Mental Health Nursing

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attempting to observe behaviours that are relatively low in frequency may use up a large amount of observer time for only one or two occurrences. In such circumstances it is useful to use role-play methods where the patient is asked to perform the behaviour, even though it is not a natural occurrence. Finally, the effect of the observer on the patient and their behaviour must be recognised. In some cases the behaviour or symptoms that are being assessed will alter simply because of the presence of the observer. This is known as reactivity. Again, some patients with OCD report little or no urge to conduct rituals when they are being observed. This is because they rationalise that the observer will take responsibility should a catastrophe result from the ritual not being performed. On the other hand, other patients may appear more agitated, anxious and aggressive if they are aware that their behaviour is being regularly monitored. Measurement Acute psychiatric in-patient assessment 19 Conducted on admission, measurement procedures provide a baseline from which future changes may be compared. It may also assist other assessment procedures to identify relevant problem areas. Some measurements are based on a patient’s score on a specific questionnaire or rating scale and are used to help arrive at a diagnosis. As with interviewing and observation, measurement may be made at a number of levels. The most general comprises broad assessment questionnaires which are used to assess psychological, physical or social functioning. • Global Assessment of Functioning (GAF) (American Psychiatric Association, 1994). A clinician-rated 0–100 scale that assesses symptom severity or level of psychological, social and occupational functioning where non-organic psychological symptoms are present. • Health of the Nation Outcome Scales (HoNOS) (Wing et al., 1998). This 12-item scale, intended for use by nurses and psychiatrists, examines both clinical problems and social functioning. It is discussed fully in Chapter 2 of this book. Domain-specific measures identify the presence of symptoms, or level of functioning, within the parameters of the selected domain. Domains are defined by concepts such as level of social functioning, or the parameters of the patient’s medical diagnosis (e.g., depression, schizophrenia). These are sometimes referred to as nomothetic assessment procedures, as they are intended to apply to all patients within the selected group.
20 Acute Mental Health Nursing Measures for the domain of medical diagnoses • Schizophrenia ¡ Positive and Negative Syndrome Scale for Schizophrenia (PANNS) (Kay et al., 1992). Assesses psychotic and related symptoms and gives three sub-scale scores for positive, negative and general symptoms. ¡ Signs and Symptoms of Psychotic Illness (SSPI) (Liddle et al., 2002). A 20-item clinician-rated scale. Nineteen of the items assess the presence of symptoms in five areas commonly seen in psychotic illness. These are depression, excitation, diminished psychomotor activity and reality distortion; one item assesses insight. • Obsessive Compulsive Disorder (OCD) ¡ Yale–Brown Obsessive Compulsive Scale (YBOCS) (Goodman et al., 1989a, 1989b). A 10-item clinician-administered semistructured interview and 64-item clinician-administered checklist designed to measure the severity and types of symptoms in Obsessive Compulsive Disorder. Ratings result in an overall score and ratings of severity for obsessions and compulsions. A self-report version has also been developed (Baer, 2000). ¡ Maudsley Obsessional Compulsive Inventory (MOCI) (Hodgson and Rachman, 1977). A 30-item self-report scale, with items being rated as ‘True’ or ‘False’. Scores on four sub-scales can be obtained (cleaning, slowness, doubting, checking) in addition to an overall score. • Bipolar Disorder ¡ Young Mania Rating Scale (YMRS) (Young et al., 1978). An 11-item, clinician-administered rating scale that assesses the various symptoms of mania on a 0 to 4 scale, where 0 = absent and 4 = the most severe. • Depression ¡ Beck Depression Inventory (BDI) (Beck et al., 1961; Beck and Steer, 1987). The original questionnaire is a 21-item rating scale completed by patients. Items cover the main symptoms of depression in the form of statements and respondents are asked to mark the presence of each symptom over the last week. Items are scored on a 0 to 4 scale. ¡ Zung Self-Rating Depression Scale (ZSDS) (Zung and Durham, 1965). The Beck Depression Inventory and the ZSDS are the main self-administered instruments for the assessment of depression.
