Mood --> patient's self report of the current emotional experience. May ask patient to rate on a scale of 0-10. Include assessment of suicidality and/or homicidality, if indicated.
Affect --> Emotional tone of patient as observed by the nurse. Incongruence between mood and affect should be noted.
Might want to include: interaction in interview
When assessing the emotional state, what other things might want to assess other than mood and affect?
Euthymic - normal
Euphoric - elated
Labile - changeable
Dysphoric - depressed, restless
What are examples of affect?
What is described in the thought process section of the MSE?
Logical, organized, relevance and coherence of thoughts as demonstrated by word usage
Can be organized, coherent, or have flight of ideas, neologisms, looseness of associations, thought blocking, circumstantiality
Flight of Ideas
rapid shift of ideas from topic to topic
Looseness of associations
relatedness of words or concepts diminished, may become incoherent (word salad)
response includes many irrelevant details, eventually reaches
goes off "on a tangent" leaving conversational goal behind
made up words
filling in memory gaps with made up stuff
meaningless rhyming of words or phrases as in "Look up at the star, I went to the bar. I drove the car. I'm stuck in the tar." Or single words as in "Mary, berry, fairy, carry." In a form of perseveration.
Mixture of meaningless words
repetition of own idea or phrase
repetition of own idea or phrase
inability to speak
What is described in the thought content section of the MSE?
Hallucinations (ie auditory, visual)
What is described in the cognition section of the MSE?
Orientation: time, place, person
LOC (alert, confused, clouded, stuporous, unconscious, comatose)
Memory: remote, recent, immediate
Fund of knowledge
Attention: performance on serial sevens, digit span tests
Abstraction: performance on tests involving similarities, proverbs
unable to generalize or ascertain overall meaning as when asked a proverb, "A rolling stone gathers no moss" will answer, "The stone is rolling too fast for the moss to stick to it."
Judgement and Insight
Ability to solve problems
Ability to make decisions
Knowledge about self
consequences of actions
What are the lifespan considerations for an elderly client?
Assess for sensory impairments
Assess for physical impairments
What are the lifespan considerations for children?
Use play, drawing, dolls, story telling in assessment
Special training needed to do assessments on children. We do not do our assessments on children in clinical
Wt are the components of the psychosocial assessment?
General History and Information
Physical or Medical issues (Rx)
Mental Status Exam
Family History and Relationship
Spiritual and Cultural Issues
What is in the general history and info section of the psychosocial assessment?
Age and Sex
DSM IV diagnosis (Axis I through V)
Major signs and symptoms
What is included in the presenting problem and personal history section of the psychosocial assessment?
Statement in client's words
Emotional, Behavioral, Cognitive & Physical changes or issues
Substance use and abuse
Methods of dealing with stress
What is included in the physical or medical issue section of the psychosocial assessment?
How condition impacts person or family
What is included in the family history and relationships section of the psychosocial assessment?
Use of drugs (current and past)
Family history of physical or mental problems
Family Life Cycle --> single, coupled, divorced, blended family
What is included in the spiritual and cultural section of the psychosocial assessment?
Importance of religion or spirituality
Influence on current life
Who or what give client hope and meaning
What cultural group does the client identify with
What impact does client's culture have on current life and illness
Alternative or complementary practices
What is involved in the clinical interview portion of the psychosocial assessment?
Content and direction of the clinical interview are decided by the client
This differs from the assessment interview!!!
Employ therapeutic communication skills and active listening. They are acquired skills!
What is involved in the "How to begin and interview" section?
What are some possible phrases used in beginning an interview?
“Where should we start?”
“Tell me about what has been going on with you.”
“What are some of the stresses you have been coping with recently?”
“Perhaps you can begin by letting me know what some of your concerns have been recently.”
“Tell me about your difficulties.”
What are some helpful guidelines in beginning a clinical interview?
When you do not know what to say, say nothing
When in doubt focus on feelings
Avoid giving advice
Do not rely on asking questions
Pay attention to nonverbal clues
Focus on the client
What are some common client behaviors?
Asks nurse to keep a secret
leaves before the session is over
Interrupted by another client
Communicates thoughts of suicide
Does not want to talk
Seeks to prolong the interview
Gives the nurse a present
Asks the nurse a personal question
What are some personal factors that affect communication?
