All Nurses Are Psych Nurses (Podcast)

Caring for patients with behavioral health needs who are admitted to units for another primary diagnosis

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There’s an adage that every nurse is a psych nurse. While your specialty may be medical-surgical or cardiac care nursing, patients sometimes are admitted to the unit with behavioral health needs in addition to their primary diagnosis.

“It’s common knowledge that patients who come in with heart trouble, heart attacks, heart surgeries, etc. almost always receive some kind of depression as a little something extra to go with their diagnosis,” says Jim Pehotsky, RN, a clinical nurse at Cleveland Clinic Lutheran Hospital who cares for patients with behavioral health needs. “And it’s important for us to be mindful of that as nurses because that might be something that needs to be treated and, if it’s treated, it might improve the prognosis of that patient.”

In a recent episode of Cleveland Clinic’s Nurse Essentials podcast, Pehotsky discusses the importance of focusing on what the patient needs as a whole person – including behavioral health needs. He taps into his 15 years of experience on a psychiatric unit and shares insight on:

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  • Advocating for patients with additional behavioral health diagnoses
  • Assessing patients and the physical environment to keep them and caregivers safe
  • Providing guidance to sitters so they know what risk factors to look for
  • Considering a patient’s psychological wellbeing when planning for discharge
  • Using de-escalation tools with patients and family members

Click the podcast player above to listen to the episode now, or read on for a short edited excerpt. Check out more Nurse Essential episodes at or wherever you get your podcasts.

Podcast excerpt

Podcast host Carol Pehotsky, DNP, RN, NEA-BC: How do we best advocate for patients who have an additional diagnosis of behavioral health need when they’re having surgery? Maybe their medications have been put on hold as part of that surgery or they came in unable to tolerate their medications. What are some things that a medical-surgical nurse, for example, should be looking for to advocate for that patient’s needs?

Jim Pehotsky: Well, every kind of mental health diagnosis – and there are many, many different kinds of diagnoses – can involve a patient having a physical problem going on as well. A person with a diagnosis of paranoid schizophrenia, for example, may need a knee surgery at some point. A person with profound depression may have some type of diagnosis where they end up having that heart surgery. What’s going to happen to the person who’s already depressed when they come out of that heart surgery?

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So, a good nurse is going to make sure that before that patient has that surgery, they’re going to want to know that patient’s history. It would be important to know that a patient – such as someone who has delusions, someone who has some type of paranoia – may have to go off their medications in order to have that surgery for various reasons. Some medications may have an adverse effect on anesthesia, some medications may affect bleeding, etc., and the surgeon may say, “Well, I will go ahead and do this surgery, but this patient needs to be off this medication for X amount of days.” Well, what does that mean for someone who relies on that medication to be stable mentally? It could really cause a problem.

Plus, when that patient comes out of anesthesia, we don’t know how that patient is going to react. So, if the good nurse is making sure they know that patient’s history, then that is a one big step to helping that patient stay safe. Especially when they come out of that surgery, they may not have their faculties about them, they may get anxious, they may be confused or delusional, they may be afraid.