seminar slides (Therapeutic relationships,MSE,suicide) Flashcards
what is therapeutic communication?
an interpersonal interaction between the nurse and client whereby the focuses on the client’s specific needs to promote an effective exchange of information
non-therapeutic communication techniques
-failure to listen
-giving false reassurance
-giving advice
-probing
-cliches
-giving literal meanings
-changing subject
what is an MSE?
a critical assessment tool to assess an individuals current mental state
what is the purpose of an MSE
the MSE aids in collecting and organizing objective data at the time of the interview and helps determine the clients abilities, strengths, capabilities, and need for supports
what is the mini mental status exam (MMSE)
a 30-point questionnaire which is used to measure cognitive impairment (used with dementia)
examines attention, calculation, recall, language, ability to follow commands and orientation
factors influencing ability to complete MSE
-ability to participate or give feedback
-physical health
-emotional well being
-ability to communicate
-culture
-the interviewer’s approach
components of the MSE
-appearance
-behaviour
-speech/language
-mood and affect
-thought process
-thought content
-perceptual disturbances
-sensory/cognitive
-judgment/insight
what is appearance in the MSE
what the individual looks like
includes: height, weight, look stated age, grooming, hygiene, clothing, odour, identifying characteristics, facial expression
what is behaviour in the MSE
attitude of the individual during the interview, are they cooperative, hostile, shy, do they make eye contact
are there gestures or mannerisms (tremors, tics etc)
gait, posture, coordination, pacing, muscle rigidity, slow moving
speech characteristics in the MSE
assess for quality (coherent), quantity (amount) of speech, and rate
fluency/ease
what is mood in MSE
mood is what the client reports about their emotional state
euthymic
normal mood
euphoric
elated mood
dysphoric
depressed mood
what is affect in MSE
the clients emotional response during MSE
detected from facial expression, vocalization, and behaviours
described in range, intensity, and appropriateness
full Range in affect
emotions are consistent with stated feelings; congruent with situation
restricted range in affect
little outward expression
flat affect
almost abscent emotions
appropriateness in affect
either congruent or incongruent
emotions are appriopriate for situation or inappriopriate
lability in affect
rapid shift in emotional expressions; happy one moment, then tearful
thought process in MSE
the manner in which thoughts are formed and expressed: relevance, organization, flow of conversation (logic), goal-directed
linear thought process
the individual presents information in a logical flow, easy to follow the individual’s thoughts
circumstantial thought process
the individual takes a long time to make a point; provides very unnecessary information but eventually makes the point
tangential thought process
the individual diverts from the main topic of discussion and to discuss less important information, the individual does not respond specifically to the question asked
loose association thought process
lack of logical relationship between thoughts. conversation shifts from one topic to another in an unrelated manner (can be difficult to follow)
flight of ideas thought process
rapid, continuous verbalization, shifting from topic to topic, commonly seen in mania
word salad in thought process
incoherent mixture of words/phrases (dementia or schizophrenia)
clang association in thought process
words with similar sounds but are not associated in meaning (blue, shoe, sue)
echolalia in thought process
parrot like repetition of overheard words or phrases (autism)
neologism in thought process
new words or combination of words created by an individual - seen in schizophrenic disorder
perseveration in thought process
individual gives the same verbal response to various questions (cognitive impairment disorders)
thought blocking in thought process
thoughts interrupted by silence or delay in response
thought content in MSE
what is the individual thinking about
delusions in thought content MSE
false fixed beliefs based on an incorrect inference about reality; not shared by others; cannot be corrected by reasoning; thus interferes with thinking & reality
obsessional ideas in thought content MSE
insistent thoughts (over and over in your head; “thoughts one can’t get rid of”)
phobias in thought content MSE
irrational fears
suicidal/homicidal ideations in thought content MSE
any thoughts/plans to hurt yourself or others, lethality
thought content - delusions: thought broadcasting
belief that one’s thoughts are obvious/apparent to others or being broadcasted to the world
thought content - delusions: delusions of paranoia
irrational distrust of others and/or belief others are harassing/threatening
thought content - delusions: somatic delusions
delusions involving the body or bodily functions
(rotting on the inside)
thought content - delusions: delusions of grandeur
exaggerated belief of one’s importance or power
thought content - delusions: ideas of reference
belief that other people & events have special significance to the individual (a person on the TV is talking specifically to them)
perceptions in MSE
taking in sensory information from one’s surrounding/environment and processing this into mental representations. it is the way an individual views oneself, the environment, and relationship to others in the environment
perceptual disturbances associated with mental illness are hallucinations and illusions
hallucinations in perception MSE
sensory perceptions not associated with external stimuli and are not shared by others
examples: visual, auditory, olfactory, gustatory, tactile
perception - hallucinations MSE: visual
client reports seeing things that are not present to others (i.e snakes on the wall)
perception - hallucinations MSE: auditory
client reports hearing things others cannot (voices etc) seen in schizophrenia
perception - hallucinations MSE: olfactory
client states she smells things with no supportive evidence (rotting garbage etc) seen in psychosis
perception - hallucinations MSE: gustatory
client complains of constant taste in mouth (sour, milk etc)
-lithium actually causes metal taste in mouth*
perception - hallucinations MSE: tactile
client reports feeling things on skin (i.e. bugs crawling all over body) seen in alcohol withdrawl
perceptions - illusions MSE
misrepresentation of real sensory stimuli
perceiving a piece of wool as an insect, when in the shower you thought your phone range etc.
