NR 548 Psychiatric Assessment for
Psychiatric-Mental Health Nurse Practitioner
Exam 2 Week 3-4 Covered
1. Psychiatric interview: the process by which psychiatric assessment is conduct- ed
-primary tasks
• building a therapeutic alliance between the PMHNP & client
• obtaining a database of psychiatric info about the client
• establishing a dx
• negotiating a tx plan
2. Therapeutic Alliance: a feeling that you should create over the course of the
,diagnostic interview, a sense of rapport, trust, and warmth
-most important goal of the interview process
-the cooperative working relationship between the therapist and client
• begins during the initial or opening phase of the interview
-fundamental component of successful therapy
• Without trust, adherence to treatment recommendations may be compromised
• interview may not elicit the information needed to formulate an appropriate dx & plan
of care without rapport & trust
3. Creating rapport: tips: -Be Yourself
-Be Warm, Courteous, and Emotionally Sensitive
-Actively Defuse the Strangeness of the Clinical Situation
-Give Your Patient the Opening Word
-Gain Your Patient's Trust by Projecting Competence
4. How to approach threatening topics (sensitive/embarrassing material): -
-Normalization
-Symptom Expectation
-Symptom Exaggeration
-Reduction of Guilt
,-Use Familiar Language When Asking about Behaviors
5. Normalization: Introducing Q with some type of normalizing statement
-two principal ways to do this:
1. start the question by implying that the behavior is a normal or understandable
response to a mood or situation
• ex: Sometimes when people are very depressed, they think of hurting themselves. Has
this been true for you?
2. Begin by describing another patient (or patients) who has engaged in the behavior,
showing your patient that she is not alone
• ex: I've talked to several patients who've said that their depression causes them to have
strange experiences, like hearing voices or thinking that strangers are laughing at them. Has
that been happening to you?
, 6. Symptom Expectation: communicate that a behavior is in some way normal or
expected
-Phrase your Q's to imply that you already assume the patient has engaged in some behavior
and that you will not be offended by a positive response
-high index of suspicion of some self-destructive activity
-Ex: patient is profoundly depressed and has expressed feelings of hopelessness. You
suspect suicidality, but you sense that the patient may be too ashamed to admit it. Rather
than gingerly asking "Have you had any thoughts that you'd be better off dead?" you
might decide to use symptom expectation. "What kinds of ways to hurt yourself have you
thought about?"
*reserve this technique for situations in which it seems appropriate
7. Symptom Exaggeration: suggesting a frequency of a problematic behavior that is
higher than your expectation, so that the patient feels that their actual, lower frequency
of the behavior will not be perceived by you as being "bad."
-helpful in clarifying the severity of symptoms
*reserve this technique for situations in which it seems appropriate
8. Reduction of guilt: seeks to directly reduce a patient's guilt about a specific
Psychiatric-Mental Health Nurse Practitioner
Exam 2 Week 3-4 Covered
1. Psychiatric interview: the process by which psychiatric assessment is conduct- ed
-primary tasks
• building a therapeutic alliance between the PMHNP & client
• obtaining a database of psychiatric info about the client
• establishing a dx
• negotiating a tx plan
2. Therapeutic Alliance: a feeling that you should create over the course of the
,diagnostic interview, a sense of rapport, trust, and warmth
-most important goal of the interview process
-the cooperative working relationship between the therapist and client
• begins during the initial or opening phase of the interview
-fundamental component of successful therapy
• Without trust, adherence to treatment recommendations may be compromised
• interview may not elicit the information needed to formulate an appropriate dx & plan
of care without rapport & trust
3. Creating rapport: tips: -Be Yourself
-Be Warm, Courteous, and Emotionally Sensitive
-Actively Defuse the Strangeness of the Clinical Situation
-Give Your Patient the Opening Word
-Gain Your Patient's Trust by Projecting Competence
4. How to approach threatening topics (sensitive/embarrassing material): -
-Normalization
-Symptom Expectation
-Symptom Exaggeration
-Reduction of Guilt
,-Use Familiar Language When Asking about Behaviors
5. Normalization: Introducing Q with some type of normalizing statement
-two principal ways to do this:
1. start the question by implying that the behavior is a normal or understandable
response to a mood or situation
• ex: Sometimes when people are very depressed, they think of hurting themselves. Has
this been true for you?
2. Begin by describing another patient (or patients) who has engaged in the behavior,
showing your patient that she is not alone
• ex: I've talked to several patients who've said that their depression causes them to have
strange experiences, like hearing voices or thinking that strangers are laughing at them. Has
that been happening to you?
, 6. Symptom Expectation: communicate that a behavior is in some way normal or
expected
-Phrase your Q's to imply that you already assume the patient has engaged in some behavior
and that you will not be offended by a positive response
-high index of suspicion of some self-destructive activity
-Ex: patient is profoundly depressed and has expressed feelings of hopelessness. You
suspect suicidality, but you sense that the patient may be too ashamed to admit it. Rather
than gingerly asking "Have you had any thoughts that you'd be better off dead?" you
might decide to use symptom expectation. "What kinds of ways to hurt yourself have you
thought about?"
*reserve this technique for situations in which it seems appropriate
7. Symptom Exaggeration: suggesting a frequency of a problematic behavior that is
higher than your expectation, so that the patient feels that their actual, lower frequency
of the behavior will not be perceived by you as being "bad."
-helpful in clarifying the severity of symptoms
*reserve this technique for situations in which it seems appropriate
8. Reduction of guilt: seeks to directly reduce a patient's guilt about a specific
