventions while allowing the patient to rest to reduce fatigue.
4. Maintain a quiet and calm environment and approach the patient slowly and calmly.
Patients with disturbed thought processes may respond with exaggerated or aggressive behaviors if overstimulated.
5. Do not challenge or accept illogical thinking.
Patients who express delusions should not have their reality challenged, but the nurse can offer understanding of what the patient is experiencing while maintaining reality.
6. Teach how to stop negative thinking.
Teach the patient strategies such as stating “stop!” or a loud noise such as clapping to interrupt unwanted thoughts.
Ineffective Coping
Patients suffering from mental health disorders may fail to effectively deal with existing problems due to unmanaged stress, poor coping skills, or other life pressures.
Nursing Diagnosis: Ineffective Coping
Related to:
- Inadequate confidence in the ability to deal with a situation
- Inadequate sense of control
- Inadequate social support
- Ineffective tension release strategies
- Inadequate resources
As evidenced by:
- Altered attention
- Altered communication pattern
- Destructive behaviors
- Difficulty organizing information
- Inability to ask for help
- Lack of goal-directed behavior
- Inadequate follow-through
- Inadequate problem-solving skills
- Substance abuse
Expected outcomes:
- Patient will demonstrate effective coping when faced with unfavorable situations.
- Patient will verbalize confidence in dealing with psychosocial issues.
Assessment:
1. Assess history of coping.
The nurse can first assess how the patient has coped in the past with difficult situations. The patient may not be equipped with the necessary skills and strategies to cope effectively.
2. Assess for possible causes of ineffective coping.
Lack of problem-solving skills, poor self-concept, lack of social support, or stressors such as finances, living environment, or career pressures will each require their own specific strategies.
3. Assess for destructive habits.
Ineffective coping may be made worse by the use of drugs, alcohol, overeating, sexual behavior, smoking, and more that require treatment.
Interventions:
1. Establish trust and a therapeutic relationship with the patient.
An unbiased attitude establishes trust. An open and patient tone will reduce feelings of isolation and ultimately facilitate coping.
2. Assist the patient in setting realistic goals.
Patients may feel helpless in goal-setting especially if they never reach goals. Instruct the patient on how to set short, manageable goals.
3. Allow the patient to express their fears, feelings, concerns, and expectations.
Verbalization of perceived or actual threats can help reduce anxiety and promote open communication with the patient. These should be met without judgment from the healthcare team.
4. Support relaxation and leisure activities.
Coping with stress, grief, or other mental health issues requires time for hobbies, exercise, and distraction. Remind the patient to take time to read, write, walk, and enjoy activities.
5. Encourage therapy and counseling.
Mental health professionals can help the patient learn and implement healthy coping mechanisms.
Risk for Self-Mutilation
Mental health issues like borderline personality disorder, post-traumatic stress disorder, eating disorders, anxiety, and depression can affect the patient’s ability to cope and lead to an increased risk of self-injury.
Nursing Diagnosis: Risk for Self-Mutilation
Related to:
- Mental health disorder
- Emotional instability
- Alteration in body image
- Lack of a support person
- Relationship disturbances
- Inability to express tension verbally
- Irresistible urge to cut self
- Ineffective problem-solving skills
- Ineffective coping skills
- Negative feelings
- Poor self-esteem
- Poor communication with family
- Failure to see long-term consequences
- Perfectionism
- Need for immediate stress reduction
- Misuse of substances
As evidenced by:
A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred yet, and nursing interventions are directed at prevention.
Expected outcomes:
- Patient will remain safe and free from self-inflicted injury.
- Patient will identify triggers that cause the urge to self-harm.
- Patient will demonstrate interventions to help reduce the urge to harm self.
Assessment:
1. Conduct a history of the patient’s mental health and identify at-risk populations.
Specific psychiatric disorders increase the risk for self-mutilation, such as borderline personality disorder, bipolar disorder, and major depressive disorder. The nurse should also note at-risk populations for self-harming behaviors such as childhood abuse, incarceration, unstable living situations, and gender identity or sexual orientation crises.
2. Assess the patient’s ability to regulate their emotional state.
Patients with mental health issues may have problems regulating emotions, resulting in impulsivity and poor coping, increasing the risk of self-mutilation.
3. Assess the family dynamics and support system.
Disrupted family dynamics can be a factor for self-harm in adolescents. Patients with mental health disorders who lack a support system are also at an increased risk.
