Mental Health and Behavioural Nursing
Therapeutic communication
Use open-ended questions, reflection, restating, silence, clarification, and offering self. Avoid 'why' questions, false reassurance ('everything will be fine'), giving advice, changing the subject, and approval or disapproval. Recognise transference and countertransference, maintain professional boundaries, and decline money or gifts that could exploit the relationship.
Safety first
Suicide risk assessment is a nursing priority: direct questions are appropriate, and a patient with a plan and means needs continuous observation, a ligature-resistant environment, and removal of harmful items. A verbal no-harm agreement is not a substitute for observation. In withdrawal, use protocol-driven scales (CIWA for alcohol) and monitor for seizures and delirium tremens; benzodiazepines are first-line.
Psychopharmacology
SSRIs take two to four weeks to work and may increase suicidal thinking early in treatment, especially in young people. Watch for serotonin syndrome and neuroleptic malignant syndrome. Lithium requires level monitoring and steady sodium and fluid intake. Antipsychotics cause extrapyramidal symptoms, tardive dyskinesia, and metabolic effects; clozapine requires white cell monitoring.
Traps
When a patient refuses medication, the nurse explores the reason and educates rather than forcing. Restraints are a last resort, require an order, and never replace observation. 'The patient is manipulative' is a label - describe the behaviour instead.
Worked rule
When a patient says something alarming, reflect the feeling before solving: 'You sound as though you have no reason to keep going.' That opens assessment rather than closing it.