1. Mental Health Assessment Skills
Chapter 9
Mental Health Assessment Skills
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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.
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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.
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4. 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.
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5. 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
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6. 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
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7. 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.
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8. 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
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9. 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.
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10. 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.
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11. 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?
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12. 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?
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13. 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.
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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.
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Data Collection (pp )
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?
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16. 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
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17. 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.
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18. 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?
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19. 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.
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20. 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.
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21. 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?
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22. 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.
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23. 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.
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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.
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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.
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Thinking (p. 99)
Thought content relates to what an individual is thinking.
Clients may experience the following:
Delusions
Obsessions
Phobias
Preoccupations
Amnesia
Confabulations
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27. 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
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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
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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
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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
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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
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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
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