Mental Health / Psychiatric Nursing
Psychiatric nursing questions test safety, therapeutic relationship and least-restrictive intervention. The single most important concept is risk assessment: suicide and self-harm risk must be assessed directly and asked about openly - asking does not increase risk.
Therapeutic communication: Use open questions, reflection, clarification and silence. Avoid false reassurance ("it will be fine"), minimising, advice-giving and arguing with delusions. Build trust, set clear boundaries, and maintain confidentiality within legal limits.
Key conditions:
- Depression: low mood, anhedonia, sleep and appetite change; highest suicide risk may occur as energy returns during treatment.
- Mania: elevated mood, reduced sleep, grandiosity; provide low-stimulation environment and protect from impulsive harm.
- Psychosis: hallucinations and delusions; do not challenge or reinforce the content - focus on feelings and reality-based safety.
- Anxiety and OCD: anxiety-reduction techniques; do not participate in compulsive rituals.
- Substance use: withdrawal can be life-threatening (e.g., alcohol withdrawal seizures, delirium tremens) - monitor medically.
Legal and ethical: Know when confidentiality can be breached (imminent risk to self or others, safeguarding). Restraint and seclusion are last resorts, require legal authority, monitoring and documentation, and the least restrictive option must be tried first.
Traps
- Selecting a physically restrictive intervention before verbal de-escalation.
- Reassuring a patient that a delusion is false, or agreeing with it.
- Missing that a suddenly calm, cheerful patient on suicide precautions may still be at high risk.
Rule of thumb
When a patient expresses suicidal intent: stay with them, ensure safety, remove means, and escalate - assessment and safety before any teaching or counselling.