Mental Health Nursing: Essential Theories
& Patient Care Plans
Comprehensive Q&A Guide - Latest Edition 2025
SECTION 1: FOUNDATIONAL CONCEPTS &
THEORIES
Question 1: What is the therapeutic nurse-patient relationship and what are its
phases according to Peplau's theory?
Answer: The therapeutic nurse-patient relationship is a professional, goal-directed interaction
between nurse and patient that promotes the patient's health and well-being. According to
Hildegard Peplau's Interpersonal Relations Theory (1952, revised), there are four sequential
phases:
1. Orientation Phase: The nurse and patient meet as strangers. The patient's needs are
identified, trust begins to develop, and the contract for the relationship is established.
The nurse assesses the patient's perception of their problem and clarifies expectations.
2. Identification Phase: The patient begins to respond selectively to the nurse and
identifies with them. The patient expresses feelings and begins to feel stronger. Multiple
transference reactions may occur.
3. Exploitation Phase: The patient makes full use of available services and explores all
possibilities of the relationship. The patient begins to develop independence and works
toward goal achievement.
4. Resolution Phase: The patient's needs have been met through collaborative efforts. The
patient gradually breaks away from the nurse and the therapeutic relationship ends. This
phase requires successful completion of previous phases.
Question 2: Describe Maslow's Hierarchy of Needs and its application in mental
health nursing.
,Answer: Abraham Maslow's Hierarchy of Needs (1943) is a five-tier pyramid model of human
motivation that mental health nurses use to prioritize patient care:
1. Physiological Needs (base): Basic survival needs including air, water, food, shelter,
sleep, and homeostasis. In mental health, this includes ensuring patients eat, sleep, and
maintain physical health.
2. Safety Needs: Security, stability, freedom from fear, structure, and order. Mental health
applications include providing a safe therapeutic environment, crisis intervention, and
medication management.
3. Love and Belonging Needs: Relationships, affection, intimacy, family, and friendship.
Nurses facilitate group therapy, family involvement, and social skills development.
4. Esteem Needs: Self-respect, achievement, recognition, and respect from others.
Therapeutic interventions focus on building self-confidence and promoting autonomy.
5. Self-Actualization (top): Realizing personal potential, self-fulfillment, and personal
growth. The ultimate goal of mental health treatment is helping patients achieve their
full potential.
Clinical Application: Nurses must address lower-level needs before higher-level needs. For
example, a suicidal patient's safety needs must be secured before working on self-esteem issues.
Question 3: What is the Stress-Adaptation Model and how does it explain
mental illness?
Answer: The Stress-Adaptation Model (also called the Diathesis-Stress Model) explains
mental illness as resulting from the interaction between biological predisposition (diathesis)
and environmental stressors. Key components include:
Biological Factors: Genetic vulnerability, neurochemical imbalances, brain structure
abnormalities, and temperament create predisposition to mental illness.
Psychological Factors: Coping skills, personality traits, cognitive patterns, and previous
trauma influence stress response.
,Environmental Stressors: Life events, chronic stress, trauma, substance abuse, and social
factors trigger symptoms in vulnerable individuals.
Adaptation: The model suggests that mental illness occurs when stressors exceed an
individual's adaptive capacity. The same stressor may cause illness in one person but not
another, depending on their biological vulnerability and coping resources.
Nursing Implications: Treatment focuses on reducing stressors, enhancing coping
mechanisms, addressing biological vulnerabilities (medications), and building resilience.
Nurses assess both the patient's stressors and their adaptive resources to develop
comprehensive care plans.
Question 4: Explain the Cognitive-Behavioral Theory and its therapeutic
applications.
Answer: Cognitive-Behavioral Theory, developed by Aaron Beck and Albert Ellis, posits that
thoughts, feelings, and behaviors are interconnected, and that maladaptive thinking patterns
lead to emotional and behavioral problems.
Core Principles:
Cognitive distortions (negative automatic thoughts) contribute to mental health
disorders
Thoughts influence emotions and behaviors
Changing thought patterns can change feelings and behaviors
Present-focused and problem-oriented approach
Common Cognitive Distortions:
All-or-nothing thinking (black and white thinking)
Overgeneralization (one event means everything)
Mental filtering (focusing only on negatives)
Catastrophizing (expecting the worst)
Personalization (taking things personally without evidence)
, Therapeutic Applications:
1. Cognitive Restructuring: Identifying and challenging distorted thoughts
2. Behavioral Activation: Scheduling activities to improve mood
3. Exposure Therapy: Gradual confrontation of feared situations
4. Skills Training: Teaching relaxation, problem-solving, and assertiveness
Nursing Role: Nurses help patients identify cognitive distortions, challenge negative thoughts,
and practice new behavioral patterns through homework assignments and therapeutic
conversations.
Question 5: What is the Recovery Model in mental health care?
Answer: The Recovery Model is a holistic, person-centered approach to mental health care
that emphasizes hope, empowerment, and the potential for individuals to live fulfilling lives
despite mental illness. Developed in the 1990s, it represents a paradigm shift from medical
model thinking.
Core Principles:
1. Hope: Recovery is possible for everyone; mental illness doesn't define a person
2. Person-Centered: Individual leads their own recovery journey
3. Holistic: Addresses all life aspects - physical, emotional, social, spiritual
4. Empowerment: Patients are experts in their own recovery
5. Respect: Dignity, rights, and self-determination are paramount
6. Responsibility: Patients take responsibility for their wellness
7. Meaningful Life: Focus on living well, not just symptom reduction
Key Components:
Self-direction and self-determination
Individualized and person-centered care
Strengths-based approach (not deficit-focused)
Peer support and mutual aid
& Patient Care Plans
Comprehensive Q&A Guide - Latest Edition 2025
SECTION 1: FOUNDATIONAL CONCEPTS &
THEORIES
Question 1: What is the therapeutic nurse-patient relationship and what are its
phases according to Peplau's theory?
