mental health assessment for bboard
TRANSCRIPT
Introduction to Mental Health Nursing Assessment
Year 2 Semester A 2008
Willie McDonald
Aims
What is it and why is it important
Skills involved in Mental Health Nursing Assessment
Approaches, Methods and Process
Assessment tools
Assessment – What is it?
“Estimating the character of something or someone” Barker (2004)
At the heart of assessment: the collection of information with the intention of making a judgement
Each time we set out to find out something new, we embark on an assessment
Usually undertaken with a view to some action in the future
Assessment – Why is it Important?
“You can’t really help people unless you are first able to assess their problem”
Barker (1985)
“Assessment should lead to the richest possible view of the patient as a person with successes and failures”
Martin (1987)
“Learning from the person” (Barker
2004)
Proverb
Seek first to understandthen to be
understood
Assessment Skills
Fundamental, a key competence
Crucial aspect of care
Comprehensive
Impact of unidentified need
Inaccurate assessment
Nursing Assessment
“I'm suggesting you probably need two years postgrad experience before you learn good assessment skills, and I don't mean just summing up a situation.
I mean actually knowing when to persist with something or how to glean information from someone who may not particularly be in the mood to tell you and when it's prudent to withdraw...
If you didn't have those sort of skills you would probably be off work more than you are here with broken noses”
“If you can't assess somebody in 30 seconds you are in big trouble in dangerous or difficult situations”
Aims of Assessment
Detailed description of circumstances and problems
Clear description of current symptoms
Comprehensive risk assessment
Social circumstances and Support networks
Views of significant others
Care planning and Evaluation
Whole lived experience
Physiological
Biological
Behavioural
Social
Spiritual (Parse 1995)
The Patient as the ExpertTwo way process – encourage collaboration
The person behind the patient
Their perception of their world and themselves
Values and Goals
Empathy
Unbiased
Approaches to AssessmentFormal – structuredInformal – more haphazard
This can often be determined by the patient
BroadNarrow – Selective then Specific
Formal – more uniformity, questions worked out in advance, reduces assessor bias from prejudices and idiosyncrasies.
Outcome should be the same no matter who completes it.
Informal – no structure, ask questions that are thought to be important, assessor bias and value judgements can influence the kind of information collected. May be better suited to someone talkative, articulate.
Use of standardized rating scales.
Be aware of influential factors – culture, family, biological state, environment.
Peplau, Robinson, Ward – share the view that mental health nursing is concerned to address the person’s human response to problems involving his relationship to himself and others.
Funnelling (Hawkins 1986)
Broad Assessment
All areas of functioning
Use of open questions
Selective Assessment
Identify relevant symptoms and problems
Use of leading or selecting questions
Specific Assessment
Focus on fine detail
Use of closed questions
Approaches
Funnel Sequence Inverted Funnel
Sequence
Tunnel Sequence
Erratic Sequence
Process
Why am I doing this assessment?
What is the aim of the assessment?
What should I assess?
How will I get the information?
How will I decide what that info means?
Different conditions?
Assessment – Step by Step
1. Method – Kipling, ongoing process, joint assessment
2. Information – attentive, individual, past, present & future plans
3. Analysis – all available info, patient’s perspective
4. Picture – formulation, streamline, incl potential improvement
5. Judgement – focus, priority, collaboration, honesty
Barker (2004)
Assessment Framework
Who ?
What ?
Where ?
When ? How ?
Why ?
Their names are What and Why and WhenTheir names are What and Why and When
And How and Where and Who”And How and Where and Who”
““I keep six honest serving men, (They taught me all I I keep six honest serving men, (They taught me all I know):know):
Methods
InterviewDirect observationMeasurement – using valid Assessment Tools
e.g. rating scales, questionnaires
All are aimed at collecting information on: Measurement – scale and size
Clarification – context and conditions
Explanation – purpose and function
Variation of the circumstances – scale and frequency
Proverb
To listen well is as powerfula means of influence
as to talk well
InterviewMain goals – descriptive, diagnostic, therapeutic
Engaging and Relationship building, communication skills
Trust building
Patient’s views
Professional collaboration
Problem identification – remember funnelling
Problem resolution
ObservationAssessment and Management
Overt v Covert
Obtain precise description
Individual aspects
Social aspects
Mind reading and inference
““I think it's actually quite holistic really. If you walk into the I think it's actually quite holistic really. If you walk into the house, you immediately notice what the house is like, is it house, you immediately notice what the house is like, is it different from normal, does she wash the dishes, you know different from normal, does she wash the dishes, you know that sort of thing, how well is the person dressed, you that sort of thing, how well is the person dressed, you know, that's always a good sign, look at their children if know, that's always a good sign, look at their children if they've got children.they've got children.
