Psychiatric Assessment of the Adult and Older Adult

Many assessment principles are the same for children and adults; however, with adults/older adults, consent for participation in the assessment comes from the actual client and not parents or guardians. The exception to this is adults/older adults who have been determined incapacitated by a court of competent jurisdiction. Some adults may be easier to assess than children/adolescents as they are more psychologically minded. That is, they have better insights into themselves and their motivations than children/adolescents (although this is not universally true).

Older adults present some of their own unique assessment challenges in that they may have higher levels of stigma associated with seeking psychiatric care. Additionally, there are higher rates of neurocognitive disorders superimposed on other clinical conditions such as depression or anxiety, which creates additional diagnostic challenges.

This week, you will develop your own personal format for initial interviews of mental health clients. You also will explore the restrictions and limitations for practice as a PMHNP in your home state and create a plan for passing the national certification exam.

Week 1-developing skills in interviewing and diagnostic reasoning

As we begin Week 1, the module is focused on developing an interview format that provides you with questions/responses that you will use in your work-ups and diagnostic assessments or some call them Psychiatric H & P. By now, you have seen many different formats and ways that providers conduct interviews. 

For this document, I encourage you to think of your personal style as well as assure that all relevant information is collected in the first interview. Do not use a template that you find online or that your preceptor uses in the office. The purpose of this assignment is for you to think through how you interview patients. There are many examples online to use as a guide. The key elements are similar to a medical H &P, HPI, PPH, PMH, FH, SH, ROS (psychiatric), MSE, Clinical Assessment and Formulation, Diagnosis, and Plan. This will be your ‘bread and butter’, so to speak for your entire career. It is worth spending some time and effort on this. If you put in a canned template, I will not accept your work.
 

My personal style is what I would call ‘conversational’. I try to engage in some social conversation to get the visit started and then as the patient talks, I make notes on follow-up questions. I keep a list of the basic things that I need for my write-up: HPI, PPH, PMH, Soc/Dev, Substance use, Medication history, Stressors, coping abilities, therapy history. At the end of what I consider ‘the interview’ I review my list to make sure that I have all the information and I sometimes say to patients, “let me make sure that I got all the information that I need to make an accurate diagnosis and develop a treatment plan”. Then, I will say to the patient, “do you have anything that you’d like to add?”

This conversational style is not for everyone and I know many providers that use more of a ‘checklist’ style. Think about what you want and how you will feel most comfortable. Feel free to provide feedback to your colleagues –there are no right or wrong styles. 

Instructions- Week 1: 

Despite what you may believe (or may have been told), there is no such thing as one “right” way to do an interview. In fact, there are numerous books written about the various ways of conducting the clinical interview. In actual clinical practice, you will find the format that “works” best for you and addresses your unique strengths and the needs of the client.

In this Discussion, you will practice finding the interview format that works for you and share those ideas with your colleagues for feedback.

                                                                      Learning Objectives

Students will:

• Develop formats for initial interviews of mental health clients

To prepare for this Discussion:

• Review  the Learning Resources.
• Develop an interview format you would use for an initial interview of a client.

                                                           ASSIGNMENT

• Attach  the interview format document you would use for an initial interview of a client.
• Describe      what interview format your preceptor uses for the initial interview of a  client.
• Describe      which element of your interview format is most helpful in your practice.

                                               Learning Resources

Required Readings

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.

• Section 5.1, “Psychiatric Interview, Mental Status      Examination” (pp. 192–211)
• Section 5.2, “The Psychiatric Report and Medical      Record” (pp. 211–217)
• Section 5.3, “Psychiatric Rating Scales” (pp. 217–236)
• Section 5.5, “Personality Assessment: Adults and      Children” (pp. 246–257)
• Section 5.7, “Medical Assessment and Laboratory Testing      in Psychiatry” (pp. 266–275)
• Chapter      6, “Classification in Psychiatry” (pp. 290–308)

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

• “Cautionary Statement for Forensic Use of DSM-5”
• “Assessment Measures”
• “Cultural Formulation”
• “Glossary of Technical Terms”
• “Glossary of Cultural Concepts of Distress”

Barton Associates. (2017). Nurse practitioner scope of practice laws. Retrieved from https://www.bartonassociates.com/locum-tenens-resources/nurse-practitioner-scope-of-practice-laws/

American Psychiatric Association. (2016). Practice guidelines for the psychiatric 

evaluation of adults. Retrieved from http://psychiatryonline.org/doi/pdf/10.1176/appi.books.9780890426760

Required Media

Laureate Education (Producer). (2017b). Working with Adults and Older Adults” [Video file]. Baltimore, MD: Author.

