Psychiatric Mental Health Assessment and Diagnosis of Adults for Advanced Practice Mental Health Nurses

Kunsook S. Bernstein, Robert Kaplan

• Publisher: Routledge
• Year: 2022
• ISBN:
  9781000610154
• Edition: 1
• Topic: Médecine
• Subtopic: Soins infirmiers en psychiatrie et santé mentale

This text provides a comprehensive and evidence-based introduction to psychiatric mental health assessment and diagnosis in advanced nursing practice.

Taking a clinical, case-based approach, this textbook is designed to support graduate nursing students who are studying psychiatric mental health nursing as they develop their reasoning and decision-making skills. It presents:

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• Therapeutic communication and psychiatric interviewing techniques, alongside basic psychiatric terminologies.

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• The major psychiatric diagnoses, drawing on the DSM-5.

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• A step-by-step guide to conducting a comprehensive psychiatric mental health assessment.

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• Case examples demonstrating assessment across major psychopathologies.

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• Good practice for conducting mental health evaluations.

This is an essential text for all those undertaking psychiatric mental health nurse practitioner programs and a valuable reference for advanced practice nurses in clinical practice.

1 Therapeutic Interviewing and Mental Health Evaluation of Adults

DOI: 10.4324/9781003137597-2

Section 1: Principles of Therapeutic Interviewing

Therapeutic interviewing is the craft by which the advanced psychiatric mental health nurse (APMHN) attempts to clearly understand their clients. It can be an instrument of healing for individuals who are in both physical and psychological need, and therefore is an essential skill for APMHNs to learn and apply. It involves the use of verbal and nonverbal messages during the interview by tailoring the nurse’s verbal skills to suit the unique physical and emotional needs of the client, as they are revealed. The aim is to establish a professional therapeutic nurse–client relationship that engages the client with the healing process. Consequently, the role of the APMHN, especially when interviewing a client for the initial psychiatric evaluation, goes beyond simply information gathering.

In this section of the chapter, the underlying principles of therapeutic interviewing are discussed. These principles, which may determine whether an initial interview fails or succeeds, are not rigid; instead, they provide flexible guidelines, discussed in the next section, within a structured framework that enable the interviewer to create a warm and safe atmosphere appropriate to the circumstances. The first encounter with the mental health clinician can be the beginning of the healing process for many clients seeking mental health services. Therefore, engaging in therapeutic interviewing while collecting pertinent clinical data, such as physical, mental, and emotional status, and conducting needs assessments is an art, and one necessary for the APMHN to be masterful in, to effectively promote their clients’ healing.

Each interview may vary depending on the purpose, location, time allocation, and other circumstances. For example, an APMHN may interview a client who is scheduled for their initial psychiatric assessment and treatment at an allocated time in an outpatient clinic, or they may be assessing and interviewing a client in the emergency room for a psychiatric crisis. At other times, an APMHN may be called to evaluate a client in a general hospital or long-term care facility on a consultative basis, or they may work regularly in a psychiatric hospital conducting daily assessments and longer-term treatments of assigned clients. Yet, regardless of the context, to provide an effective interview during the psychiatric mental health assessment, an APMHN must have a broad sense of the assessment goals. These goals will be explained in more detail in the Case Exemplar section of this chapter, but are presented briefly here for the reader to have a broad understanding of interview dynamics, as delineated by Shea (1998a), even though the different contexts within which an interview may occur, as noted above, may lead to certain goals being more important or more achievable than others in any particular interview or interview setting:

1. To establish a sound engagement of the client in a therapeutic alliance.
2. To collect a valid database.
3. To develop an evolving and compassionate understanding of the client.
4. To develop an assessment from which a tentative diagnosis can be made.
5. To develop an appropriate disposition and treatment plan.
6. To effect some decrease of anxiety in the client.
7. To instill hope and ensure that the client will return for the next appointment.

In addition, the APMHN must also have an awareness of the characteristics of a successful therapeutic relationship between clinician and client, whether that relationship consists of a single meeting or a series of meetings. Johnson and Vanderhoef (2016) defined those characteristics as genuine, empathetic, authentic, respectful, nonjudgmental, accepting, and maintaining professional boundaries. Ultimately, then, to formulate a mental health assessment and diagnosis through a skillful interview, the APMHN needs to be clear about the assessment goals, knowledgeable about the characteristics of therapeutic communication techniques, and cognizant of psychiatric terminology.

This section uses a case scenario to explore the core issues challenging APMHNs during mental health assessments. Based on the principles of therapeutic communication to interview clients with psychiatric disorders, the focus here is on the interactional process whereby APMHNs use commonly known therapeutic communication techniques, noted in Table 1.1, to build rapport with each client, while formulating a comprehensive mental health assessment, which leads to diagnosis. Finally, the chapter concludes with a glossary of common psychiatric terminology with which the APMHN must be familiar to write the formal assessment.

Table 1.1 Therapeutic Communication Techniques and Examples

Technique	Example
Accepting	“What you said makes sense.” Nodding.
Broad openings	“Is there anything you would like to talk about?”
Clarifying information	“I’m not sure I follow what you are trying to say.”
Consensual validation	“Tell me whether my understanding of it agrees with yours.”
Encouraging comparison	“Was it something like …?”
Encouraging expression	“Does this add to your stress?”
Exploring	“Tell me more about that.”
Formulating a plan of action	“What would you do to channel your anger constructively?”
General leads	“Go on,” “And then?”
Making observations	“You seem to be tense.”
Offering self	“I will stay with you for a while.”
Placing event in time or sequence	“What seems to lead up to …?”
Restating	Client: “I can’t sleep, staying up all night.” Nurse: “You have difficulty sleeping.”
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