But just immediately you assess the physical environment But just immediately you assess the physical environment and the physical appearance of the person. and the physical appearance of the person.
Then I think if you're going to check their mental state Then I think if you're going to check their mental state you'd sit down and chat about it, and you do get on to the you'd sit down and chat about it, and you do get on to the mental health assessment and do that, and medication, mental health assessment and do that, and medication, side-effects, whether they've got any other physical side-effects, whether they've got any other physical problems that they're having, any other social problems problems that they're having, any other social problems that they're having with regards to their children and all that they're having with regards to their children and all sorts of things, you know partner problems, also help sorts of things, you know partner problems, also help identify areas where they can fit into community facilities.”identify areas where they can fit into community facilities.”
Nursing Assessment
Measurement
Provide a baseline
Can help with diagnosis
Broad or Specific
Validated and evidence based
Inter-rater and Test-retest Reliability
Self assessment - diaries
Assessment Tools
Mini Mental State Examination (MMSE)
Beck Depression Inventory
Hospital Anxiety and Depression (HAD) Scale
CAGE Questionnaire
MMSE30 point questionnaire which covers 8 domains:
OrientationRegistrationAttention and calculationRecallLanguageReading and writing3 stage commandConstruction
Beck Depression Inventory
21 item scale each rated from 0 – 3 to assess the intensity of depression:MoodOutlookSatisfaction and InterestSelf-esteemSleep appetite and weight lossSexual habits
Hospital Anxiety and Depression (HAD) Scale
I feel tense or wound up I still enjoy the things I used to enjoy I get a sort of frightened feeling as if something awful is about to happenI can laugh and see the funny side of thingsWorrying thoughts go through my mindI feel cheerfulI can sit at ease and feel relaxedI feel as if I am slowed downI get a sort of frightened feeling like butterflies in the stomachI have lost interest in my appearanceI feel restless as if I have to be on the moveI look forward with enjoyment to thingsI get sudden feelings of panicI can enjoy a good book or radio or TV programme
Anxiety (Odd) /21 Depression (Even) /21
CAGE Questionnaire
Alcohol dependence is likely if the patient gives 2 or more positive answers:
Have you ever felt you should CUT down your drinking?Have people ANNOYED you by criticising your drinking?Have you ever felt bad or GUILTY about your drinking?Have you ever had a drink first think in the morning to steady your nerves or get rid of a hangover (EYE- opener)?
Bernadt et al have claimed that the CAGE test (scores >=2) has a sensitivity of 93% and a specificity of 76% for the identification of problem drinkers.
AccountabilityClearly recorded, legibly, concisely, unambiguously
Signed and dated
Evidence of patient’s/carer’s perceptions
Observations supported with appropriate evidence
All sources of info have been tapped, info sharing
Sufficient info to plan care
Assessment complete, if not are reasons noted
Conclusion
What assessment is
Why it is necessary
Mental Health Nurse’s role
Approaches, process and methods
What to do with the information
References
Barker PJ (2004) Assessment in Psychiatric and Mental Health Nursing Stanley Thornes: Cheltenham
Barker PJ (ed) (2003) Psychiatric and Mental Health Nursing, The craft of caring. (Section Two) Arnold: London
Fletcher SC (2002) The Tidal Model: the questions answered. Mental Health Practice. Vol 5 (8): pp 29 – 37.
Norman I, Ryrie I (2004) The Art and Science of Mental Health Nursing Open University Press: Maidenhead
O’Carroll, M., Park, A. (2007) “Assessment” Essential Mental Health Nursing Skills. Mosby Elsevier: London pp 125-146