Presentation by Julie Webster

1. PSYCHOLOGICAL
ASSESSMENT SKILLS
Julie Webster
Clinical Nurse Specialist
Broomfield Hospital
15th November 2017

2. AT WHICH STAGES, AND WHEN
MIGHT WE LOOK FOR
PSYCHOLOGICAL DISTRESS?
 ? Examples..
 ………. At diagnosis
 Transition from relapsing remitting to secondary progressive
 The young family struggling to cope
 The patient with limited function and restricted living arrangements waiting to be rehoused
 The husband who can’t cope with wife’s outbursts and aggression
 PIP claims –the patient who’s award has been reduced and she has lost her mobility car..
 The patient who cant cope with existing diagnosis of epilepsy, breast cancer and new diagnosis of MS..
 The aggressive overpowering mother who is upset her daughter has been diagnosed
 And more
 And that was my experience
just last week……..
 In clinic
 On the telephone
 Reading e-mails

3. WHAT TYPES OF
PSYCHOLOGICAL STRESS ARE
WE ASSESSING FOR?
 ? discussion
 Depression
 Anxiety
 Non-finite grief
 Post traumatic stress disorder
 Body image

4. IMPORTANT SKILLS
 Empathy (or sympathy?)
 Unconditional Positive Regard
 Bracketing Assumptions
 Open questions
 Feelings, not “How are you?”
 Use of silence
 Warmth
 Genuineness

5. EXPLORATION STRATEGIES
 Listen to the emotional content
 Meaning for the patient, not you
 Non-verbal clues (e.g. sighing, facial expression)
 Reflection - use their words
 Summarising - checking you understand
 Metaphors and analogies. Words and Imagery

6. BARRIERS TO EXPLORATION
 Offering advice or reassurance before
the issue is explored
 Explaining away distress as normal
 Attending only to physical aspects
 Changing the subject
 “Jollying” people along
 Being busy
 Making assumptions
 Patient’s belief that nothing can be
done
 Staff beliefs that nothing can be done
 Not wanting to burden busy staff
 Staff reluctance to “open a can of
worms”
 Staff lacking in confidence about what
to do with the information
 Defending/protecting ourselves from
impact of distress

7. SCREENING TOOLS
HAD - developed from the Beck anxiety and depression
inventories for a hospital population, Aim is to provide a brief
assessment of patients concerns at different points during
treatment
Distress Thermometer – much broader, more of a holistic
assessment rather than a psychological screening, but could
identify those people who you may need to explore
emotional issues with further. Reflects a range of contexts
that can lead to increased distress for example financial
concerns or relationship problems.
? Any others…

8. WHAT STRATEGIES CAN WE
CONSIDER TO HELP
SOMEONE WHO IS
PSYCHOLOGICALLY
DISTRESSED?

9. What can help??
 Explanation of what they are experiencing
 Manage symptoms effectively
(pain/fatigue)
 Ask the patient what they think will help
 Distraction techniques
 Self help
 Relaxation techniques
 Breathing techniques
 Complementary therapies
 Exercise
 CBT
 Holding space – our
expertise/knowledge
 Containment – keeping it within the
environment

10. HOW DO WE KNOW WHEN
SOMEONE NEEDS
ADDITIONAL HELP
Discuss…

11. ADJUSTMENT OR SOMETHING
MORE SERIOUS?
What is normal Adjustment?
How do we know the difference between sadness and
depression?
What was normal for the patient already?
Other things going on – finance/family/work
What is their support network?
Contain and hold distress – we don’t always have to do
something..

12. ONWARD REFERRAL
 Given your observations, should the patient be referred on to a
specialist service?
 If so, whom?
 Options may include:
 Specialist Level 3 (trained and accredited professionals) & 4 (Mental
Health Services)services (for depression, anxiety etc)
 Chaplaincy (for spiritual needs)
 Social Services (for practical help or support)
 Voluntary Support Groups
 Local support in primary care(IAPT)
THE PATIENT MUST CONSENT to any onward referral

13. SUICIDE.
• If you show it is ok to ask about suicide, they will feel it is ok to talk.
• Thinking about suicide doesn’t necessarily mean they are going to do it
• SHARE THE INFORMATION
• Provide information on sources of support out of hours (on call
psychiatrist, A&E, Samaritans, out of hours GP)
• Check for : a definite plan and means, reasons not to, previous
attempts.

14. ACKNOWLEGEMENT
A. McCabe, psychotherapist and her team at Farleigh
Hospice who have allowed me to share information

15. FURTHER READING
NICE Guidance
Depression in adults with chronic physical health
problems NICE clinical guideline 91)
Generalised anxiety disorder and panic disorder NICE
clinical guideline 113)
Distress Thermometer Toolkit Dr Jo McVey and Jane
Arthur
Information sheet – what it really means to hold space for
someone