Psychosocial Assessment Flashcards
Basic Interview Stages
- Opening/Introduction (sets the tone)
- Body/Development (patient responds to questions)
- Closing (termination of the interview)
Opening/Introduction
- establish rapport
- explain purpose and nature of interview
“MAY I SIT DOWN FOR ABOUT 10 MINUTES TO
TALK ABOUT WHAT BROUGHT YOU INTO THE HOSPITAL?”
“ FEEL FREE TO SAY IF THERE IS ANYTHING YOU DON’T WANT TO TALK ABOUT.”
Body/Development: Types of Interview Questions
- Closed
- Open-ended
- neutral
- leading
Closed Questions
answer is restricted to few words
Open-ended Questions
invitation to explore thoughts/feelings
Neutral Questions
freedom to answer without pressure
Leading Questions
limits accuracy of response
Body/Development Techniques
- listen attentively
- use simple language
- clarify points not understood
- question in logical sequence
- ask one question at a time
- do not impose own values
- avoid using personal examples
- convey respect and interest
- be aware of body language
- be aware of voice
- sit at even level
- use silence to allow patient to organize thoughts
- use eye contact ad be unhurrried
Closing Techniques
- offer to answer questions
- offer clear conclusion
- thank the patient
- express concern for future welfare
- plan for next meeting
- provide a summary
Considerations
- effective nurse communication
- holistic approach
- interview environment
- patient’s developmental level
- patient emotional factors
- patient family factors
- patient culture
Goal to the psychosocial assessment
to understand the patient
evaluates:
- mental health and illness
- social well-being
- perception of self
- ability to function in community
- multiple domains of mental status
Components of the Psychosocial Assessment
- identify patient
- chief complaint
- history of present illness
- psychiatric history
- med/surg history
- medication list
- alcohol/drug use
- family history
- developmental history
- social history
- violence risk
- mental status exam
Social History Components
- social relationships
- living situation
- significant life events
- employment
- education
- legal
- spiritual
- cultural
- financial situation
- coping skills
- interests/hobbies
Obtaining Military History
General question: Would it be okay if I asked you about your military experience?
If yes,
- how has military affected you?
- did you see combat, enemy fire, or causalities?
- were you or a buddy wounded, injured or hospitalized?
- do you have a service-connected condition?
Mental Status Exam
- analogous to the physical exam
- assessment of brain fx (mental function, emotions, behaviors)
- some aspects obtained by observation
- some aspects obtained by direct questioning
Mental Status Exam Components
- general apperance
- motor activity
- speech/communication
- emotional state
- thought content
- thought processes
- perceptual disturbances
- cognition
- abstract reasoning
- insight and judgement
General Apperance
- apparent age
- dress
- hygiene/grooming
- posture
- facial expression
- eye contact
- pupils
- general state of health/nutrition
- acute distress
motor activity
- rate of movement
- gait
- unusual movements
rate of movement
- slowed=bradykinesia
- agitated=hyperkinesia
Gait
- freedom
- pacing
- posture
Unusual movements
- tics
- tremors
- jitteriness
- hand wringling
- muscle spasms
- lip smacking
- unable to remain still (akathisia)
Communication
process of content being expressed
- resistant
- disorganized
- negative
- requires prompting
Speech
how content is articulated
- fluency
- rate
- amount
- tone
- volume
- repetition
Mood
subjective emotional state
- sad
- angry
- guilty
- anxious
Affect
outward expression of emotional state
- flat
- blunted/constricted
- tearful
- euthymic
Types of thoughts
- phobias
- hypochondriasis
- ideas of reference
- magical thinking
- obsessions/preoccupations
- thought insertion
- thought broadcasting
- suicidal ideation*
- homicidal ideation*
- delusions
Types of Delusions
- grandiose
- persecutory
- jealously
- religious
- somatic
- ideas of reference
- thought insertion
- though broadcasting
Thought Process
description of how thoughts are formulated, organized, and expressed
Hallucinations
- perceptions in the absence of stimuli to account for them
- may involve any of 5 senses
- auditory most common (command vs. non command)
- do you hear voices when no one is around
illusions
misperception of stimuli, mistaking wind for a voice
depersonalization
- feeling detachment from oneself
ex: looking down and seeing oneself
derealization
- feeling environment has changed
- ex: feeling a barrier between oneself and the world
Cognition
-alertness
-orientation
-memory
-calculations
concentration/attention
-visuspatial ability
-abstract reasoning
insight
- patients understanding of: own feelings, how presenting and functioning, potential causes of psychiatric symptoms
- reality testing with psychosis “I know there are not little men in my home, but I can see them and hear their voices”
Judgment
- capacity to make healthy decisions, also to act on healthy decisions
- may or may not correlate with level of insight
- can be tested with hypothetical examples
- recommended to use real patient situations
Functional Ability
- self-care
- socialization
- appetite
- sleep
