Mental health persists as a major concern for the US healthcare system, meaning that nurses interested in getting into psychiatry are in high demand across hospitals and clinics every year. A psychiatric mental health nurse practitioner (PMHNP) ensures that patients with acute mental illness and associated disorders find relief, therapy and medication where needed.
All nurse practitioners (NPs) and specialists find that their workloads vary immensely from day to day. However, these particular NPs need to be on their toes to aid and assist people who experience mental health breakdowns and distress at any given moment.
The Role of a PMHNP
A PMHNP typically supports patients with psychiatric disorders, those who are experiencing mental health breakdowns, and people recovering from substance abuse.
PMHNPs will closely discuss issues with patients, create care plans, and carry out assessments to assign the best courses of action. For example, in some cases, patients may require intervention therapy, cognitive behavioral therapy (CBT) or new courses of medication.
As such, the role is extremely collaborative. PMHNPs need to work with nursing staff, pharmacists and general practitioners beyond their remits to help ensure that their patients receive the support they need.
PMHNPs will also need to be on hand in an emergency, particularly if they are assigned to specific patients, and can provide insight into how to care for them to bring them back to a calm state.
PMHNPs and Emergency Strategies
When first learning how to become a psych NP, nursing students will study how to apply general psychiatric techniques in situations where care is needed to prioritize patient safety. Rockhurst University’s programs, for example, include a variety of modules where emergency and generic psychiatric care techniques are developed over time.
While PMHNPs may need the support of others should a patient require physical support, their skillset can help to calm and reassure people experiencing mental health breakdowns and who are a risk to themselves.
Here are a few ways that PMHNPs may be able to support such patients in emergency situations, though all cases will naturally vary.
De-escalating Scenarios
While it’s not a given that the patients treated by PMHNPs in emergencies will be their own (and will therefore understand the problems arising), they can still apply gentle therapy techniques to help bring people back from mental health episodes.
For example, a PMHNP may be able to support an emergency case by intervening with distraction and breathing techniques or by encouraging a patient to apply CBT practice at short notice. This, of course, depends entirely on whether or not a patient is responsive enough to come around to self-de-escalation.
In cases where patients can communicate clearly with carers, PMHNPs may ask them to talk through their thought processes and explore which coping strategies can help with soothing.
As mentioned, in cases where patients need physical support or may even be violent due to an episode, PMHNPs will frequently have to collaborate with others to help calm their emergency charges back to a level where they are comfortable and communicative.
Recommending Medication
PMHNPs understand the importance of specific medication courses that can improve or ease mental health conditions, whether in an emergency or from day to day. As such, in an emergency, a PMHNP will quickly assess medication needs and ascertain whether or not an urgent course is required.
This will require PMHNPs to access records and make snap decisions, albeit with the support of nurses and other specialists already assigned to the case. By collaborating in this way during an emergency, PMHNPs will learn more about the medication courses already taken. They can therefore make drug decisions that won’t clash or cause further issues.
PMHNPs need to think critically in emergencies about the safest ways to de-escalate a mental health crisis. Not all cases will de-escalate with emergency medication, meaning that some NPs may choose to pursue the urgent counseling route as a priority.
The danger with prescribing immediate or urgent medication in a mental health crisis is that some drugs can affect other treatments negatively. Therefore, a working knowledge of psychiatric drugs and the support of a pharmacist will be crucial in this situation.
Providing Immediate Safety
In some cases, patients experiencing mental health breakdowns may do so due to changes to their environment or the treatment received thus far. In this case, it’s up to PMHNPs to look for ways to help bring people experiencing these breakdowns back to safety.
This might mean encouraging a one-to-one session with a patient in an emergency, as they might feel overcrowded or overpowered. Alternatively, emergency psychiatric patients may simply need to move to an alternative space, such as a private room, to help calm them.
Sometimes, PMHNPs may find that the route to relieving emergency cases is to ask patients directly about what they need. With some mental health disorders, communicating even basic needs can become difficult.
In this case, PMHNPs must listen actively to what a patient has to say and effectively read between the lines while addressing case notes. It is a balancing act that, in the event of an emergency, will need quick, confident decision-making. Again, PMHNPs need to reach out to other specialists, particularly those already working a patient’s case, for advice and support.
All Emergency Cases Are Different
When graduating and entering work as a PMHNP, students must remember that the mental health spectrum is extremely broad. So also is the range of treatments available for people experiencing breakdowns.
Over time, PMHNPs will find effective strategies to support patient mental health in emergencies – even if they vary considerably from one case to the next.
There is no guarantee of a specialist ‘toolkit’ that PMHNPs can use to care for emergency patients. The most effective strategies in these situations are to fall back on soft skills and human intervention – to apply therapeutic technique where possible and to call on help from others for insight and physical support.
