Mental Health Nursing

14 Acute Mental Health Nursing
How to assess
There are three methods of assessment – interviewing, observation and
measurement. To increase the validity of assessments, assessors should
incorporate all three, as reliance on only a single method introduces
potential for bias. For example, observation provides an account of behaviours.
It does not, however, account for motivations as these can only be
determined through interviews. So, a comprehensive assessment collects
complementary information, from which a broad insight into the patient’s
problems can be obtained.
Interviewing
The interview occupies a central place in the assessment process as it
provides an opportunity for both the patient and the assessor to begin a
therapeutic relationship. The initial face-to-face contact also enables the
assessor to provide an orientation to the ward environment, guidance,
information, engagement and reassurance that may be necessary according
to the patient’s needs (DoH, 2002). The interview enables the patient
to state their problems in their own terms, thereby ensuring that their own
views and experience are given central importance.
The assessment interview consists of a range of questions designed to help
identify features of the patient’s current experiences that are problematic or
distressing. Of early importance is the patient’s ability and willingness to be
interviewed. Where patients are experiencing severe psychological distress,
or are in need of physical interventions or observation, it is usually inappropriate
to attempt to conduct a full interview. In these cases the nurse can utilise
information from a number of other sources including carers, relatives and
referrers, so that a detailed description of the patient’s current functioning can
be validated with the patient once their symptoms are controlled.
Assuming an interview can be carried out, it is essential that the assessor
has the skills necessary to develop a therapeutic alliance and to be able
to help the patient to manage any distress associated with both their symptoms
and of being in an unfamiliar environment. Admission to a psychiatric
unit alone may be a source of anxiety for patients and their families
or carers. Thus, the assessor needs to show awareness of these emotions
and to respond empathetically. Statements such as ‘It seems as though you
are finding this quite difficult at this time’ may be sufficient to indicate
that the patient’s distress has been acknowledged. Subsequent responses
will vary according to the nature of distress the patient is experiencing, but
is likely to include providing information and reassurance on the nature of
the ward environment.
Applying Hawkins’s (1986) ‘funnelling’ to the interview process the
initial assessment involves the use of broad, open-ended questions such as