Interventions:
1. Conduct a skin assessment and monitor for behavioral cues of self-mutilation.
Signs of self-harm include burns, scratches, and scars on the patient’s body, easily concealed with clothing like long sleeves and pants.
2. Attempt to understand the patient’s reasons for self-harm.
Patients with mental health issues often harm themselves as a way to deal with difficult emotions. The nurse can inquire about the function self-harming serves for the patient. The nurse can then develop individualized interventions for effective coping.
3. Reinforce alternative ways for the patient to manage depression and anxiety.
Provide alternatives to self-mutilation like exercise, journaling, and creative outlets that can help reduce the risk of self-harming tendencies.
4. Discuss coping strategies.
The patient must first identify triggers for self-harm, which may be anxiety, stress, anger, or sadness. The nurse can then tailor coping strategies such as assertiveness training, impulse control, or relaxation techniques.
Risk for Suicide
Patients who are at risk for suicide may have a diagnosed mental health disorder, though they may also be experiencing a sudden life change affecting their mental health.
Nursing Diagnosis: Risk for Suicide
Related to:
- Mental health disorders
- Cognitive dysfunction
- Difficulty coping
- Ineffective impulse control
- Anxiety
- Depressive symptoms
- Guilt
- Grief
- Access to weapons
- Poor support system
As evidenced by:
A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred yet, and nursing interventions are directed at prevention.
Expected outcomes:
- Patient will not use drugs or substances that could increase the risk of suicide.
- Patient will express feelings, concerns, and suicidal ideations if present.
Assessment:
1. Assess causative factors that contribute to the patient’s suicidal ideation.
Risk factors for suicide include mental health conditions like depression, bipolar disorder, schizophrenia, post-traumatic stress disorder, and eating disorders. Patients who experience abuse or struggle with gender or sexual identity are also at risk. Recent life events like the death of a loved one or the loss of a significant relationship are also risk factors.
2. Assess the patient’s risk for suicide through verbal and behavioral cues.
Verbal and behavioral cues about ending one’s life are often present in patients with mental health problems who are considering suicide. Remain aware of statements like wanting to “end it all” or “it doesn’t matter anyway” and changes in behavior such as giving away possessions or engaging in risky activities.
3. Assess for a suicide plan.
Direct questions such as “Do you want to kill yourself?” or “Do you have a plan for killing yourself?” are likely to offer honest responses.
Interventions:
1. Offer space to verbalize feelings, concerns, and suicidal thoughts.
If the nurse can build a trusting and therapeutic relationship with the patient, they may feel comfortable confiding their emotions and suicidal ideations. The nurse can validate the patient’s emotional pain while keeping them safe and guiding them toward resources.
2. Refer the patient to mental health counseling.
Mental health counseling is crucial for patients with suicidal ideations to help develop appropriate coping skills and manage mental health conditions. Inpatient psychiatric hospitalization may be necessary in serious instances, such as when the patient expresses a plan or obtains a weapon.
3. Ensure pharmacological treatment of psychiatric disorders.
Depending on the type of mental illness, the patient may require a medication regimen to manage symptoms and reduce thoughts of suicide. These may include antidepressants, antianxiety medications, or antipsychotics.
4. Help develop a strong support system to call upon.
In instances where the patient is feeling especially depressed or hopeless, they need a support person to contact. The nurse can help them decide who they can trust and depend upon and also offer resources such as suicide hotlines.
References
- About Mental Health Problems. Mental Health Foundation. 2022. https://www.mentalhealth.org.uk/explore-mental-health/about-mental-health-problems
- Mental Disorders. World Health Organization. 2022. https://www.who.int/news-room/fact-sheets/detail/mental-disorders
- Moitra M, Santomauro D, Collins PY, Vos T, Whiteford H, et al. (2022) The global gap in treatment coverage for major depressive disorder in 84 countries from 2000–2019: A systematic review and Bayesian meta-regression analysis. PLOS Medicine 19(2): e1003901. https://doi.org/10.1371/journal.pmed.1003901
- Psychiatric Mental Health Nursing Concepts of Care and Evidence-Based Practice. 8th Edition. Mary C. Townsend, DSN, PMHCNS-BC. 2015. FA Davis Company.
- What is Mental Health? MentalHealth.gov. Last Updated: 02/28/2022. https://www.mentalhealth.gov/basics/what-is-mental-health
