NCLEX Review Guide: Mental Health Problems & Moral Injury

Mental Health vs. Mental Illness

• Mental health is a state of well-being where individuals realize their potential, cope with normal life stresses, work productively, and contribute to their community. It exists on a continuum from optimal functioning to severe impairment.
• Mental illness refers to diagnosable disorders that significantly interfere with cognitive, emotional, or behavioral functioning. These conditions require professional intervention and may include depression, anxiety, schizophrenia, and bipolar disorder.

Major Depressive Disorder

• Major symptoms include persistent sadness, loss of interest in activities, significant weight changes, sleep disturbances, fatigue, feelings of worthlessness, and difficulty concentrating for at least 2 weeks. Assess for suicidal ideation in all depressed patients.
• Nursing interventions focus on establishing therapeutic relationships, monitoring for suicide risk, encouraging medication compliance, and promoting self-care activities.

Anxiety Disorders

• Generalized Anxiety Disorder (GAD) involves excessive worry about multiple life areas for 6+ months, accompanied by physical symptoms like muscle tension, fatigue, and restlessness.
• Panic Disorder features recurrent panic attacks with intense fear, palpitations, sweating, trembling, and feelings of impending doom lasting 5-20 minutes.

Understanding Moral Injury

• Moral injury occurs when healthcare professionals witness, perpetrate, or fail to prevent acts that violate their moral beliefs and values. This psychological wound results from being unable to provide care that aligns with professional and personal ethical standards.
• Common triggers include inadequate staffing, resource limitations, futile care situations, and witnessing preventable patient harm. Unlike burnout, moral injury stems from ethical conflicts rather than workload stress.

Signs and Symptoms

• Emotional symptoms include guilt, shame, anger, numbness, and loss of meaning in work. May progress to depression, anxiety, or PTSD if untreated.
• Physical manifestations encompass sleep disturbances, appetite changes, headaches, and gastrointestinal issues similar to other stress-related conditions.

Therapeutic Communication

1. Establish rapport using active listening, empathy, and non-judgmental attitudes
2. Use open-ended questions to encourage expression of feelings
3. Validate patient experiences and normalize emotional responses
4. Maintain appropriate boundaries while showing genuine concern
5. Document mental status assessments and interventions accurately

Crisis Intervention

• Priority: Ensure safety by removing harmful objects, providing constant observation for high-risk patients, and implementing suicide precautions as indicated.
• De-escalation techniques include speaking calmly, maintaining non-threatening posture, offering choices when possible, and avoiding power struggles with agitated patients.