What are some environmental factors that affect communication?
What makes up the verbal communication section of psychosocial assessment?
All words a person speaks or uses
Communicates --> beliefs and values, perceptions and meaning
Convey --> Interest and understanding or insult and judgment
messages clearly or conflicting or implied messages
clear, honest feeling or disguised distorted feeling
What makes up nonverbal communication section of psychosocial assessment?
65% to 95% if a sent message
Emotions expressed in the eyes
Observable autonomic physiological responses
What are the Attending behaviors of communication?
Culturally and individually appropriate
What are some cultural considerations?
Culture is more than race/ethnicity
Race is not specific but one aspect of one's identity
Race is significant because of racism and social beliefs
Race may be significant due to physiologic differences in genetic makeup
What areas are problematic for interpreting messages when looking at cultural communication barriers?
use of eye contact
perception of touch
view of a health care worker
What is cultural competence?
Sensitivity to those issue
Knowledge, attitude, attributes and skills
Flexibility, empathy and & non-judgmental approach
What is are the areas of the cultural assessment?
Role of the family
who makes decisions
who should be included in discussions,
Avoid stereotyping --> may not identify with respective ethnic group
Cultural influences all aspects of life, especially illness and end of life
What are some tools for enhancing communication?
Use of silence
Techniques to enhance communication
Silence --> not the absence of communication but transmitting and receiving messages
Significant means to influence and be influenced
No universal rule concerning silence
Icy silence may be an expression of anger
Giving the “silent treatment” is an insult
May be an indication of emotional blocking
Timing is essential
Can communicate strength and support allowing client to regain composure & cont.
Can be a moment of reflection for both
If nurse feels compelled to fill every void with words, it is often due to their own anxiety, self-consciousness & discomfort
Prolonged & frequent silence is not helpful
Techniques to enhance communication
Observing client nonverbal behavior
Listen to & understanding verbal message
Understanding context of client’s life
Listening to false notes (inconsistencies)
Noticing verbal & nonverbal messages
Communicates that client is not alone
S - Sit squarely facing the client (sort of)
O - Observe an open posture
L - Lean forward toward the client
E - Establish eye contact
R - Relax
What are some clarifying techniques to enhance communication?
Paraphrasing --> restate in different words
Restate --> mirrors overt and covert message
Reflection --> may be a question or simple statement that conveys and observation that shows acceptance
Exploring --> enables the nurse to examine important ideas, experiences or relationships
What are some ways to encourage conversation?
Avoid misunderstandings "help me understand what you mean"
Don't change the subject
Don't be afraid to acknowledge your feelings
What are some obstructive techniques?
Asking excessive questions
Giving approval or disapproval
Asking "why" questions
What are some techniques to monitor or minimize?
Asking excessive questions: puts nurse in role of interrogator and conveys lack of respect
Giving false reassurance: underrates other person's feelings & belittles their concerns
Client can see as way to do the "right thing"
Does something in order to please the nurse (get approval)
May not lead to change in behavior but seeking of approval
Why should advising be avoided in communication practices?
Interferes with client's abliity
to make decisions
Can foster dependency
Undermines sense of competence and adequacy
Keeps nurse in control (feeling like strong one)
Client may need information to help define problem of identity solutions
Why should the "why question" be avoided?
requesting an explanation
can be experienced as intrusive and judgemental
serves to make client defensive
more useful to ask what happened
Describe what is important about how stress leads to anxiety
Produced by change in enviornment
internal or external
Individual perceives change as
Stress leads to a variety of psychological responses
Anxiety the most common response
What are the categories of anxiety?
Normal --> healthy life force necessary for survival
Acute or state anxiety --> crisis threatens sense of security
Chronic or trait anxiety --> Long-term anxiety (chronic fatigue or insomnia), Discomfort in relationships or poor job performance
What are the 4 levels of anxiety?
Important to identify which level if used in Nursing Diagnosis!
What are the properties of defense mechanisms?
Manage conflict and affect
Discrete from one another
Ofen hallmarks of psychiatric syndromes, but reversible