Page 1 and 2: EDITED BY Marc Harrison David Howar
Page 4 and 5: Acute Mental Health Nursing From Ac
Page 6 and 7: Contents List of contributors vii F
Page 8 and 9: List of Contributors Ian Baguley qu
Page 10 and 11: List of Contributors ix background
Page 12 and 13: Foreword When I first started my ca
Page 14 and 15: An introduction to acute mental hea
Page 16 and 17: • Care management • Management
Page 18 and 19: organisations providing it. Followi
Page 20 and 21: works, and to be understanding of t
Page 22 and 23: Introduction ONE Acute psychiatric
Page 24 and 25: Assessment framework Acute psychiat
Page 26 and 27: Evidence suggests that the quality
Page 28 and 29: ‘Can you tell me something about
Page 30 and 31: negative thoughts, anxiety may sugg
Page 34 and 35: These scales are often used as ‘s
Page 36 and 37: thoughts as and when they occur. Th
Page 38 and 39: Acute psychiatric in-patient assess
Page 40 and 41: Acute psychiatric in-patient assess
Page 42 and 43: Introduction TWO Measuring health a
Page 44 and 45: Measuring health and social functio
Page 48 and 49: have timely, accurate and appropria
Page 58 and 59: easy to see why many staff have bec
Page 60 and 61: Acknowledgements Parts of this chap
Page 64 and 65: Introduction THREE Social inclusion
Page 66 and 67: Social inclusion and acute care 53
Page 68 and 69: Health Consortium (GPMH, 1989) desc
Page 76 and 77: professionals, belief in the value
Page 78 and 79: in relation to the people who are a
Page 80 and 81: networks that we can hope to help t
Page 82 and 83:
ward, and activities that they can
Page 84 and 85:
Social inclusion and acute care 71
Page 86 and 87:
• Current adjustment: physical he
Page 88 and 89:
Page 90 and 91:
Page 92 and 93:
Strategies for surviving acute care
Page 94 and 95:
patients said they did not get enou
Page 96 and 97:
involvement can certainly be approa
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to exert a measure of control or ch
Page 100 and 101:
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Case management: perspectives of th
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Introduction SIX Integrated care pa
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outcomes to help identify alternati
Page 128 and 129:
services. Pre-formulation helps sec
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nature of pathway documentation can
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Integrated care pathways: the ‘ac
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11. Referred for neurology opinion
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36. 11 point assessment completed B
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Stage 13 Stage 14 Integrated care p
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evealed and analysed, and change of
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SEVEN Risk assessment and managemen
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Risk assessment and management in a
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Observation 163 of people who had c
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towards others. For nurses, having
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no evaluative work conducted to ass
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Observation 169 All local trusts an
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Table 8.1 Four levels of observatio
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most intensive level of observation
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Observation 175 (DoH, 1999a, 2001);
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strongly influenced by cultural iss
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who conducted the special observati
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Fletcher (1999) employed an ethnogr
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Observation 183 Bowers, L. and Park
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Introduction NINE Cognitive behavio
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Cognitive behaviour therapy in in-p
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provided a great deal of hope for a
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Assessment of Need (Phelan et al.,
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3. Changing cognitive processes. 4.
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hallucinations, which are so common
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nurse practitioner. Until very rece
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Psychosocial interventions 199 clie
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Psychosocial interventions 201 a fi
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levels of staff sickness. If workin
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Psychosocial interventions 205 for
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Problem list and assessment Psychos
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should be introduced until the pati
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Psychosocial interventions 211 rece
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Psychosocial interventions 213 Barr
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Psychosocial interventions 215 Barr
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Psychosocial interventions 217 Rix,
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emphasises the need for mental heal
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encountered with their use. Anti-ps
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can be almost exclusively attribute
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to establish a link between EPS and
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Interventions to enhance compliance
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The use of cognitive behavioural in
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• giving patients information abo
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Medication management 233 Bennett,
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Medication management 235 Meltzer,
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238 Index institutionalisation, 63-
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Mental Health Nursing

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