Mental Health Assessment Skills Chapter 9 Mental Health Assessment Skills Copyright © 2013 by Elsevier Inc. All rights reserved.

Copyright © 2013 by Elsevier Inc. All rights reserved. Learning Objectives Identify two purposes of the mental health treatment plan. List and define each step of the nursing process. Describe three methods of data collection. List six parts of a holistic nursing assessment. Identify four guidelines for conducting effective psychiatric interviews. Copyright © 2013 by Elsevier Inc. All rights reserved.

Copyright © 2013 by Elsevier Inc. All rights reserved. Learning Objectives Explain the importance of performing physical assessments on clients with psychiatric diagnoses. Explain the purpose of the mental status examination. List the five general categories of the mental status examination. Describe the process for conducting a mental status examination. Copyright © 2013 by Elsevier Inc. All rights reserved.

Mental Health Treatment Plan (p. 92) Every psychological problem has physical effects, and each physical illness has psychological effects. The wise care provider is aware of both. Individuals entering into the mental health care system undergo a comprehensive assessment. Clients are interviewed by several members of the multidisciplinary health care team. List and describe the purposes of the mental health treatment plan. Copyright © 2013 by Elsevier Inc. All rights reserved.

Mental Health Treatment Plan, cont’d. (p. 92) Physician Provides information regarding a client’s physical state and the need for medications Social worker Assesses the client’s family, work, and social interactions Dietitian Learns about the client’s nutritional status Copyright © 2013 by Elsevier Inc. All rights reserved.

Mental Health Treatment Plan, cont’d. (p. 92) Psychiatrist and psychologist Explore the client’s emotional and cognitive (intellectual) functioning Nurse Assesses how the illness or disability affects the client’s activities of daily living Other care providers Contribute information through their observations and interactions with the client Copyright © 2013 by Elsevier Inc. All rights reserved.

Mental Health Treatment Plan, cont’d. (p. 93) When the team and the client agree on the treatment goals, a course of action is planned. Medical treatments (medications) are combined with psychotherapies, behavioral therapies, and other therapeutic actions. Treatment plans are developed especially for the individual client. Copyright © 2013 by Elsevier Inc. All rights reserved.

Mental Health Treatment Plan, cont’d. (p. 93) Purposes of the mental health treatment plan Acts as a guide for planning and implementing client care Serves as a vehicle for monitoring the client’s progress and the effectiveness of therapeutic interventions Serves as a means for communicating and coordinating client care Copyright © 2013 by Elsevier Inc. All rights reserved.

DSM-IV-TR Diagnosis (p. 93) The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) is a tool that is used to facilitate diagnosis and guide clinical practice. Clients are assessed and classified according to five categories or axes. This system helps care providers gain a more complete understanding of each person. Copyright © 2013 by Elsevier Inc. All rights reserved.

Nursing (Therapeutic) Process (p. 93) Designed to support goal-directed care for clients Serves as an organizational framework for effective care Consists of five steps: Assessment Diagnosis Planning Intervention Evaluation Encourages us to focus on the client and develop appropriate and effective care measures List and define each step of the nursing process. Copyright © 2013 by Elsevier Inc. All rights reserved.

Nursing (Therapeutic) Process, cont’d. (p. 93) Assessment Data are collected. Diagnosis Data are sorted into related areas, and problems are identified. Each problem then is examined in detail. Planning “Expected outcomes” then are used to monitor the client’s progress. Discuss all the sources of assessment data and what is involved in the diagnosis phase What is involved in the planning stage of the nursing process? Copyright © 2013 by Elsevier Inc. All rights reserved.

Nursing (Therapeutic) Process, cont’d. (p. 94) Intervention Planned actions are implemented. Actions are carried out by all mental health care team members. Therapeutic actions guide clients toward their goals. Evaluation Effectiveness of care is determined. What is the goal of the evaluation phase? Copyright © 2013 by Elsevier Inc. All rights reserved.

Nursing (Therapeutic) Process, cont’d. (p. 94) Clients are involved as partners in care. Caregivers help clients problem-solve by involving them in the care-planning process. The art of choosing the best course of action must be practiced carefully. Let the “do no harm” principle guide you as you grow. Copyright © 2013 by Elsevier Inc. All rights reserved.

Copyright © 2013 by Elsevier Inc. All rights reserved. Assessment (p. 94) Assessment The “gathering, verifying and communicating of information relative to the client” Holistic assessment includes gathering information regarding physical, intellectual, social, cultural, and spiritual aspects of each client. Copyright © 2013 by Elsevier Inc. All rights reserved.

Copyright © 2013 by Elsevier Inc. All rights reserved. Data Collection (pp. 94-95) Data are grouped into objective and subjective categories. Objective data refers to information that can be measured and shared. Gathered through the senses of sight, smell, touch, and hearing Subjective data relates to clients’ perceptions. The experiences of pain, nausea, and anxiety cannot be measured by anyone other than the individual who is experiencing them. What are the methods of data collection? What are some examples of subjective and objective data? Copyright © 2013 by Elsevier Inc. All rights reserved.

Data Collection Methods (p. 95) Data collection methods for care providers include the following: Interview A meeting of persons for the purpose of obtaining or exchanging information Observational techniques Process of purposeful looking Rating scales and inventories Data gathering tools specifically designed to bring out certain types of information Copyright © 2013 by Elsevier Inc. All rights reserved.

