NR 326 Week 2 Insights and Assessments
Student Name
Chamberlain University
NR-326: Mental Health Nursing
Prof. Name
Date
Clinical Observations and Mental Health Indicators
A disheveled appearance, grandiosity, rapid speech patterns, and avoidance of eye contact may indicate worsening mental health conditions. Although an irregular heart rate is clinically significant, it does not directly suggest mental health deterioration.
Individuals diagnosed with major depressive disorder often present with self-care deficits—particularly in hygiene—alongside hopelessness and self-esteem issues. They are less likely to exhibit disturbed sensory perception (hallucinations) or thought processes (delusions), or ineffective impulse control, which are more typical in bipolar disorder.
Common Assessment Tools in Mental Health
The most widely used evaluation tools in mental health nursing are validated survey tools, which help detect changes in behavior, emotional state, and symptom severity. Although tools such as stethoscopes, electrocardiograms, and reflex hammers may be used, they do not yield mental health–specific data.
Goals of Nursing in Mental Health
Core Objectives
Nursing in mental health focuses on enabling clients to adapt to environmental stressors, which may involve modifying thoughts, feelings, and behaviors to align with social and cultural norms. Crisis intervention and management skills are essential, particularly during acute mental health crises.
Therapeutic Relationship
Establishing a strong nurse-client relationship early promotes safety and trust, enabling effective recovery during vulnerable periods. Nurses aim to restore, promote, and maintain optimal mental health for both themselves and their clients.
Professional Identity
Professional identity in mental health nursing begins with self-awareness, where nurses understand their own emotions, thoughts, and behaviors and their influence on patient care. Personality assessments are particularly useful in this process, whereas tools like depression scales or lifestyle interventions (exercise, diet) serve different purposes.
Clinical Manifestations in Mental Health
Mental health assessments prioritize psychosocial, cognitive, emotional, and behavioral symptoms over physical findings. Common assessment cues include:
| Symptom/Behavior | Examples and Notes |
|---|---|
| Perceptual disturbances | Hearing voices, visual hallucinations, inability to accept facts |
| Poor hygiene | Infrequent bathing, unkempt hair, untreated skin conditions |
| Eye contact | Avoidance may indicate disorder or cultural variation |
| Inappropriate behavior | Aggression, shouting, sexual innuendos, physical touching |
| Substance misuse | Alcohol, illicit drugs, prescription misuse |
| Suicidal ideation | Passive or active, with or without a plan |
| Self-harm/violence | Cutting, physical aggression toward others |
| Self-defeating behavior | Actions leading to repeated negative outcomes |
| Legal issues | Frequent law enforcement encounters |
| Survey tool score changes | Worsening or improving condition |
Baseline assessments are essential for identifying changes over time. For example, worsening depression symptoms may present as social withdrawal, neglecting self-care, and reduced food intake.
Nursing Diagnoses in Mental Health
Nursing diagnoses help establish appropriate interventions, goals, and outcomes, promoting autonomy and professionalism in mental health nursing.
Common Nursing Diagnoses
| Diagnosis | Typical Indicators |
|---|---|
| Labile emotional control / Impaired mood regulation | Frequent mood changes |
| Ineffective impulse control | Risk-taking behavior |
| Hopelessness | Depressive symptoms |
| Disturbed personal identity | Personality disorder |
| Disturbed body image / Chronic low self-esteem | Passive behaviors, anorexia |
| Ineffective/defensive coping | Anger, aggression |
| Self-mutilation | Cutting |
| Disturbed sensory perception | Hallucinations |
| Disturbed thought processes | Delusions |
| Self-care deficit | Poor hygiene |
Contributing Environmental Factors
- Dysfunctional family dynamics
- Ineffective interpersonal relationships
Behavioral Causes
- Post-trauma syndrome
- Post-rape syndrome
- Relocation stress
- Aggressive coping
- Anorexia-related low self-esteem
Survey Tools in Mental Health
Measurement tools assist in quantifying subjective client experiences and establishing illness severity.
| Tool | Purpose |
|---|---|
| GAD-7 | Generalized anxiety disorder screening |
| SPIN | Social phobia assessment |
| ASRM | Mania self-rating |
| BEST | Borderline symptom severity tracking |
| SBQ-R | Suicide risk assessment |
| SAD PERSONS / Adapted | Suicide risk screening (adults, children) |
| COWS | Opioid withdrawal assessment |
| CAGE / CAGE-AID | Alcohol and drug misuse screening |
Substance Misuse Case Example
A client experiencing opioid withdrawal scores 28 on the COWS assessment. The nurse documents:
“The client scored 28 on the COWS assessment. Alprazolam administered orally per provider orders.”
Nursing Actions in Mental Health
Key interventions include:
- Crisis intervention and aggression management
- Medication administration (scheduled or PRN)
- Therapeutic communication (reframing, reassurance)
- Environmental modification (reduce stimuli, isolate if needed)
- Interdisciplinary collaboration
- Encouraging constructive activities
- Removing clients from unsafe situations
Effective de-escalation often involves relocating the client to their personal space to minimize confrontation.
Crisis in Mental Health
A crisis is a sudden event that disrupts life balance, overwhelms coping mechanisms, and is typically short-lived. It can result in personal growth or injury. Individuals with mental health vulnerabilities are more susceptible to crises, which may also worsen pre-existing conditions.
Phases of Crisis with Client Examples
| Phase | Description | Example |
|---|---|---|
| Phase 1 | Event perceived as crisis, anxiety rises, problem-solving begins | Evan lost his job, updated his resume, searched job ads |
| Phase 2 | Coping fails, anxiety worsens, function declines | Rachel’s dog died; she stopped eating, sleeping, and working |
| Phase 3 | Seeks external resources, tries new coping | Doug, after a tornado loss, asked his brother to help |
| Phase 4 | Crisis unresolved, panic, disorientation, possible psychosis | Phyllis, homeless and hungry, found confused in grocery store |
Variables Influencing Crisis Severity
- Perception of the Event – Personal interpretation defines severity.
- Available Support – Strong family and financial resources improve resilience.
- Coping Mechanisms – Past experiences, education, and self-awareness affect resolution.
References
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.).
Townsend, M. C., & Morgan, K. I. (2018). Psychiatric mental health nursing: Concepts of care in evidence-based practice (9th ed.). F.A. Davis.
NR 326 Week 2 Insights and Assessments
Varcarolis, E. M. (2021). Foundations of psychiatric mental health nursing: A clinical approach (8th ed.). Elsevier.