Answer: The therapeutic nurse-patient relationship is a professional, goal-directed interaction
between nurse and patient that promotes the patient's health and well-being. According to
Hildegard Peplau's Interpersonal Relations Theory (1952, revised), there are four sequential
phases:
1. Orientation Phase: The nurse and patient meet as strangers. The patient's needs are
identified, trust begins to develop, and the contract for the relationship is established.
The nurse assesses the patient's perception of their problem and clarifies expectations.
2. Identification Phase: The patient begins to respond selectively to the nurse and
identifies with them. The patient expresses feelings and begins to feel stronger. Multiple
transference reactions may occur.
3. Exploitation Phase: The patient makes full use of available services and explores all
possibilities of the relationship. The patient begins to develop independence and works
toward goal achievement.
4. Resolution Phase: The patient's needs have been met through collaborative efforts. The
patient gradually breaks away from the nurse and the therapeutic relationship ends. This
phase requires successful completion of previous phases.
Question 2: Describe Maslow's Hierarchy of Needs and its application in mental
health nursing.
,Answer: Abraham Maslow's Hierarchy of Needs (1943) is a five-tier pyramid model of human
motivation that mental health nurses use to prioritize patient care:
1. Physiological Needs (base): Basic survival needs including air, water, food, shelter,
sleep, and homeostasis. In mental health, this includes ensuring patients eat, sleep, and
maintain physical health.
2. Safety Needs: Security, stability, freedom from fear, structure, and order. Mental health
applications include providing a safe therapeutic environment, crisis intervention, and
medication management.
3. Love and Belonging Needs: Relationships, affection, intimacy, family, and friendship.
Nurses facilitate group therapy, family involvement, and social skills development.
4. Esteem Needs: Self-respect, achievement, recognition, and respect from others.
Therapeutic interventions focus on building self-confidence and promoting autonomy.
5. Self-Actualization (top): Realizing personal potential, self-fulfillment, and personal
growth. The ultimate goal of mental health treatment is helping patients achieve their
full potential.
Clinical Application: Nurses must address lower-level needs before higher-level needs. For
example, a suicidal patient's safety needs must be secured before working on self-esteem issues.
Question 3: What is the Stress-Adaptation Model and how does it explain
mental illness?
Answer: The Stress-Adaptation Model (also called the Diathesis-Stress Model) explains
mental illness as resulting from the interaction between biological predisposition (diathesis)
and environmental stressors. Key components include:
Biological Factors: Genetic vulnerability, neurochemical imbalances, brain structure
abnormalities, and temperament create predisposition to mental illness.
Psychological Factors: Coping skills, personality traits, cognitive patterns, and previous
trauma influence stress response.
,Environmental Stressors: Life events, chronic stress, trauma, substance abuse, and social
factors trigger symptoms in vulnerable individuals.
Adaptation: The model suggests that mental illness occurs when stressors exceed an
individual's adaptive capacity. The same stressor may cause illness in one person but not
another, depending on their biological vulnerability and coping resources.
Nursing Implications: Treatment focuses on reducing stressors, enhancing coping
mechanisms, addressing biological vulnerabilities (medications), and building resilience.
Nurses assess both the patient's stressors and their adaptive resources to develop
comprehensive care plans.
Question 4: Explain the Cognitive-Behavioral Theory and its therapeutic
applications.
Answer: Cognitive-Behavioral Theory, developed by Aaron Beck and Albert Ellis, posits that
thoughts, feelings, and behaviors are interconnected, and that maladaptive thinking patterns
lead to emotional and behavioral problems.
Core Principles:
Cognitive distortions (negative automatic thoughts) contribute to mental health
disorders
Thoughts influence emotions and behaviors
Changing thought patterns can change feelings and behaviors
Present-focused and problem-oriented approach
Common Cognitive Distortions:
All-or-nothing thinking (black and white thinking)
Overgeneralization (one event means everything)
Mental filtering (focusing only on negatives)
Catastrophizing (expecting the worst)
Personalization (taking things personally without evidence)
, Therapeutic Applications:
1. Cognitive Restructuring: Identifying and challenging distorted thoughts
2. Behavioral Activation: Scheduling activities to improve mood
3. Exposure Therapy: Gradual confrontation of feared situations
4. Skills Training: Teaching relaxation, problem-solving, and assertiveness
Nursing Role: Nurses help patients identify cognitive distortions, challenge negative thoughts,
and practice new behavioral patterns through homework assignments and therapeutic
conversations.
Question 5: What is the Recovery Model in mental health care?
Answer: The Recovery Model is a holistic, person-centered approach to mental health care
that emphasizes hope, empowerment, and the potential for individuals to live fulfilling lives
despite mental illness. Developed in the 1990s, it represents a paradigm shift from medical
model thinking.
Core Principles:
1. Hope: Recovery is possible for everyone; mental illness doesn't define a person
2. Person-Centered: Individual leads their own recovery journey
3. Holistic: Addresses all life aspects - physical, emotional, social, spiritual
4. Empowerment: Patients are experts in their own recovery
5. Respect: Dignity, rights, and self-determination are paramount
6. Responsibility: Patients take responsibility for their wellness
7. Meaningful Life: Focus on living well, not just symptom reduction
Key Components:
Self-direction and self-determination
Individualized and person-centered care
Strengths-based approach (not deficit-focused)
Peer support and mutual aid