Assessment Process (p. 95) The psychiatric assessment tool focuses on obtaining data about the problems, coping behaviors, and resources of clients. Risk factor assessment Required for clients who may pose a risk for violence toward themselves or others Helps “formulate a nursing diagnosis based on the identification of risk factors that potentially present an immediate threat to the patient” Completed by a registered nurse Discuss the six parts of the nursing holistic assessment. Copyright © 2013 by Elsevier Inc. All rights reserved.

The Health History (pp. 95-96) Effective interviews Success of any client interview rests on the caregiver’s ability to listen objectively and respond appropriately. Guidelines for an effective interview: Personal values must not cloud professional judgments. Make no assumptions. Take into account the client’s cultural and religious values and beliefs. Pay attention to nonverbal communications. Have clearly set goals. Monitor your own reactions. Why is the self-awareness of the nurse important in the interview process? Copyright © 2013 by Elsevier Inc. All rights reserved.

The Health History cont’d. (p. 96) Sociocultural assessment Concentrates on the cultural, social, and spiritual aspects of an individual Focuses on six areas: Age Ethnicity (culture) Gender Education Income Belief system Risk factors and stressors also are defined during the sociocultural assessment. Copyright © 2013 by Elsevier Inc. All rights reserved.

The Health History cont’d. (p. 96) Review of each body system and its functioning Clients are questioned about the following: General health care Past illnesses Hospitalizations Family health history Questions then focus on the function of each body system. The lifestyle and activities of daily living also are assessed. Copyright © 2013 by Elsevier Inc. All rights reserved.

Physical assessment (p. 97) Performed to discover physical problems that can be treated medically A complete physical examination is performed by a physician or a nurse practitioner. Not needed every day Diagnostic studies include the following: Standard blood tests Urine tests Hormone function tests Human immunodeficiency virus (HIV) and tuberculosis (TB) X-ray, positron emission tomography (PET), and magnetic resonance imaging (MRI) Electrocardiograms (ECGs) Why is it important to perform physical assessments on clients with psychiatric diagnoses? Copyright © 2013 by Elsevier Inc. All rights reserved.

Mental Status Assessment (p. 98) Allows care providers to observe and describe a client’s behavior in an objective, nonjudgmental way Explores the following areas: General description Emotional state Experiences Thinking Sensorium Cognition Why is a mental status assessment performed? List and describe the five general categories of the mental status examination. Copyright © 2013 by Elsevier Inc. All rights reserved.

General Description (p. 98) Client is assessed for the following: General appearance Speech Motor activity Behavior during the interaction All findings are documented. How does the client’s appearance provide cues to his or her mental status? The documentation of the assessment should provide a clear description of all aspects of the client’s appearance. Copyright © 2013 by Elsevier Inc. All rights reserved.

Copyright © 2013 by Elsevier Inc. All rights reserved. Emotional State (p. 98) To assess the client’s emotional state, the care provider considers the client’s mood and affect. Document objective descriptions of the client’s behaviors. Descriptions communicate much more information than is conveyed by a single medical term. Copyright © 2013 by Elsevier Inc. All rights reserved.

Copyright © 2013 by Elsevier Inc. All rights reserved. Experiences (p. 99) Experience assessments explore the client’s perceptions, which is the way that he or she experiences the world. An individual’s perceptions often are called his or her frame of reference. A person’s perceptions help to determine his or her sense of reality. Copyright © 2013 by Elsevier Inc. All rights reserved.

Copyright © 2013 by Elsevier Inc. All rights reserved. Thinking (p. 99) Thought content relates to what an individual is thinking. Clients may experience the following: Delusions Obsessions Phobias Preoccupations Amnesia Confabulations Copyright © 2013 by Elsevier Inc. All rights reserved.

Sensorium and Cognition (p. 100) Sensorium is that part of the consciousness that perceives, sorts, and combines information. People with a clear sensorium are oriented to time, place, and person. In this category, patients are assessed for Memory Calculation Judgment Education level Insight Copyright © 2013 by Elsevier Inc. All rights reserved.

Copyright © 2013 by Elsevier Inc. All rights reserved. Question 1 The mental health treatment plan serves several purposes. Which of the following is not one of the purposes? It is a guide for planning and implementing client care. It is a guide for physicians and nurses in diagnosing clients. It serves as a vehicle for monitoring the client’s progress and the effectiveness of therapeutic interventions. It serves as a means of communicating and coordinating client care. Correct Answer: 2 Copyright © 2013 by Elsevier Inc. All rights reserved.

Copyright © 2013 by Elsevier Inc. All rights reserved. Question 2 The nurse is reviewing her client’s history and is making observations about her client as well. What step of the nursing process is the nurse implementing? Assessment Identifying problems Planning Intervention Correct Answer: 1 Copyright © 2013 by Elsevier Inc. All rights reserved.

Copyright © 2013 by Elsevier Inc. All rights reserved. Question 3 The nurse is reviewing the effectiveness of her care. Which phase of the nursing process is she performing? Identifying problems Planning Providing intervention Performing evaluation Correct Answer: 4 Copyright © 2013 by Elsevier Inc. All rights reserved.

Copyright © 2013 by Elsevier Inc. All rights reserved. Question 4 The nurse is going to perform a holistic assessment on her client. Which of the following is not one of the aspects of a holistic assessment? Physical Mental Cultural Intellectual Correct Answer: 2 Copyright © 2013 by Elsevier Inc. All rights reserved.

Copyright © 2013 by Elsevier Inc. All rights reserved. Question 5 The nurse is trying to obtain a history from her client. She is having a difficult time because her client is using false statements to fill in gaps of memory loss. This client’s behavior is known as what? Amnesia Confabulation Delusions Flight of ideas Correct Answer: 2 Copyright © 2013 by Elsevier Inc. All rights reserved.