Psychiatric Nurses make assessments to each of their patients all through the shift. They even make assessments when they are not conscience they are assessing the people around them. It becomes such a part of who they are – it happens without taking notes or being aware mentally it is taking place. Accuracy of the nursing assessment determines whether the steps of the nursing process produce accurate nursing diagnoses, planning, and intervention.
The First Step of the Nursing Process is the interview process, in the manner that the interview is conducted depends on the information that is gathered and if a trust bond can be established between the nurse and the patient. A client expects the person conducting the interview to be an expert who is confident in the professional role, maintains confidentiality, demonstrates warmth and genuineness, is nonjudgmental toward them and their past or current behavior, and recognizes that clients are experts on themselves and their behavior.
Subjective: Client’s current problem and reason for seeking help, Past mental illness and treatment, Family history and mental illness, Medical history, Allergies to medications, foods, and other substances, Past and present medications and their effects, Past and present abuse, Substance abuse history, Educational and/or vocational history, Health habits, Safety issues, Cultural beliefs and practices
Objective: Behavior, Communication, Physical assessment, Laboratory or testing data, Mental status, Appearance, Hygiene, grooming, appropriateness of clothing, posture, and gestures,
Behavior:Eye contact, motor behavior, body language, behavioral responses to others and environment, volume and speed of speech, tone of voice, flow of words.
Affect and Mood: Happy, sad, anxious, sullen, hostile, inappropriate for situation, silly, and range of emotions.
Orientation: To person, place, time, situation, relationship with others.
Perception: Awareness of reality vs. fantasy, hallucinations, delusions, illusions, suicidal or homicidal ideation or plans.
As a nurse it is our duty to make good judgment because we can affect someone's life…sometimes their whole life. Speaking with a young lady in her mid 30's ( and yes 30 is young) she did not look like the other clients and I had to look twice to make sure she was not a new staff member. Her hair was well kept – her clothes were very nice and it made her stand out from the others. She smiled as I sat down at the table of "uno card game" being played. I ask "Who is winning…?" She laughed and said she had won twice on pure luck. After round two of the game and some small talk as the cards were being played she made a comment that opened up our conversation. There was a lady behind her was pacing the floor and talking to herself non-stop. Very pre-occupied with what was going on in her head and did not give the people around her any of her attention. She stated, "I am leaving today and it cannot be one minute to soon." I ask where she was going and she began sharing how to ended up at the table playing uno.
She had a prescription for medication that treated her depression. She had noticed that she needed a change in her medication and called her Doctor to make an appointment like she had done many times in the past. This time he ask for her to stop by the lab on the way to his office – except she never made it to his office that day. The told me about the nurse she came in contact with to sign papers required for insurance and be processed for the lab draws. She looked across the table at me, "She ask me one question that I answered honestly. I was not upset – nor did I say I had any other plans. She asks, did I have any thoughts in the last year of depression or wanting to harm myself." I answered," yes" – but not since then. She explained she was getting blood work before going to her doctor's office to get a medication adjustment.
The interviewer exited the room and returned with another nurse she assumed was in charge. They began explaining that she would be transferred to a state hospital for 72 hours for an evaluation due to her thoughts in the last year. She became upset when they would not hear what she was telling them. Since she refused to go -To make a long story short she was given a court order for a 72 hours evaluation.
She was in college working on her bachelor's degree – a time in school she did not need to miss class. The college professors agreed to work with her as she went through trial in her life.
She was not angry she was in the hospital as much as she was upset over missing the Halloween holiday with her young son – her church cooks out – handing out candy at Halloween to the neighbor kids. You could see her frustration as she shared her story.
Without knowing 100% of the story – her history – or background it made me stop and think. Her life was stopped in mid air by another person's judgment. The nurse that interviewed her changed her path for 3 days. Her family had to do without her, a judge gave a court order for her to be observed, she had to miss school, she was absent from her job, and she now had a record in a mental hospital. She did not miss Halloween – she lived it inside a mental hospital. Without this entire event taking place – I would have never met her or had our conversation.
What we say to our patients and how we treat them during their stay in our care can change one person's life. She will never forget the nurse who sent her down this path – good or bad.
The statement she made that made my heart jump was this: "I can guarantee one thing for sure. I will never answer a question like that again honest. I will never admit, no matter how bad I feel to having any thoughts of self harm, or feeling depressed." The nurse patient relationship was broken.
Patients and families count on nurses to keep them informed, to connect them to their physicians and other caregivers, to listen to them, to ease their anxiety, and to protect and watch over them during their healthcare experience. Because of these high expectations of nurses, it’s no wonder that nursing performance, and more specifically, the nurse patient relationship, is so central to patient satisfaction and a quality patient experience.
Patients do not care how much you know ….. until they know how much you care.
Angela Brooks is a leading distributor of aYoung Living Essential Oils. Dedicated to natural health solutions, Brooks provides people with healing alternatives without harsh side effects. Additionally, Brooks is a mental health nurse of 21 plus years and author of the new best seller on amazon committed to bringing mental happiness to the nursing profession by motivating and supporting nurses around the country.
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