Jamesetta A Newland

Abstract

This chapter describes the elements that make up a comprehensive psychiatric-mental health assessment of children and adolescents. This assessment can be used in primary care settings to help identify children and adolescents in need of mental health services. Key areas include history taking, physical examination process, risk, protective factors, teaching needs of the child or adolescent and family, and ways to communicate the assessment findings to the patient and family and, if appropriate, the school so that they are able to pursue appropriate treatment as needed. The chapter provides advanced practice registered nurses and other primary care practitioners (PCPs) in primary care and mental health settings with a way to systematically approach the assessment of the behavioral and mental health of their patients. It aims to assist PCPs with the knowledge and confidence to proceed with their evaluation of the child's history, behavior, complaints, school performance, social skills, family functioning, and available resources for care.

Abstract

Background: End-of-life care is provided in a variety of healthcare settings, not just palliative care hospitals. This is one reason why it is very important to assess all barriers to end-of-life care and to provide safe and quality services to patients. This study was aimed at describing nurses' attitudes in providing end-of-life care and exploring barriers and facilitating behaviors of nurses in multi-profile hospitals in Eastern Europe. Methods: A descriptive, correlational design was applied in this study, using a cross-sectional survey of 1320 registered nurses within 7 hospitals in Lithuania. Results: Registered nurses working in the three different profiles emphasized safe and effective care and the importance of meeting the patient's spiritual needs at the end of life. The main barriers assigned by nurses caring for patients at the end of life were angry family members, inadequate understanding of nursing care by the patient's relatives; lack of time to talk to patients, lack of nursing knowledge to deal with the bereaved patient's family, lack of evaluation of nurses' opinions, and the evasion by physicians to talk about the diagnosis and their over-optimistic view of the situation. The main facilitating behaviors to improve nursing care were end-of-life training, volunteering, and family involvement. Conclusions: Spiritual needs were identified by nurses as the primary needs of patients at the end of life. Family-related barriers remain one of the main barriers to end-of-life care. Also, the behavior of physicians and their relationship with nurses remains one of the most sensitive issues in end-of-life care.