Respond to your colleagues by constructively critiquing their interview format and providing feedback.
NOTE: (POSITVE COMMENT)
In the psychiatric setting, assessing the needs of a client is mostly done through personal interaction where the PMHNP is expected to ask various questions. In fact, it suffices to say that interviews with patients is one of the most effective ways of assessing their mental health needs and coming up with the most appropriate interventions. It is widely known in psychiatry that clinical interviews stand as one of the most effective diagnostic tools. In this setting, the use of other validating criteria such as lab tests as well as imaging are not commonly used (Lin et al., 2003) Therefore, the interview should be done in a proper manner in order to identify patients’ needs. The best interview format should be based on the strengths of the interviewer especially in the initial interaction with the patient where the strengths and weaknesses of the clint are no known.
The format that I would use in the initial interview with the patient is one which is conversational in nature. This is because at this point, there is no previous relationship between me and the patient. There is no discernible trust between us, and the patient may nervous. Therefore, a conversational approach to the initial interview shall be used with the view of building rapport. The process of building a rapport may help in identifying various issues about the patient even without necessarily asking direct questions. For instance, the process of building rapport may help the practitioner to establish whether a patient is going through a psychotic issue or a less serious mental health issue (Varghese & Dahale, 2018). This will determine how the rest of the initial interview and other interactions with the patient shall be conducted.
Once rapport has been established in the initial discussions which will have to involve any issues, I can then move on into the health issues or concerns of the patient. At this point, it is important to make sure that the perspective of the patient about the prevailing problem as well as their explanatory model regarding the problem are acknowledged (Varghese & Dahale, 2018). This does not mean that I should accept them. However, this will allow me to show compassion, empathy and implement active listening skills. This will not only strengthen the trust between the patient and myself but also improve the therapeutic relationship between us at an early stage. This initial interview should be used to collect information about the patient including such as age, gender, marital status, and occupation. The chief complaint or presenting problem, the history of present illness, precipitating factors, social history, behavioral patterns, psychiatric
history of the patient, family history, alterations in roles as well as social functioning and the performance of a mental health examination, among others.
Ideally, at this initial stage, I would use the opportunity to perform a comprehensive psychiatric assessment of the patient to establish what I am dealing with and to start the necessary interventions as soon as possible. While I take notes during the interview, I will ensure that I record what the patient says as he or she says it .I will also add notes regarding how the patient presents his or her information. This will help in proper diagnosing. The questions shall not be structured. They will be random and open-ended to suit the different needs of the patient. As it is a psychiatric condition, we must pose leading questions on behavior and prevalent health conditions. The questions posed include symptoms of the illness, how long the illness started its gradual shift to critical condition, current life stresses, the criteria of the illness in the DSM-IV, any suicidal or homicidal ideations, and the impact of the illness on the overall quality of the patient’s life. However, if it is established during the early stages that the patient may be psychotic, the initial interview shall continue using structure questions that are more focused than in other cases. This is because in such patients, open-ended questions may be confusing and disorganizing (Sadock, Sadock & Ruiz, 2014).
During the initial interview, the rules of engagement shall be set out and the patient shall be allowed to ask questions to clarify on issues regarding the rest of the sessions. This is also the right stage to inform the patient about the prevailing legal and ethical issues such as the confidentiality of the information that shall be shared during all sessions. Simply put, the format of the initial interview for my case shall focus on building rapport, collecting all the necessary information to make a diagnosis and helping the patient to understand how the therapeutic relationship shall be optimized in the subsequent sessions.
Preceptor’s Format and Helpful Elements
The preceptor uses the format like I have described. Instead, there is a checklist or a template that exists in the facility. The preceptor uses the template in all cases. This template was created by the preceptor, but it is varied in different cases depending on the presenting patient’s problem. Most of the questions in the checklist are structured. The preceptor tends to ask too, if the patient has medications of mental treatment to establish the duration of treatment, type of therapy allocated as well as any arising symptoms , entails substance abuse history to investigate if the patient has any addictions, determination of the personal history of the patient such as family history and experiences, and sexual history. It suffices to say that after many years of experience, the preceptor has developed an approach that works. The facility also gets a high traffic of patient and the template allows the preceptor to effectively handle each case in a quick manner. The downside here is that this approach may prevent the preceptor from developing a rapport early and this may not suit the needs of patients. My interview format is not restricted. It allows the practitioner to maneuver between the different needs of patients hence providing patient-centered care. The most helpful element of the model is the personal history of the patient because it provides the origin of where the problems started. For example, if the patient has suicidal ideations it could be traced to their childhood experiences and how they deal with stress. (Parker, J 2014) reiterates that mental healthcare at the primary level requires an effective short consultation. One of my philosophies in nursing is to provide care that focuses on the needs, values, preferences, and beliefs of the patient while ensuring that a therapeutic relationship is established. It also reveals to the psychiatrist how well the patient’s family can support in recovery. It also helps to understand mental illness through cultural lenses (Lauracuente,2019). It is also an element that determines how open and communicative the patient is willing to be throughout the entire process.
Lin, D., Martens, J., Majdan, A., & Fleming, J. (2003). Initial psychiatric assessment: A practical guide to the clinical interview. British Columbia Medical Journal, 45(4), 172-177
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.
Varghese, M., & Dahale, A. B. (2018). The Geropsychiatric Interview-Assessment and Diagnosis. Indian journal of psychiatry, 60(Suppl 3), S301
Parker, J. (2014). Adapting the psychiatric assessment for primary care. South African Medical Journal, 104(1).
Laracuente, R. (2019). Empathy in Psychiatry: Reflection on a Patient Interview. Arts and Culture,14(3),8.
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