,
,Psychiatric-Mental Health Nursing
SENIOR CONTRIBUTING AUTHORS
REBECCA PUCHKORS, BAYLOR UNIVERSITY
JEANNE SAUNDERS, DAYTONA STATE COLLEGE
DAVID SHARP, MISSISSIPPI COLLEGE
,OpenStax
Rice University
6100 Main Street MS-375
Houston, Texas 77005
To learn more about OpenStax, visit https://openstax.org.
Individual print copies and bulk orders can be purchased through our website.
©2024 Rice University. Textbook content produced by OpenStax is licensed under a Creative Commons
Attribution 4.0 International License (CC BY 4.0). Under this license, any user of this textbook or the textbook
contents herein must provide proper attribution as follows:
- If you redistribute this textbook in a digital format (including but not limited to PDF and HTML), then you
must retain on every page the following attribution:
“Access for free at openstax.org.”
- If you redistribute this textbook in a print format, then you must include on every physical page the
following attribution:
“Access for free at openstax.org.”
- If you redistribute part of this textbook, then you must retain in every digital format page view (including
but not limited to PDF and HTML) and on every physical printed page the following attribution:
“Access for free at openstax.org.”
- If you use this textbook as a bibliographic reference, please include
https://openstax.org/details/books/psychiatric-mental-health in your citation.
For questions regarding this licensing, please contact .
Trademarks
The OpenStax name, OpenStax logo, OpenStax book covers, OpenStax CNX name, OpenStax CNX logo,
OpenStax Tutor name, Openstax Tutor logo, Connexions name, Connexions logo, Rice University name, and
Rice University logo are not subject to the license and may not be reproduced without the prior and express
written consent of Rice University.
HARDCOVER BOOK ISBN-13 978-1-711472-91-1
B&W PAPERBACK BOOK ISBN-13 978-1-711472-90-4
DIGITAL VERSION ISBN-13 978-1-961584-42-6
ORIGINAL PUBLICATION YEAR 2024
1 2 3 4 5 6 7 8 9 10 OF 24
,OPENSTAX
OpenStax provides free, peer-reviewed, openly licensed textbooks for introductory college and Advanced
Placement® courses and low-cost, personalized courseware that helps students learn. A nonprofit ed tech
initiative based at Rice University, we’re committed to helping students access the tools they need to complete
their courses and meet their educational goals.
RICE UNIVERSITY
OpenStax is an initiative of Rice University. As a leading research university with a distinctive commitment to
undergraduate education, Rice University aspires to path-breaking research, unsurpassed teaching, and
contributions to the betterment of our world. It seeks to fulfill this mission by cultivating a diverse community
of learning and discovery that produces leaders across the spectrum of human endeavor.
PHILANTHROPIC SUPPORT
OpenStax is grateful for the generous philanthropic partners who advance our mission to improve educational
access and learning for everyone. To see the impact of our supporter community and our most updated list of
partners, please visit openstax.org/foundation.
Arnold Ventures Burt and Deedee McMurtry
Chan Zuckerberg Initiative Michelson 20MM Foundation
Chegg, Inc. National Science Foundation
Arthur and Carlyse Ciocca Charitable Foundation The Open Society Foundations
Digital Promise Jumee Yhu and David E. Park III
Ann and John Doerr Brian D. Patterson USA-International Foundation
Bill & Melinda Gates Foundation The Bill and Stephanie Sick Fund
Girard Foundation Steven L. Smith & Diana T. Go
Google Inc. Stand Together
The William and Flora Hewlett Foundation Robin and Sandy Stuart Foundation
The Hewlett-Packard Company The Stuart Family Foundation
Intel Inc. Tammy and Guillermo Treviño
Rusty and John Jaggers Valhalla Charitable Foundation
The Calvin K. Kazanjian Economics Foundation White Star Education Foundation
Charles Koch Foundation Schmidt Futures
Leon Lowenstein Foundation, Inc. William Marsh Rice University
The Maxfield Foundation
, Study where you want, what
you want, when you want.
When you access your book in our web view, you can use our new online
highlighting and note-taking features to create your own study guides.
Our books are free and flexible, forever.
