Community Health and Mental Health Nursing
What to master
Community. Levels of prevention structure most questions: primary (immunisation, health education, seatbelts, safe water), secondary (screening, early detection, contact tracing), tertiary (rehabilitation, chronic disease management, support groups). Know epidemiology basics - incidence (new cases), prevalence (all existing cases), attack rate, herd immunity - plus home-visit safety and the community-as-client model. Public health nurses aggregate data and act on populations, not just individuals.
Mental health. Therapeutic communication: open questions, reflection, silence, clarification, and confrontation used only after trust. Non-therapeutic: false reassurance, giving advice, "why" questions, changing the subject, and arguing with delusions. Know the mental status examination, suicide risk assessment (ask directly - asking does not plant the idea), and safety planning. Know psychotropic adverse effects: extrapyramidal symptoms and tardive dyskinesia with antipsychotics; neuroleptic malignant syndrome (fever, rigidity, autonomic instability, raised creatine kinase); serotonin syndrome (agitation, clonus, hyperreflexia, fever) with SSRIs; lithium toxicity (tremor, vomiting, ataxia - check levels and hydration).
Traps in questions
- Selecting a "kind" response that is actually false reassurance.
- Choosing to explore feelings before ensuring physical safety in an acutely suicidal or violent patient - safety first.
- Labeling a screening programme as primary prevention.
- Confronting a delusion directly instead of acknowledging the feeling and reality-testing gently.
Worked example
A client says, "The neighbours are poisoning my food." Options: "That isn't true; nobody is poisoning you," "Tell me more about what you're experiencing," "You should eat only packaged food," "Let's talk about something pleasant." Choose "Tell me more about what you're experiencing" - it validates the experience without endorsing the delusion, builds trust, and gathers assessment data.
Rule of thumb
Physical safety first, then therapeutic relationship; ask about suicide directly and calmly.