NR 548 Psychiatric Assessment for Psychiatric-Mental Health Nurse Practitioner Exam 2 Week 3-4 Covered

NR 548 Psychiatric Assessment for
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Psychiatric-Mental Health Nurse Practitioner JT JT JT




Exam 2 Week 3-4 Covered JT JT JT JT




1. Psychiatricinterview:theprocessbywhichpsychiatricassessmentisconduct- ed
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-primary tasks
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• building a therapeutic alliance between the PMHNP & client
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• obtaining a database of psychiatric info about the client
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• establishing a dx JT JT




• negotiating a tx plan JT JT JT




2. Therapeutic Alliance:a feeling that you should create over the course of the diagnostic
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, interview, a sense of rapport, trust, and warmth
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-most important goal of the interview process
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-the cooperative working relationship between the therapist and client
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• begins during the initial or opening phase of the interview
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-fundamental component of successful therapy JT JT JT JT




• Without trust, adherence to treatment recommendations may be compromised
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• interview may not elicit the information needed to formulate an appropriate dx & plan of
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care without rapport & trust
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3. Creating rapport: tips: -BeYourself JT JT JT TJ




-BeWarm, Courteous, and Emotionally Sensitive
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-Actively Defuse the Strangeness of the Clinical Situation
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-GiveYourPatienttheOpeningWord
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-GainYourPatient'sTrust by Projecting Competence
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4. How to approach threatening topics (sensitive/embarrassing material):-
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-Normalization

-Symptom Expectation JT




-Symptom Exaggeration JT




-Reduction of Guilt JT JT

,-Use Familiar LanguageWhen Asking about Behaviors
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5. Normalization:Introducing Q with some type of normalizing statement JT JT JT JT JT JT JT JT




-two principal ways to do this:
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1. start the question by implying that the behavior is a normal or understandable response
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JT to a mood or situation
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• ex:Sometimeswhenpeopleareverydepressed,theythinkofhurtingthemselves. Has this
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2. Begin by describing another patient (or patients) who has engaged in the behavior, showing
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JT your patient that she is not alone
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• ex:I'vetalkedtoseveralpatientswho'vesaidthattheirdepressioncausesthemto havestrange
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experiences, like hearing voices or thinking that strangers are laughing at them. Has that been
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JT happening to you? JT JT

, 6. Symptom Expectation:communicate that a behavior is in some way normal or expected JT JT JT JT JT JT JT JT JT JT JT JT




-PhraseyourQ'stoimplythatyoualreadyassumethepatienthasengagedinsome behavior and
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JT that you will not be offended by a positive response
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-high index of suspicion of some self-destructive activity
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-Ex:patient is profoundly depressed and has expressed feelings of hopelessness. Yoususpect
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suicidality,butyousensethatthepatientmaybetooashamedtoadmit it.Rather than gingerly
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JT asking "Have you had any thoughts that you'd be better off dead?" you might decide to use
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JT symptom expectation."What kinds of ways to hurt yourself have you thought about?"
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*reserve this technique for situations in which it seems appropriate
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7. Symptom Exaggeration:suggesting a frequency of a problematic behavior that is higher JT JT JT JT JT JT JT JT JT JT JT




JT than your expectation, so that the patient feels that their actual, lower frequency of the
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JT behavior will not be perceived by you as being "bad." JT JT JT JT JT JT JT JT JT




-helpful in clarifying the severity of symptomsJT JT JT JT JT JT




*reserve this technique for situations in which it seems appropriate
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8. Reduction of guilt:seeks to directly reduce a patient's guilt about a specific behavior in JT JT JT JT JT JT JT JT JT JT JT JT JT JT




JT order to discover what they have been doing
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-useful in obtaining a hx of domestic violence & other antisocial behavior
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