Nurs 6660 Week 1 Discussion – Comprehensive Integrated Psychiatric Assessment – YMH Boston Vignette 4 video
Week 1 Initial Discussion Post
During the initial mental health assessment of the adolescent client, the psychiatric mental health nurse practitioner(PMHNP) must ask open-ended questions in order to facilitate the conversation and develop trust between parties (client (s) and practitioner. The assessment conducted by the NP serves as a platform of interrelated purposes to present the chief complaint, formulate a primary/differential diagnosis, determine the cause of the issue, identify risk of suicidal/homicidal ideations and to gather an individualized treatment plan (Mash & Hundsley, 2005; Sands, 2004). In order for the PMHNP to elicit responses from the client, they rely on an exchange of and open line of communication. Many providers utilize ‘Socratic’ questioning to bring about insight on the presenting issues and assist in the exploration of additional views and solutions to those presenting issues (Kiyimba, Karim, & O’Reilly, 2017).
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What the Practitioner Did Well
As evidenced in Vignette 4 (2013c), this practitioner seemed as if he was welcoming to this client and made him feel relaxed in this new and unfamiliar environment. After the client was seated in the PMHNP’s office, the therapist explained how limited confidentiality works and what he is required by law to report. Limited confidentiality must be established during this initial interview process so that the client understands that though most information discussed during the session is confidential, there are instances where it can not be. Such examples are, the client being a danger to himself, poses a danger to others or there is someone that is a danger to the client (Sadock, Sadock, & Ruiz, 2014). After the conversation has begun and the PMHNP has asked the client some opening questions, through his line of questions he was able to quickly establish a positive rapport with this male client which can be helpful in his overall treatment later on. Nurs 6660 Week 1 Discussion – Comprehensive Integrated Psychiatric Assessment – YMH Boston Vignette 4 video
Suggested areas of Improvement
As a NP student there are areas that the therapist could work on for future interactions with this client and those he will treat in the future. First of all, the therapist did not shake the client’s hand after they had entered the room. He did not greet the client with a smiling face and had body language that suggested to this author that he might be rigid in his thinking, not have a sense of humor or be judgmental about certain issues that may be discussed in session. The therapist may be subconsciously construing that he lacks empathy and genuineness. According to Sadock, Sadock, & Ruiz (2014), if the client is offered an extended hand to shake and does not shake it then that is likely to be indicative of some underlying issue that should be explored at a later time. The NP should be attuned to both verbal and nonverbal cues that the client is giving. Also, the therapist seems to be positioned at desk more than 6 feet from the client and adjacent to the client’s chair. This type of seating could be a source of added anxiety to an already anxious patient because of the awkwardness of placement. Finally, this author has noticed that the therapist tends to be writing a lot of notes during the initial line of questions and not maintaining direct eye contact. The client could perceive this nonverbal cue as the therapist not really having a personal interest in his issue or that he is writing information based on his opinion of their interaction during session. This can quickly cause the development of distrust in the client/counselor relationship and hinder progress to treatment and problem resolution.
Compelling Concerns during the Current Interview Stage
The only real concern that this author has is the fact that the mother, that is a major source of the client’s anger, is not present for the initial interview to support the client and to offer her perspective. The client’s mother may be able to offer an accurate account of when she thought that his symptoms became apparent or worsened to the point that she though professional help was warranted. His mother can also offer her own incite as to the client’s behaviors toward her or others and his possible triggers. Having the perspectives of the client and close family can provide the client with more information than having just the client’s rationale for the issues he is experiencing.