sensory and cognition in MSE evaluates
-level of consciousness
-orientation
-memory(short - long - immediate)
-attention & concentration
-abstract reasoning
sensory and cognition MSE: level of consciousness
alert, responsive, sleepy, confused, delirious
sensory and cognition MSE: orientation
person (who), place (where), time (day,month, year) & situation (what is happening)
sensory and cognition MSE: immediate memory
list 3 words & client recalls them after 10 minutes
sensory and cognition MSE: recent memory
events in the past few hours (breakfast, morning care etc)
sensory and cognition MSE: long term
memory of events from years ago
sensory and cognition MSE: attention & cognition
able to maintain attention
are they easily distracted
i.e start at 20 subtract in 3’s
sensory and cognition MSE: abstract reasoning
interpret a proverb
intellectual ability: who is the premier?
ability to have abstract/logical/illogical thinking
insight MSE
does the client understand their situation? the client’s ability to examine ideas, thoughts, and feelings, problem solve, and understand their illness
i.e. what lead to your hospital admission
judgment MSE
does the client have the ability for decision making?
one’s ability to reach a logical decision about a situation after reviewing/contemplating options or possibilities
I.e what would you do if the fire alarm went off on the unit
risk for suicide/homicide MSE
assess the clients potential for self harm or harm to others
-ask overtly
world suicide prevention day
sept 10th
how many suicides a year globally
700 000
more than __ of all deaths by suicides occur on the first attempt
1/2
suicide deaths per day in canada
12
nl # of suicides in 2021
81 reported
males vs females suicide
males 3x more likely to DIE
females 3x more likely to ATTEMPT
suicide accounts for __ of all deaths in Canadians ages 15-24 years
29%
term: suicide
the act of killing oneself
term: suicidal intent
thoughts about concrete plan to die by suicide
term: suicide attempt
behaviour in which one responds to ambivalent feelings about living
term: suicidal ideation
thoughts about wanting to die
protective factors from suicide
-hope
-children
-strong supports
-gratification in life
-positive coping skills
-cultural, religious, and personal beliefs (may be forbidden)
risk factors for suicide
-history/previous attempts
-family history
-hopelessness
-lack of social supports
-losses (finances, loved one, job, gambling)
-childhood trauma
-mood disorders/substances related disorders
-terminal illness
-barriers to mental health treatment
risk groups for suicide
-age groups(teens, mid-aged adults, elderly)
-gender diverse populations
-indigenous people
-incarcerated people
-dx of mental illness
-substance misuse
warning signs of suicide (IS PATH WARM)
-Ideation
-Substance misuse
-Purposelessness
-Anxiety
-Trapped
-Hopelessness
-Withdrawn
-Anger
-Reckless behaviour
-Mood changes
vulnerable times for suicide risk in hospital
-shift change/report
-meal-times
-busy times on the unit/when staff are busy with something else
methods to die by suicide
-violent (hanging, firearms(men), drug ingestion(female)
-ingestion(poisoning, overdose, pesticides)
-drowning
-jumping
-crashing a vehicle
what to do if suicide intent is present in hospital
-ensure safety
-do not react
-be non-judgmental
-do not minimize feelings
-be empathetic but avoid false hope/cliches
-observe client 1:1
conducting an assessment - susicide: CPR
C- Current thoughts; MSE, explore anything unusual and inquire
P-plan, do they have one
R-resources; educate them on
SAD PERSONS scale to assess suicidal intent
S-sex (male)
A-age (<19 or >45)
D-depression
P-previous attempt
E-ethanol abuse (or drugs)
R-rational thinking loss(delirium/delusions)
S-social supports lacking
O-organized plan
N-no spouse
S-sickness(chronic illness, pain)
one point for each factor they are eligible for
follow up for SAD PERSONS score
0-2: home with appropriate follow up
3-6: admit or discharge with appropriate follow up
7-10:admit to hospital
additonal risk factors for suicide (besides sad persons)
-up to 4 weeks following discharge
-recent self harm/ history of violence
-choice of method
-young asian females
-care givers without adequate social/financial support or carers of the severely cognitive imapired
