# Psychiatric Nursing Basics

> Nursing notes on psychiatric nursing basics: therapeutic relationship and milieu, defence mechanisms, ECT nursing care, drug side effects and Mental Health Act.

- Canonical URL: https://prepelephant.com/topics/allied/nursing/psychiatric-nursing-basics
- Exam / course: Allied Health · Subject: Nursing
- Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team
- First published: 2026-10-02
- Last updated: 2026-10-02
- How to cite: "Psychiatric Nursing Basics", PrepElephant, https://prepelephant.com/topics/allied/nursing/psychiatric-nursing-basics

## Direct answer

Psychiatric nursing rests on the therapeutic use of self — a purposeful nurse-patient relationship, a safe structured milieu and communication adapted to the illness — alongside knowledge of common disorders and their treatments. The relationship moves through orientation, working and termination phases with clear boundaries, and everyday care draws on behavioural principles, defence mechanisms and psychotropic side-effect profiles. In India, the Mental Healthcare Act 2017 provides the framework: rights-based care in the least restrictive setting.

## What you must remember

- The therapeutic relationship has orientation (contracting, trust, data collection), working (active problem-solving) and termination (evaluation and separation) phases; consistency and boundaries matter more than friendliness.
- The therapeutic milieu is a structured, safe, predictable environment with scheduled activities and clear expectations — itself a treatment, not mere containment.
- Defence mechanisms: repression (unconscious forgetting), denial, projection (attributing one's feelings to others), displacement (redirecting emotion to a safer target), rationalisation, regression, reaction formation, undoing, conscious suppression and mature sublimation.
- Schizophrenia care: do not argue with delusions or hallucinations, present reality calmly, reduce stimulation and watch for command hallucinations; depression care includes direct, gentle suicide-risk assessment — asking does not implant the idea.
- Mania care: low stimulation, firm calm limits, high-calorie finger foods on the move, safe channelling of energy and protection from exhaustion.
- ECT nursing: confirm consent, keep nil by mouth beforehand (commonly about six hours), remove dentures and ornaments, record baseline vitals; afterwards position side-lying until fully awake, reorient and monitor airway.
- Psychotropic side effects: extrapyramidal symptoms from antipsychotics (acute dystonia, akathisia, pseudoparkinsonism, tardive dyskinesia), neuroleptic malignant syndrome (rigidity with fever — emergency), and lithium toxicity (tremor, vomiting, confusion) with its narrow therapeutic range needing level monitoring.

## Common confusion

Defence mechanisms are swapped in every examination: projection puts one's own unacceptable feelings onto others, while displacement keeps the feeling but changes the target; repression is unconscious, suppression conscious; sublimation is mature. Students also mix therapeutic honesty with over-friendliness — self-disclosure and gift exchange breach boundaries. In depression, the trap is avoiding the word suicide; the correct action is to ask directly. Remember that modern ECT is modified, anaesthetised and consent-based.

## Exam-focused takeaway

Defence-mechanism matching is the most reliable question type — memorise each definition with one example. Expect lithium stems (therapeutic range commonly 0.6–1.2 mEq/L, toxicity above about 1.5 — hold the drug and inform), extrapyramidal symptom identification and ECT preparation questions where nil by mouth and denture removal lead. Scenario questions test communication with psychotic patients and safety prioritisation in suicidality. A line on the Mental Healthcare Act 2017 — rights-based, least restrictive, decriminalising attempted suicide — strengthens long answers.

## Frequently asked questions

### What phases make up the nurse-patient relationship?

Orientation, working and termination — beginning with trust and contracting, moving to problem-solving, ending with planned evaluation and separation.

### What is the therapeutic milieu?

A structured ward environment with safety, predictable routines, planned activities and consistent staff behaviour that itself supports recovery.

### How is projection different from displacement?

Projection attributes one's own unacceptable feelings to another, while displacement keeps the feeling but redirects it to a safer target.

### What nursing care does ECT require?

Consent, nil by mouth beforehand, removal of dentures and ornaments and baseline vitals before; side-lying positioning, reorientation and airway and vital sign monitoring after.

### What are the extrapyramidal side effects of antipsychotics?

Acute dystonia, akathisia and pseudoparkinsonism early, tardive dyskinesia late — with neuroleptic malignant syndrome (rigidity and fever) as the emergency.