Get started at openstax.org/details/books/psychiatric-mental-health
Access. The future of education.
openstax.org
,Contents
Preface 1
UNIT 1 THEORIES, PRACTICE, AND TRENDS
CHAPTER 1
Foundations of Psychiatric-Mental Health Nursing 9
Introduction 9
1.1 Mental Health and Mental Illness 10
1.2 Risk and Protective Factors of Mental Health 14
1.3 Mental Health Stigma 23
1.4 Mental Health Recovery and Wellness 27
1.5 Integration of Research- and Evidence-Based Standards 32
Summary 36
Key Terms 36
Assessments 37
References 40
CHAPTER 2
Fundamentals of Theories and Therapies 47
Introduction 47
2.1 Psychoanalytic Theories and Therapies 48
2.2 Interpersonal Theories and Therapies 51
2.3 Cognitive Theories and Therapies 56
2.4 Humanistic Theories and Therapies 59
2.5 Biological Theories and Therapies 61
2.6 Developmental Theories and Therapies 63
2.7 Holistic Health and Interventions 66
Summary 72
Key Terms 73
Assessments 74
References 78
CHAPTER 3
Communication, Perception, and Assessment 83
Introduction 83
3.1 Therapeutic Communication and Relationships 84
3.2 Client Perception of Illness 93
3.3 Nursing Assessment and Clinical Tools 95
Summary 101
Key Terms 101
Assessments 101
References 104
,CHAPTER 4
Neurobiology and Pharmacological Standards 107
Introduction 107
4.1 Foundations of Neurobiology 108
4.2 Psychopharmacology 117
4.3 Innovations in Mental Health 132
Summary 136
Key Terms 136
Assessments 138
References 143
UNIT 2 THERAPEUTIC CONSIDERATIONS IN
MENTAL HEALTH
CHAPTER 5
Therapeutic Settings 145
Introduction 145
5.1 Psychiatric-Mental Health Treatment Settings 146
5.2 Group Therapy 154
5.3 Community Support Systems 158
5.4 Family Support Systems 160
Summary 162
Key Terms 162
Assessments 163
References 166
CHAPTER 6
Therapeutic Relationships 169
Introduction 169
6.1 Nurse-Client Relationship 169
6.2 Family Dynamics 173
6.3 Peer Support 177
6.4 Client Engagement 179
6.5 Trauma-Informed Care 181
Summary 187
Key Terms 187
Assessments 188
References 191
CHAPTER 7
Interprofessional Care 195
Introduction 195
7.1 Collaboration and Coordination of Care 196
7.2 Recovery and Rehabilitative Needs 199
7.3 Discharge and Transfer 201
7.4 Continued Support 204
7.5 Online Self-Help and Therapy 207
7.6 Challenges to Continuity of Care 212
Access for free at openstax.org
,Summary 215
Key Terms 215
Assessments 216
References 222
CHAPTER 8
Cultural Considerations 225
Introduction 225
8.1 Understanding Cultural Differences 226
8.2 Ethical Practice in Culture and Diversity 231
8.3 Cultural Practice in Nursing 235
8.4 Diversity, Equity, and Inclusion 242
Summary 249
Key Terms 249
Assessments 250
References 254
CHAPTER 9
Social and Emotional Concerns 259
Introduction 259
9.1 Death and Dying 260
9.2 Grief and Loss 268
9.3 Anger, Abuse, and Violence 274
Summary 287
Key Terms 287
Assessments 288
References 292
UNIT 3 CLIENT RIGHTS AND LEGAL ISSUES
CHAPTER 10
Legal and Ethical Guidelines 307
Introduction 307
10.1 Client Rights and Protections 307
10.2 Legal Issues Relating to Mental Health Nursing 310
10.3 Ethical Standards in Mental Health Nursing 327
Summary 330
Key Terms 330
Assessments 331
References 334
CHAPTER 11
Court Involvement 339
Introduction 339
11.1 Reasons for Court-Ordered Treatment 340
11.2 Violence and Safety 344
11.3 Powers of Attorney and Advance Directives 350
11.4 Guardianship and Conservatorship 353
Summary 356
, Key Terms 356
Assessments 357
References 361
CHAPTER 12
Self-Determination and Advocacy 365
Introduction 365
12.1 Client Representation for Empowerment and Relationship Rebuilding 366
12.2 Autonomy and Independence 369
12.3 Self-Advocacy 372
12.4 Client Advocacy 375
Summary 380
Key Terms 380
Assessments 380
References 385
UNIT 4 PSYCHIATRIC NURSING PRACTICE
CHAPTER 13
Clinical Guidelines and Practice 389
Introduction 389
13.1 Clinical Guidelines and Standards 390
13.2 DSM-5 Criteria and Use 397
13.3 Nursing Assessment and Care Plans 400
13.4 Promoting Recovery in Psychiatric Nursing 404
13.5 Special Considerations for PMH Practice 407
Summary 411
Key Terms 411
Assessments 412
References 420
CHAPTER 14
Neurocognitive Disorders 423
Introduction 423
14.1 Mild Neurocognitive Disorders 423
14.2 Delirium 427
14.3 Dementia 429
Summary 437
Key Terms 437
Assessments 438
References 440
CHAPTER 15
Schizophrenia Spectrum Disorder and Other Psychotic
Disorders 443
Introduction 443
15.1 Schizophrenia 444
15.2 Schizophrenia Spectrum Disorders 466
15.3 Delusional Disorder 469
Access for free at openstax.org
,Psychiatric-Mental Health Nursing
SENIOR CONTRIBUTING AUTHORS
REBECCA PUCHKORS, BAYLOR UNIVERSITY
JEANNE SAUNDERS, DAYTONA STATE COLLEGE
DAVID SHARP, MISSISSIPPI COLLEGE
,OpenStax
Rice University
6100 Main Street MS-375
Houston, Texas 77005
To learn more about OpenStax, visit https://openstax.org.
