Mental Health Nursing

‘Can you tell me something about your recent experiences?’ or ‘What was
happening that resulted in your admission to hospital?’
Once broad areas of functioning and experience have been identified,
the assessor then selects those that are relevant to the patient’s present
admission. To facilitate this process it is useful to summarise the information
that has been obtained, highlighting those that need to be explored
in greater detail. This is helped by using the skills of paraphrasing, summarising
and reflection. A typical question might include ‘We’ve now got
a lot of information on what has been happening for you, which is very
helpful. You’ve said that you’ve been experiencing some difficult emotions
lately – can you tell me some more about these?’
As the interview progresses into the selective assessment stage, the
style of questioning changes to more leading questions as these give the
patient an indication of the nature of the information that is needed
(Hawkins, 1986). For example, if open-ended questions result in responses
that are too lengthy or discursive, a question such as ‘You mentioned earlier
that you’ve been feeling under pressure – can you tell me some more
about this?’ may help to focus the response. Note that this question selects
one of the patient’s earlier responses and provides a prompt as to the areas
of their experience about which information is sought. It is at this stage
that more specific nursing models or diagnostic schemes may be utilised
to provide some structure to information gathering, although it is still
important to ensure that all psychological, social and biological areas of
functioning are given consideration. Where indicated, semi-structured
interviews are used to help identify relevant problems. If areas of functioning
that are not directly related to the nurse’s expertise are identified
as warranting further attention, an initial management plan suggesting
referral to other members of the ward team or other agencies should
be developed.
The third stage of the interview process then focuses on the specific
details of the problems identified (Hawkins, 1986). This is characterised
by greater structure and may involve the use of closed questions to refine
the interview process. Barker (1997) developed Kipling’s Six Honest Serving
Men, quoted at the beginning of this chapter, and suggests basing
questions around the words, what, where, when, who, why, how, to obtain
specific information regarding the patient’s problems.
Observation
Observation is defined as
Acute psychiatric in-patient assessment 15
regarding the patient attentively while minimising the extent to which they feel under
surveillance. (SNMAC, 1999: 2)