Student Nurse’s Subsequent Question during Mental Health Assessment
To gain trust and show empathy, the therapist may explore elements of the client’s life that provide him joy. For this client, it has been established that both his girlfriend and his coach offer him valuable advice and support when he does not feel as if this has been given by his mother. As a subsequent question during this interview the client should be asked, “So you said your coach gives you advice and support in a nonjudgmental or aggressive way. First, what sport do you play? And then, “What makes the coach’s advice more relatable to you versus advice your mother might give? Nurs 6660 Week 1 Discussion – Comprehensive Integrated Psychiatric Assessment – YMH Boston Vignette 4 video
References
Kiyimba, N., Karim, K., & O’Reilly, M. (2017). The use of why questions in child and adolescent mental health assessments. Research on Child and Social Interaction, Retrieved on 2-28-18 from https://doi.org/10.1558/resi.30280
Mash, E.J. & Hundsley, J. (2005). Special section: Developing guidelines for the evidence-based assessment of child and adolescent disorders. Journal of Child and Adolescent Psychology, 34,362-379. Retrieved from https://doi.org/10.1207/s15374424jccp34031
Sadock, B.J., Sadock, V.A., & Ruiz, P. (2014). Kaplan and Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer Nurs 6660 Week 1 Discussion – Comprehensive Integrated Psychiatric Assessment – YMH Boston Vignette 4 video
Sands, N. (2004). Mental health in triage nursing: An Australian perspective. Journal of Psychiatric Mental Health Nursing, 11, 150-155. Retrieved from https://doi.org/10.1111/j.1365-2850.2003.00697.x
YMH Boston. (2013c. May 22). Vignette 4-Introduction to a mental health assessment [Video file]. Retrieved from https: www.youtube.com/watch?v=JCJOXQa9wcE
Discussion: Comprehensive Integrated Psychiatric Assessment
The comprehensive integrated psychiatric assessment of a child or adolescent consists of gathering information from not only the child but from several sources, most notably the family members, caregivers, and the child’s teacher or school counselor. Because of this, the diagnostic assessment becomes more complicated. Issues of confidentiality, privacy, and consent must be addressed. Also, the PMHNP must take into consideration the impact of culture on the child.
In this Discussion, you review and critique the techniques and methods of a mental health professional as he or she completes a comprehensive integrated psychiatric assessment of an adolescent.
Learning Objectives
Students will:
- Evaluate comprehensive integrated psychiatric assessment techniques
- Recommend assessment questions
To Prepare for the Discussion:
- Review the Learning Resources concerning the comprehensive integrated psychiatric assessment.
- Watch the Mental Status Examination video.
- Watch the two YMH Bostonvideos.
- Nurs 6660 Week 1 Discussion – Comprehensive Integrated Psychiatric Assessment – YMH Boston Vignette 4 video
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click submit, you cannot delete or edit your own posts and cannot post anonymously. Please check your post carefully before clicking Submit!
By Day 3
Based on the YMH Boston Vignette 4 video, post answers to the following questions:
- What did the practitioner do well?
- In what areas can the practitioner improve?
- At this point in the clinical interview, do you have any compelling concerns? If so, what are they?
- What would be your next question, and why?
Week 1 Discussion
The purpose of the psychiatric interview is to elicit information from a patient to determine a diagnosis and subsequently, a treatment plan. According to Kaplan, Sadock, and Ruiz (2014) the interview can shape the patient- practitioner relationship and important aspects of the interview includes patient consent to an interview, explanation and follow through of confidentiality and privacy, providing the client with respect and consideration, developing a rapport with the client, while providing a safe and comfortable environment for the client (pp193-194).
What did the practitioner do well?
The provider did a great job providing a safe place for the client and explaining confidentiality and potential reasons why he would need to break that confidentiality. He gave his full attention to the client and asked questions to get a better understanding of the client’s answer. He asked if the client had someone he can talk to he can trust to assess support (YMH Boston, 2013).
In what areas can the practitioner improve?
Twice the client stated he did not like school and the practitioner failed to ask why. According to Scher (2016) “academic functioning is a common concern” (para 4, Adolescent interview). I believe this may have been an opportunity to see if he was having trouble at school either in academics or with peers. School was also the area of contention with the mother. The practitioner also could improve by wording his sentences in a different manner. After he said “she must have a reason” the client seemed as though he did not want to talk about the issue further (YMH Boston, 2013, 1:52). The practitioner could have asked how long this has been occurring, how often, and what other symptoms the client may have. Nurs 6660 Week 1 Discussion – Comprehensive Integrated Psychiatric Assessment – YMH Boston Vignette 4 video
What would your next question be and why?
I would ask the client to describe a typical day from the time he wakes up until he goes back to bed. This question would allow more insight into the client and his activities and I would be able to explore any other symptoms or patterns that the client does not recognize. For example, the client may reveal he stays up late talking to his girlfriend and he is too tired to focus in class. Further exploration will help guide the treatment plan.
References
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.
Scher, L.M. (2016). Psychiatric interview. Retrieved from https://emedicine.medscape.com/article/1941476-overview#a14
YMH Boston. (2013). Vignette 4- Introduction to a mental health assessment [Video file]. Retrieved from https://www.youtube.com/watch?v=JCJOXQa9wcE Nurs 6660 Week 1 Discussion – Comprehensive Integrated Psychiatric Assessment – YMH Boston Vignette 4 video