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Comprehensive 20 Assessment 1
- 1. Comprehensive assessment in Mental Health nursing
Notes de l'éditeur
- Brain storm before definition New South Wales Health, 2001, NSW Mental Health Outcome and Assessment Training (MH-OAT) Facilitators Manual, NSW Health, Sydney
- A biopsychosocial assessment involves a comprehensive assessment of all aspects of a patients problem Assessment is completed with every client regardless of the setting. Forms used in different areas may vary but the basic information is very similar The assessment interview provides the framework for a comprehensive biopsychosocial assessment of the patients current presentation to mental health services. – to develop an understanding of the person presenting for help
- 2 types of data are collected subjective and objective – data is collected in three ways Observing Examining interviewing
- some forms require additional information such as education level acquired, family of origin
- Why are the last two especially important?
- Need to obtain a description of the principle complaint and time frame in the patients own words – WHY? Important to ensure the chronology of the events and emergence of symptoms are clear – elicit a timeline and details for the problem It is always a good idea to ask any other family members, carers present if they have anything to add interview them separately if necessary.
- This information can be provided by the patient, previous clinical records, a letter from their doctor or history from family or friends If relevant the patients consent may be sought to obtain a detailed medical history from the treating doctor
- Including natural remedies – eg St.John’s Wort
- This part of the assessment covers circumstances that may be significant for understanding current situations and covers many aspects of the individuals life such as relationships, family background, work/school history and possibly developmental stages Particularly important if patient is a child
- Several risk factors need to be assessed for all patients Low risk would be no indication of violence or aggression before assessment High risk would be engaging in aggressive behaviours such as verbal abuse and physical aggression Low would have no indication of self harm prior to interview High would be those engaging in self harm or self mutilating behaviours – some due to demand hallucinations or acting on delusional beliefs Low would be no indication of suicide attempt prior to assessment high – intent on committing suicide with access to the means and a well developed plan Related to persons ability or willingness to accept treatment person deemed as being of moderate risk has some ambivalence about being in hospital or continuing their relationship with community services –High is with previous history of abscpnding and experssed reluctance to stay Nurse need to be diligent if person has any of these indicators
- There is little in the formal assessment tools that assesses the strengths of the consumer but there are new assessment tools that are just being integrated for this purpose. Examples of strengths and resources
- WHY? It has been suggested that the presence of faith I ngod, degree of religious commitment, sense of purpose , meaning and basic life values, strongly affect the patients potential for recovery (Carson, 2000) None of us can claim to understand the correct spiritual nature of things HANDOUT RE QUESTIONS THAT ARE USEFUL
- Physical systems review is carried out by a qualified medical officer WHY? To assess changes due to medication To check patient maintains or increases level as nursing intervention Changes in sleep pattern affect a persons emotions or maybe symptoms of a disorder eg depression/mania Changes may reflect depression, anxiety , eating disorders probs with body image or PICA – the consumption of nonnutritive substances As for appetite - PYSHCOGENIC POLYDIPSIA the compulsive behaviour of consuming 3 liters or more a day occurs in a small percentage of people with schizophrenia – also occurs when people have been given a multiple diagnoses and several medications – HYPONATREMIA, ELECTROLYTE IMBALANCE AND SEIZURES CAN OCCUR – additional symptoms are muscle cramps, changes in mental status such as confusion and disorientation This is sometimes augmented by a nursing physical assessment - H/O re nurses physical assessment helpful if the patient leaves the hospital under a section and needs to reported to the police, also useful if sustains injuries while on the ward Urinalysis usually carried out – however not always screen for drugs Bloods taken to screen for physical problems that maybe influencing the diagnosis of a mental health disorder – tests ordered by the medical officer Full blood count, renal & liver function, electrolytes, and thyroid function almost universally indicated H/O re Hematological tests related to psychiatric disorders
- Complex issue as there can be a diversity of cultures in the community that a nurse is working in and it is impossible for a nurse to understand all cultures. Such as ethnocentrism – our world, views etc are superior Stereotyping – failure to identify individual variations within cultural groups Cultural blindness, - an attempt to treat people fairly by ignoring differences within a culture and acting as if the differences do not exist H/O re cultural safety checklist