NR-548 Psychiatric Assessment for Psychiatric-Mental Health Nurse Practitioner
Exam 2
Question:
Psychiatric interview
Answer:
the process by which psychiatric assessment is conducted -primary tasks • building a therapeutic alliance between the PMHNP & client • obtaining a database of psychiatric info about the client • establishing a dx • negotiating a tx plan
Question:
Therapeutic Alliance
Answer:
a feeling that you should create over the course of the diagnostic interview, a sense of rapport, trust, and warmth 1 / 4
-most important goal of the interview process -the cooperative working relationship between the therapist and client • begins during the initial or opening phase of the interview -fundamental component of successful therapy • Without trust, adherence to treatment recommendations may be compromised • interview may not elicit the information needed to formulate an appropriate dx & plan of care without rapport & trust
Question:
Creating rapport: tips
Answer:
-Be Yourself -Be Warm, Courteous, and Emotionally Sensitive -Actively Defuse the Strangeness of the Clinical Situation -Give Your Patient the Opening Word -Gain Your Patient's Trust by Projecting Competence
Question:
How to approach threatening topics (sensitive/embarrassing material)
Answer:
-Normalization -Symptom Expectation 2 / 4
-Symptom Exaggeration -Reduction of Guilt -Use Familiar Language When Asking about Behaviors
Question:
Normalization
Answer:
Introducing Q with some type of normalizing statement
-two principal ways to do this:
- start the question by implying that the behavior is a normal or
understandable response to a mood or situation
• ex: Sometimes when people are very depressed, they think of hurting
themselves. Has this been true for you?
- Begin by describing another patient (or patients) who has engaged in the
behavior, showing your patient that she is not alone • ex: I've talked to several patients who've said that their depression causes them to have strange experiences, like hearing voices or thinking that strangers are laughing at them. Has that been happening to you?
Question:
Symptom Expectation
Answer:
communicate that a behavior is in some way normal or expected 3 / 4
-Phrase your Q's to imply that you already assume the patient has engaged in some behavior and that you will not be offended by a positive response -high index of suspicion of some self-destructive activity
-Ex: patient is profoundly depressed and has expressed feelings of
hopelessness. You suspect suicidality, but you sense that the patient may be too ashamed to admit it. Rather than gingerly asking "Have you had any thoughts that you'd be better off dead?" you might decide to use symptom expectation. "What kinds of ways to hurt yourself have you thought about?"
*reserve this technique for situations in which it seems appropriate
Question:
Symptom Exaggeration
Answer:
suggesting a frequency of a problematic behavior that is higher than your expectation, so that the patient feels that their actual, lower frequency of the behavior will not be perceived by you as being "bad." -helpful in clarifying the severity of symptoms
*reserve this technique for situations in which it seems appropriate
Question:
Reduction of guilt
Answer:
- / 4