Mental Health Assessment Questions And answers

Mental Health Assessment Questions And answers Patient fears and concerns - - who is this nurse/clinician? - is he or she competent? - is the person understanding? - what does he/she already know about me? - am I going to be hurt? - do I have any control over this matter? Student fears and concerns - - what should I say? - what should I do? - will the patient like me? - how will the patient respond? - can I help the person? - can I hurt the patient if I say the wrong thing? Three components of the Mental Health Assessment (MHA) - 1. Interview 2. Mental status exam 3. Physical exam How to begin the interview - - Provide information about the string, interview, and assessment process - Let patient know that they are not the only person with this particular problem (this is called UNIVERSALITY and helps patient feel less isolated) - By reducing the patients feelings of anxiety and isolation, you encourage a sense of hope and positive expectation - By the end of the interview, you have communicated that the patient will actively be involved with decisions and care General areas assessed in the MHA - 1. Presenting problem 2. History of present illness 3. Nature of previous adjustment (premorbid history) 4. Family history 5. Marital history 6. Educational history 7. Social history 8. Psychiatric history 9. Value and belief systems 10. Recent stressors/supports 11. Support systems 12. Insight 13. Special needs 14. Discharge goals Things to consider - - Include significant others when possible - Remind yourself of the importance of the setting (comfortable, private, SAFE) - The more secure the patient feels, the better they are able to focus (anxiety affects concentration) - An effective interviewer will work to decrease anxiety and increase stress - Although a form is generally used, be flexible - Make notes but stay focused on patient--you can always finish the form later - "Assessment packages are only as good as the expertise of the data collecting agent" - In crisis situations, ask patient basic information to help calm them and focus on reality - If the patient gets irritated, focus on what is important to the patient More things to consider - - Remind yourself of the basic communication skills you have learned - Body language - Use open questions as much as possible - Use closed questions for specific information - Avoid "why"--evokes defensiveness - Avoid leading questions - Be an active listener, let patient do most of the talking - Clarify as needed - Acknowledge and accept patients feelings, even if you do not disagree - REMAIN NONJUDGMENTAL Most important! - - Work at developing your own style - Patients will respond to your genuine warmth and concern - YOU are the most important tool you have The Mental Status Exam (MSE) - - Completed upon admission and used for periodic comparison and evaluation - Constantly assessing for changes How to begin - - Say you are going to ask some questions that are important in helping you learn about the patient and how you can help them - Avoid using MSE, may increase anxiety and alarm Areas to be assessed in the MSE - 1. Physical appearance 2. Psychomotor behavior 3. Mood and affect 4. Intellectual performance 5. Judgment 6. Memory 7. Speech 8. Content of thought Setting for an MSE - - Non-threatening physical environment - Assume the same height- both sit or stand - Avoid face-to-face, 90 degree angle or side by side less intense - Leave plenty of space between patient and nurse - Keep yourself positioned between the patient and door - Avoid a desk/table barrier Physical Appearance - (mainly observation) - Dress - Hygiene - Grooming - Cosmetics - Appearance in relation to age - Clothing - Facial expression - Body odor - Overall physical health Psychomotor Behavior - (mainly observation) - Hyper or hypo active - Rigid, relaxed, restless, or agitated body movements - Gait and coordination - Eye contact (indicated self concept and esteem) - Posture - Handshake (cue ego strength) - Facial grimacing - Twitches or ticks - Tremors - Gesturing - Ritualistic behaviors Mood and Affect - (observe for unusual mood or expression of emotion) - Euphoria: increased feeling of emotional and physical well being inappropriate to actual environment - Flat affect: decreased expression of feelings - Elation: increase self confidence, boastful, joy, with increased motor activity - Fear - Ambivalence - Attitude towards the nurse or interviewer - Irritability - Anger or rage - Labile: quick change of expression/mood/feelings - Apathy - Congruent with facial expression? Intellectual Performance - (describe this, do not judge)