Comprehensive 20 Assessment 1


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Comprehensive Mental Health Assessment

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  • 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
  • Comprehensive 20 Assessment 1

    1. 1. Comprehensive assessment in Mental Health nursing
    2. 2. What is Assessment ? <ul><li>‘ gathering, classifying, categorising, analysing, and documenting information about health status. It starts with the process of establishing a therapeutic alliance between the patient and the mental health worker and forms the basis of care planning. The process of assessment should be approached with empathy and compassion to support the development of trust between the patient/ client and the mental health worker.’ </li></ul><ul><li>(NSW Health, 2001) </li></ul>Elder et al, 2005
    3. 3. Comprehensive clinical assessment <ul><li>Biological </li></ul><ul><li>Psychological </li></ul><ul><li>Sociological </li></ul><ul><li>Developmental </li></ul><ul><li>Spiritual </li></ul><ul><li>Cultural </li></ul>Elder et al, 2005
    4. 4. Information required <ul><li>Identifying information </li></ul><ul><li>Reason for referral </li></ul><ul><li>Presenting problem and/or precipitating factors </li></ul><ul><li>Previous mental health/ medical/ medication history </li></ul><ul><li>Developmental/ psychosocial/ relationship history </li></ul><ul><li>Risk Factors </li></ul><ul><li>Assessment of strengths </li></ul><ul><li>Assessment of mental health status </li></ul>Elder et al, 2005
    5. 5. Identifying information <ul><li>Name, age , sex, marital status, present address, telephone number </li></ul><ul><li>Languages spoken </li></ul><ul><li>Occupation </li></ul><ul><li>Next of kin </li></ul><ul><li>G.P. </li></ul>Elder et al, 2005
    6. 6. Reason for referral <ul><li>Who has asked for the patient to be seen and why </li></ul><ul><li>The nature of the problem </li></ul><ul><li>Events that led to this presentation </li></ul><ul><li>Any recent suicide attempts </li></ul><ul><li>Any recent episodes of self harm </li></ul>Elder et al, 2005
    7. 7. Presenting problem <ul><li>Present specific symptoms and duration; </li></ul><ul><li>Time frame between onset and exacerbation of symptoms and presence of social stressors / physical illness </li></ul><ul><li>Any disturbances in mood, appetite, sexual drive, or sleep </li></ul><ul><li>Any treatments given by other doctors or specialists for this problem </li></ul><ul><li>Individuals response to treatment </li></ul>Elder et al, 2005
    8. 8. Mental health/ medical History <ul><li>Mental Health History </li></ul><ul><li>Admissions to Mental Health inpatient units </li></ul><ul><li>Episodes of self harm </li></ul><ul><li>Attempted suicides </li></ul><ul><li>Occasions of assault </li></ul><ul><li>Any mental health treatments previously/currently </li></ul><ul><li>Medical History </li></ul><ul><li>Major medical and surgical history </li></ul>Elder et al, 2005
    9. 9. Medication History <ul><li>Current medications </li></ul><ul><li>Regime </li></ul><ul><li>All prescribed and non-prescribed medication </li></ul><ul><li>Dosage, frequency and prescriber </li></ul><ul><li>When last used </li></ul><ul><li>Any compliance problems </li></ul><ul><li>Adverse reactions </li></ul><ul><li>Allergies to any drugs </li></ul>Elder et al, 2005
    10. 10. Psychosocial relationship History <ul><li>Infancy </li></ul><ul><li>Childhood and adolescence </li></ul><ul><li>Work history </li></ul><ul><li>Marital history </li></ul><ul><li>Relationship with others </li></ul><ul><li>Children </li></ul><ul><li>Illegal activities </li></ul>Elder et al, 2005
    11. 11. Risk Factors <ul><li>Harm to others </li></ul><ul><li>Harm to self </li></ul><ul><li>Suicide </li></ul><ul><li>Absconding </li></ul><ul><li>Vulnerability to exploitation or abuse (Sexual or violence) </li></ul><ul><ul><ul><ul><li>Extensive documented past history of sexual abuse/ violent relationships </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Unawareness regarding dress or personal space </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Frequent /intense thoughts re sexual activity with no possibility of distraction </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Increasingly intrusive behaviour </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Evidence of hostile, dependant or passive personality traits </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Evidence of substance abuse </li></ul></ul></ul></ul>Elder et al, 2005
    12. 12. Assessment of strengths <ul><li>Intelligence </li></ul><ul><li>Education </li></ul><ul><li>Support systems </li></ul><ul><li>Religious and spiritual beliefs </li></ul><ul><li>Motivation </li></ul><ul><li>Physical health </li></ul>Elder et al, 2005
    13. 13. Spiritual Assessment <ul><li>Often overlooked </li></ul><ul><li>Patients may be hesitant to talk about spiritual experiences as may interpreted as crazy </li></ul><ul><li>Need to remember that each individual has their own spiritual interpretation of universe </li></ul><ul><li>creating a comfortable safe setting is important to facilitate this form of assessment </li></ul>Elder et al, 2005
    14. 14. Physical Assessment <ul><li>An assessment of physical functions provides a baseline: </li></ul><ul><li>Elimination </li></ul><ul><li>Activity and exercise </li></ul><ul><li>Sleep </li></ul><ul><li>Appetite and nutrition </li></ul><ul><li>Hydration </li></ul><ul><li>Sexuality </li></ul><ul><li>Self-care </li></ul>Elder et al, 2005
    15. 15. Cultural Assessment <ul><li>Attitudes can interfere with appropriate assessment </li></ul><ul><li>Failure to communicate effectively can cause delays in diagnosis and treatment </li></ul><ul><li>Adoption of the underlying principles of cultural safety by nurses will enable appropriate assessment </li></ul>Elder et al, 2005