NR548 Exam 2
the process by which psychiatric assessment is
conducted
-primary tasks
• building a therapeutic alliance between the PMHNP
& client
• obtaining a database of psychiatric info about the
Psychiatric interview client
• establishing a dx
• negotiating a tx plan
a feeling that you should create over the course of the
diagnostic interview, a sense of rapport, trust, and
warmth
-most important goal of the interview process
-the cooperative working relationship between the
therapist and client
• begins during the initial or opening phase of the
interview
-fundamental component of successful therapy
• Without trust, adherence to treatment
Therapeutic Alliance recommendations may be compromised
• interview may not elicit the information needed to
formulate an appropriate dx & plan of care without
rapport & trust
-Be Yourself
-Be Warm, Courteous, and Emotionally Sensitive
-Actively Defuse the Strangeness of the Clinical
Situation
Creating rapport: tips -Give Your Patient the Opening Word
-Gain Your Patient's Trust by Projecting Competence
-Normalization
-Symptom Expectation
How to approach -Symptom Exaggeration
threatening topics -Reduction of Guilt
(sensitive/embarrassing -Use Familiar Language When Asking about
material) Behaviors
1
, NR548 Exam 2
Introducing Q with some type of normalizing
statement
-two principal ways to do this:
1. start the question by implying that the behavior is a
normal or understandable response to a mood or
situation
• ex: Sometimes when people are very depressed,
they think of hurting themselves. Has this been true
for you?
2. Begin by describing another patient (or patients)
who has engaged in the behavior, showing your
patient that she is not alone
Normalization
• ex: I've talked to several patients who've said that
their depression causes them to have strange
experiences, like hearing voices or thinking that
strangers are laughing at them. Has that been
happening to you?
communicate that a behavior is in some way normal
or expected
-Phrase your Q's to imply that you already assume
the patient has engaged in some behavior and that
you will not be offended by a positive response
-high index of suspicion of some self-destructive
activity
-Ex: patient is profoundly depressed and has
expressed feelings of hopelessness. You suspect
suicidality, but you sense that the patient may be too
ashamed to admit it. Rather than gingerly asking
"Have you had any thoughts that you'd be better off
dead?" you might decide to use symptom
Symptom Expectation
expectation. "What kinds of ways to hurt yourself
have you thought about?"
*reserve this technique for situations in which it
seems appropriate
2
, NR548 Exam 2
suggesting a frequency of a problematic behavior that
is higher than your expectation, so that the patient
feels that their actual, lower frequency of the behavior
will not be perceived by you as being "bad."
-helpful in clarifying the severity of symptoms
Symptom Exaggeration *reserve this technique for situations in which it
seems appropriate
seeks to directly reduce a patient's guilt about a
specific behavior in order to discover what they have
been doing
-useful in obtaining a hx of domestic violence & other
antisocial behavior
Domestic Violence
Reduction of guilt -"Have you ever been in situations where fights
occurred and you were affected?"
• If patient answers "yes," you can flesh out whether
role was being a witness, victim, or perpetrator
resource person, teacher, leader, surrogate, technical
According to Peplau's expert, and counselor
Theory of Interpersonal
Relations, establishing
early rapport allows the
role of the nurse to evolve
from stranger to:
3
the process by which psychiatric assessment is
conducted
-primary tasks
• building a therapeutic alliance between the PMHNP
& client
• obtaining a database of psychiatric info about the
Psychiatric interview client
• establishing a dx
• negotiating a tx plan
a feeling that you should create over the course of the
diagnostic interview, a sense of rapport, trust, and
warmth
-most important goal of the interview process
-the cooperative working relationship between the
therapist and client
• begins during the initial or opening phase of the
interview
-fundamental component of successful therapy
• Without trust, adherence to treatment
Therapeutic Alliance recommendations may be compromised
• interview may not elicit the information needed to
formulate an appropriate dx & plan of care without
rapport & trust
-Be Yourself
-Be Warm, Courteous, and Emotionally Sensitive
-Actively Defuse the Strangeness of the Clinical
Situation
Creating rapport: tips -Give Your Patient the Opening Word
-Gain Your Patient's Trust by Projecting Competence
-Normalization
-Symptom Expectation
How to approach -Symptom Exaggeration
threatening topics -Reduction of Guilt
(sensitive/embarrassing -Use Familiar Language When Asking about
material) Behaviors
1
, NR548 Exam 2
Introducing Q with some type of normalizing
statement
-two principal ways to do this:
1. start the question by implying that the behavior is a
normal or understandable response to a mood or
situation
• ex: Sometimes when people are very depressed,
they think of hurting themselves. Has this been true
for you?
2. Begin by describing another patient (or patients)
who has engaged in the behavior, showing your
patient that she is not alone
Normalization
• ex: I've talked to several patients who've said that
their depression causes them to have strange
experiences, like hearing voices or thinking that
strangers are laughing at them. Has that been
happening to you?
communicate that a behavior is in some way normal
or expected
-Phrase your Q's to imply that you already assume
the patient has engaged in some behavior and that
you will not be offended by a positive response
-high index of suspicion of some self-destructive
activity
-Ex: patient is profoundly depressed and has
expressed feelings of hopelessness. You suspect
suicidality, but you sense that the patient may be too
ashamed to admit it. Rather than gingerly asking
"Have you had any thoughts that you'd be better off
dead?" you might decide to use symptom
Symptom Expectation
expectation. "What kinds of ways to hurt yourself
have you thought about?"
*reserve this technique for situations in which it
seems appropriate
2
, NR548 Exam 2
suggesting a frequency of a problematic behavior that
is higher than your expectation, so that the patient
feels that their actual, lower frequency of the behavior
will not be perceived by you as being "bad."
-helpful in clarifying the severity of symptoms
Symptom Exaggeration *reserve this technique for situations in which it
seems appropriate
seeks to directly reduce a patient's guilt about a
specific behavior in order to discover what they have
been doing
-useful in obtaining a hx of domestic violence & other
antisocial behavior
Domestic Violence
Reduction of guilt -"Have you ever been in situations where fights
occurred and you were affected?"
• If patient answers "yes," you can flesh out whether
role was being a witness, victim, or perpetrator
resource person, teacher, leader, surrogate, technical
According to Peplau's expert, and counselor
Theory of Interpersonal
Relations, establishing
early rapport allows the
role of the nurse to evolve
from stranger to:
3