Individual print copies and bulk orders can be purchased through our website.
©2024 Rice University. Textbook content produced by OpenStax is licensed under a Creative Commons
Attribution 4.0 International License (CC BY 4.0). Under this license, any user of this textbook or the textbook
contents herein must provide proper attribution as follows:
- If you redistribute this textbook in a digital format (including but not limited to PDF and HTML), then you
must retain on every page the following attribution:
“Access for free at openstax.org.”
- If you redistribute this textbook in a print format, then you must include on every physical page the
following attribution:
“Access for free at openstax.org.”
- If you redistribute part of this textbook, then you must retain in every digital format page view (including
but not limited to PDF and HTML) and on every physical printed page the following attribution:
“Access for free at openstax.org.”
- If you use this textbook as a bibliographic reference, please include
https://openstax.org/details/books/psychiatric-mental-health in your citation.
For questions regarding this licensing, please contact .
Trademarks
The OpenStax name, OpenStax logo, OpenStax book covers, OpenStax CNX name, OpenStax CNX logo,
OpenStax Tutor name, Openstax Tutor logo, Connexions name, Connexions logo, Rice University name, and
Rice University logo are not subject to the license and may not be reproduced without the prior and express
written consent of Rice University.
HARDCOVER BOOK ISBN-13 978-1-711472-91-1
B&W PAPERBACK BOOK ISBN-13 978-1-711472-90-4
DIGITAL VERSION ISBN-13 978-1-961584-42-6
ORIGINAL PUBLICATION YEAR 2024
1 2 3 4 5 6 7 8 9 10 OF 24
,OPENSTAX
OpenStax provides free, peer-reviewed, openly licensed textbooks for introductory college and Advanced
Placement® courses and low-cost, personalized courseware that helps students learn. A nonprofit ed tech
initiative based at Rice University, we’re committed to helping students access the tools they need to complete
their courses and meet their educational goals.
RICE UNIVERSITY
OpenStax is an initiative of Rice University. As a leading research university with a distinctive commitment to
undergraduate education, Rice University aspires to path-breaking research, unsurpassed teaching, and
contributions to the betterment of our world. It seeks to fulfill this mission by cultivating a diverse community
of learning and discovery that produces leaders across the spectrum of human endeavor.
PHILANTHROPIC SUPPORT
OpenStax is grateful for the generous philanthropic partners who advance our mission to improve educational
access and learning for everyone. To see the impact of our supporter community and our most updated list of
partners, please visit openstax.org/foundation.
Arnold Ventures Burt and Deedee McMurtry
Chan Zuckerberg Initiative Michelson 20MM Foundation
Chegg, Inc. National Science Foundation
Arthur and Carlyse Ciocca Charitable Foundation The Open Society Foundations
Digital Promise Jumee Yhu and David E. Park III
Ann and John Doerr Brian D. Patterson USA-International Foundation
Bill & Melinda Gates Foundation The Bill and Stephanie Sick Fund
Girard Foundation Steven L. Smith & Diana T. Go
Google Inc. Stand Together
The William and Flora Hewlett Foundation Robin and Sandy Stuart Foundation
The Hewlett-Packard Company The Stuart Family Foundation
Intel Inc. Tammy and Guillermo Treviño
Rusty and John Jaggers Valhalla Charitable Foundation
The Calvin K. Kazanjian Economics Foundation White Star Education Foundation
Charles Koch Foundation Schmidt Futures
Leon Lowenstein Foundation, Inc. William Marsh Rice University
The Maxfield Foundation
, Study where you want, what
you want, when you want.
When you access your book in our web view, you can use our new online
highlighting and note-taking features to create your own study guides.
Our books are free and flexible, forever.