Hagen, B. (Producer). (n.d.-a). Conducting a mental status exam [Video file]. Mill Valley, CA: Psychotherapy.net.

Optional Resources

American Psychological Association. (2008). Assessment of older adults with diminished capacity. Retrieved from https://www.apa.org/pi/aging/programs/assessment/capacity-psychologist-handbook.pdf 

Rosen, S. L., & Reuben, D. B. (2011). Geriatric assessment tools. Mount Sinai Journal of Medicine, 78(4), 489–497. doi:10.1002/msj.20277

Substance Abuse and Mental Health Services Administration (SAMHSA). (2015). TIP 59: Improving cultural competence. Retrieved from http://store.samhsa.gov/product/TIP-59-Improving-Cultural-Competence/SMA15-4849

 Write a 260- to 350-word article that reviews a recent innovation in health care and its impact on existing systems (e.g., first- and second-movers, wearables, printed organs, genetic testing) 

 

Include a citation of your article in your assignment.

Cite 3 reputable references to support your assignment (e.g., trade or industry publications, government or agency websites, scholarly works, or other sources of similar quality).

Format your assignment according to APA guidelines.

  

A new director decides to reorganize the department you work in. This reorganization comes about without input from the employees and many of the nurses that you oversee are feeling resentful of the change. As a nurse leader, identify factors that may lead to conflict and ways you can manage them.

My Topic:

High rate of fall during night shift in the ward for patient with dementia (700words)

For each article that you will be using need to have a checklist from  https://casp-uk.net/casp-tools-checklists/ (I’ve downloaded and attached the file below PLEASE USE IT)

DOWNLOAD ALL THE FILES AND READ THEM BEFORE ATTEMPTING THE ESSAY.

You will develop a syllabus for an 8-week undergraduate nursing course in your area of interest that conveys the essential components of that course to the learner. 

Assignment GuidelinesWhen preparing your syllabus, pay attention to the organization and layout to ensure it is easy to read. Your syllabus should set the tone for your course and convey enthusiasm for the course topic; show how your course fits into a broader picture; communicate what, when, and how students will learn; clarify what students need to do to be successful; and communicate your expectations of student performance to satisfactorily complete your 8-week course.Your course syllabus should include:General information about the course: The instructor’s name (you), course title, course number, course credit hours, class days and time period (start and end times), class location (room number), and any prerequisites. You may also wish to include your office hours and contact information.A course description: A description of the course and how students will benefit; this is similar to a catalog description of a course.Course outcome objectives expected: A list of outcome statements describing the knowledge and skills that you expect students to have learned after completing your 8-week course. Your objectives should be: Appropriate to course and educational levelRealistic and clearStated in measurable termsRequired materials and learning resources: Textbook(s), supplies, and anything you may require students to bring to class each dayInstructional methods and activities: List the teaching strategies and approaches you plan to use for students to achieve the learning objectives (e.g., lecture, games, inquiry, discussions). If appropriate, you may want to include any special events or activities (e.g., field trips, experiments, guest speakers, projects). Note: This section is a list of your instructional methods and activities and not an explanation or description of how they will be implemented.Classroom policies or rules: This section should include any policies or rules that are specific to your course (e.g., classroom behavior, absenteeism, tardiness, late assignments, makeup work, and tests).Evaluation methods: This section should include all graded course requirements with the percent value (of the total course grade) for each requirement. This is where you list each of the course requirements or means of evaluating student learning (e.g., tests, quizzes, assignments, presentations, group work). You do not need to provide a rubric for grading each of the course requirements, guidelines, and grading criteria.You do need to provide the total percent value or the grade weight of each requirement.If using tests or quizzes, state the number of tests or quizzes and the grade weight for each.Note: As part of your teaching plan and presentation during weeks 6 and 7, you will provide guidelines and grading criteria (a rubric) for one of your required assignments.An outline and general time line of the course content: This section should be a table or flowchart depicting a schedule of the content to be covered over the 8-week period. In addition to the content, your table or flowchart should include: Estimated dates for when you plan to cover the content. Specific dates are not necessary, but some time line estimate should be provided (e.g., week 1 or class 1)Any activities, assignments, and tests, etc., with corresponding due datesRequired readings for each date and any supplemental or suggested readings you may want to list