Get started at openstax.org/details/books/psychiatric-mental-health
Access. The future of education.
openstax.org
,Contents
Preface 1
UNIT 1 THEORIES, PRACTICE, AND TRENDS
CHAPTER 1
Foundations of Psychiatric-Mental Health Nursing 9
Introduction 9
1.1 Mental Health and Mental Illness 10
1.2 Risk and Protective Factors of Mental Health 14
1.3 Mental Health Stigma 23
1.4 Mental Health Recovery and Wellness 27
1.5 Integration of Research- and Evidence-Based Standards 32
Summary 36
Key Terms 36
Assessments 37
References 40
CHAPTER 2
Fundamentals of Theories and Therapies 47
Introduction 47
2.1 Psychoanalytic Theories and Therapies 48
2.2 Interpersonal Theories and Therapies 51
2.3 Cognitive Theories and Therapies 56
2.4 Humanistic Theories and Therapies 59
2.5 Biological Theories and Therapies 61
2.6 Developmental Theories and Therapies 63
2.7 Holistic Health and Interventions 66
Summary 72
Key Terms 73
Assessments 74
References 78
CHAPTER 3
Communication, Perception, and Assessment 83
Introduction 83
3.1 Therapeutic Communication and Relationships 84
3.2 Client Perception of Illness 93
3.3 Nursing Assessment and Clinical Tools 95
Summary 101
Key Terms 101
Assessments 101
References 104
,CHAPTER 4
Neurobiology and Pharmacological Standards 107
Introduction 107
4.1 Foundations of Neurobiology 108
4.2 Psychopharmacology 117
4.3 Innovations in Mental Health 132
Summary 136
Key Terms 136
Assessments 138
References 143
UNIT 2 THERAPEUTIC CONSIDERATIONS IN
MENTAL HEALTH
CHAPTER 5
Therapeutic Settings 145
Introduction 145
5.1 Psychiatric-Mental Health Treatment Settings 146
5.2 Group Therapy 154
5.3 Community Support Systems 158
5.4 Family Support Systems 160
Summary 162
Key Terms 162
Assessments 163
References 166
CHAPTER 6
Therapeutic Relationships 169
Introduction 169
6.1 Nurse-Client Relationship 169
6.2 Family Dynamics 173
6.3 Peer Support 177
6.4 Client Engagement 179
6.5 Trauma-Informed Care 181
Summary 187
Key Terms 187
Assessments 188
References 191
CHAPTER 7
Interprofessional Care 195
Introduction 195
7.1 Collaboration and Coordination of Care 196
7.2 Recovery and Rehabilitative Needs 199
7.3 Discharge and Transfer 201
7.4 Continued Support 204
7.5 Online Self-Help and Therapy 207
7.6 Challenges to Continuity of Care 212
Access for free at openstax.org
,Summary 215
Key Terms 215
Assessments 216
References 222
CHAPTER 8
Cultural Considerations 225
Introduction 225
8.1 Understanding Cultural Differences 226
8.2 Ethical Practice in Culture and Diversity 231
8.3 Cultural Practice in Nursing 235
8.4 Diversity, Equity, and Inclusion 242
Summary 249
Key Terms 249
Assessments 250
References 254
CHAPTER 9
Social and Emotional Concerns 259
Introduction 259
9.1 Death and Dying 260
9.2 Grief and Loss 268
9.3 Anger, Abuse, and Violence 274
Summary 287
Key Terms 287
Assessments 288
References 292
UNIT 3 CLIENT RIGHTS AND LEGAL ISSUES
CHAPTER 10
Legal and Ethical Guidelines 307
Introduction 307
10.1 Client Rights and Protections 307
10.2 Legal Issues Relating to Mental Health Nursing 310
10.3 Ethical Standards in Mental Health Nursing 327
Summary 330
Key Terms 330
Assessments 331
References 334
CHAPTER 11
Court Involvement 339
Introduction 339
11.1 Reasons for Court-Ordered Treatment 340
11.2 Violence and Safety 344
11.3 Powers of Attorney and Advance Directives 350
11.4 Guardianship and Conservatorship 353
Summary 356
, Key Terms 356
Assessments 357
References 361
CHAPTER 12
Self-Determination and Advocacy 365
Introduction 365
12.1 Client Representation for Empowerment and Relationship Rebuilding 366
12.2 Autonomy and Independence 369
12.3 Self-Advocacy 372
12.4 Client Advocacy 375
Summary 380
Key Terms 380
Assessments 380
References 385
UNIT 4 PSYCHIATRIC NURSING PRACTICE
CHAPTER 13
Clinical Guidelines and Practice 389
Introduction 389
13.1 Clinical Guidelines and Standards 390
13.2 DSM-5 Criteria and Use 397
13.3 Nursing Assessment and Care Plans 400
13.4 Promoting Recovery in Psychiatric Nursing 404
13.5 Special Considerations for PMH Practice 407
Summary 411
Key Terms 411
Assessments 412
References 420
CHAPTER 14
Neurocognitive Disorders 423
Introduction 423
14.1 Mild Neurocognitive Disorders 423
14.2 Delirium 427
14.3 Dementia 429
Summary 437
Key Terms 437
Assessments 438
References 440
CHAPTER 15
Schizophrenia Spectrum Disorder and Other Psychotic
Disorders 443
Introduction 443
15.1 Schizophrenia 444
15.2 Schizophrenia Spectrum Disorders 466
15.3 Delusional Disorder 469
Access for free at openstax.org
