Unit 6 Assignment – Clinical Preparation Tool 2
Instructions
Choose one diagnosis from the Neurocognitive Disorders group use w/Mini-Mental Status Exam (MMSE) as your tool.
Choose one of the tools/instruments from the pdf link:
- Heart and Stroke. (n.d.). Mini-mental state examination (MMSE).
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders(5th ed.). American Psychiatric Publishing, Inc.
- Scan Pages 591-643
Overview
As you will learn throughout the program, the diagnosis of a variety of psychiatric illnesses is not always an easy or straightforward process. Multiple observations and assessment methods are often employed to reach a diagnosis. This approach can include the use of standardized assessment instruments. This then aids you in defining a treatment plan and choosing specific treatment plans to use in the care of your clients.
You are tasked with identifying a standardized assessment instrument/tool to measure the disorders listed for each week. You will keep these instruments in the form of a “portfolio” that you can use in your clinical practice to assess clients who present with a variety of symptoms.
Instructions:
Instrument/ Tool criteria:
For each assessment, you are tasked with selecting, you will identify an instrument and:
- List what DSM diagnosis the tool/instrument is used for.
- Identify an assessment/diagnosis instrument.
- Appraise a scholarly, peer-reviewed article that addresses the use of the instrument to support your choice as an evidence-based instrument for practice.
- Evaluate the instrument’s appropriateness for diagnosing the condition it is designed to assess or if the developers of the instrument reported that the instrument is only part of a comprehensive assessment for the disorder.
- Describe whether or not the instrument can be used to measure patient response to therapy/treatment or if it is strictly for assessment and diagnosis.
- Discuss the psychometrics/scoring of the instrument, including reliability and validity.
- Discuss any limitations associated with the use of the instrument.
- Include a link to view the assessment if possible.
Use the following template in completing your portfolio assignments. Your information can be in bulleted format or just a couple of sentences for each criterion listed above. However, you must use APA citations. You are NOT required to write this in a paper format. Turn in one document for each week’s topics. (However, create a file on your desktop to compile your portfolio as you move through the term.) This will ensure you can have easy access to show the full portfolio and once you begin clinicals and practice. Throughout the program, you will continue to add to the portfolio in each course.
Assignment File(s)
Please review the example of this assignment
Please use the attached Template to complete this assignment.
MMSE.pdf
Issue Number 3, January 1999 Series Editor: Meredith Wallace, PhD, RN, MSN, CS
The Mini Mental State Examination (MMSE) By: Lenore Kurlowicz, PhD, RN, CS and Meredith Wallace, PhD, RN, MSN
WHY: Cognitive impairment is no longer considered a normal and inevitable change of aging. Although older adults are at higher risk than the rest of the population, changes in cognitive function often call for prompt and aggressive action. In older patients, cognitive functioning is especially likely to decline during illness or injury. The nurses’ assessment of an older adult’s cognitive status is instrumental in identifying early changes in physiological status, ability to learn, and evaluating responses to treatment.
BEST TOOL: The Mini Mental State Examination (MMSE) is a tool that can be used to systematically and thoroughly assess mental status. It is an 11-question measure that tests five areas of cognitive function: orientation, registration, attention and calculation, recall, and language. The maximum score is 30. A score of 23 or lower is indicative of cognitive impairment. The MMSE takes only 5-10 minutes to administer and is therefore practical to use repeatedly and routinely.
TARGET POPULATION: The MMSE is effective as a screening tool for cognitive impairment with older, community dwelling, hospitalized and institutionalized adults. Assessment of an older adult’s cognitive function is best achieved when it is done routinely, systematically and thoroughly.
VALIDITY/RELIABILITY: Since its creation in 1975, the MMSE has been validated and extensively used in both clinical practice and research.
STRENGTHS AND LIMITATIONS: The MMSE is effective as a screening instrument to separate patients with cognitive impairment from those without it. In addition, when used repeatedly the instrument is able to measure changes in cognitive status that may benefit from intervention. However, the tool is not able to diagnose the case for changes in cognitive function and should not replace a complete clinical assessment of mental status. In addition, the instrument relies heavily on verbal response and reading and writing. Therefore, patients that are hearing and visually impaired, intubated, have low English literacy, or those with other communication disorders may perform poorly even when cognitively intact.
MORE ON THE TOPIC: Folstein, M., Folstein, S.E., McHugh, P.R. (1975). “Mini-Mental State” a Practical Method for Grading the
Cognitive State of Patients for the Clinician. Journal of Psychiatric Research, 12(3); 189-198. Foreman, M.D., Grabowski, R. (1992). Diagnostic Dilemma: Cognitive Impairment in the Elderly. Journal of
Gerontological Nursing, 18; 5-12. Foreman, M.D., Fletcher, K., Mion, L.C., & Simon, L. (1996). Assessing Cognitive Function. Geriatric Nursing,
17; 228-233.
Permission is hereby granted to reproduce this material for not-for-profit educational purposes only, provided The Hartford Institute for Geriatric Nursing, Division of Nursing, New York University is cited as the source.
Available on the internet at www.hartfordign.org. E-mail notification of usage to: hartford.ign@nyu.edu.
The Mini-Mental State Exam
Patient___________________________________ Examiner ____________________________ Date____________
Maximum Score Orientation
5 ( ) What is the (year) (season) (date) (day) (month)? 5 ( ) Where are we (state) (country) (town) (hospital) (floor)?
Registration 3 ( ) Name 3 objects: 1 second to say each. Then ask the patient
all 3 after you have said them. Give 1 point for each correct answer. Then repeat them until he/she learns all 3. Count trials and record. Trials ___________
Attention and Calculation 5 ( ) Serial 7’s. 1 point for each correct answer. Stop after 5 answers.
Alternatively spell “world” backward.
Recall 3 ( ) Ask for the 3 objects repeated above. Give 1 point for each correct answer.
Language 2 ( ) Name a pencil and watch. 1 ( ) Repeat the following “No ifs, ands, or buts” 3 ( ) Follow a 3-stage command:
“Take a paper in your hand, fold it in half, and put it on the floor.” 1 ( ) Read and obey the following: CLOSE YOUR EYES 1 ( ) Write a sentence. 1 ( ) Copy the design shown.
_____ Total Score ASSESS level of consciousness along a continuum ____________
Alert Drowsy Stupor Coma
“MINI-MENTAL STATE.” A PRACTICAL METHOD FOR GRADING THE COGNITIVE STATE OF PATIENTS FOR THE CLINICIAN. Journal of Psychiatric Research, 12(3): 189-198, 1975. Used by permission.
A series provided by The Hartford Institute for Geriatric Nursing
(hartford.ign@nyu.edu)
www.hartfordign.org
Portfolio Template Assessment Tool- Instruments (4) (1).docx
1
Assessment Instruments
Anxiety and Related Disorders
Week X
DSM:
Instrument:
Article:
Appropriateness for Dx:
Response to Therapy/Treatment:
Psychometrics:
Limitations:
References
Student Example Portfolio Assessment Tool-Instruments (7) (1).docx
1
Assessment Instruments
Student Example Anxiety and Related Disorders
Week 7
Instrument: Social Phobia Inventory (SPIN)
Article: Psychometric properties of the Social Phobia Inventory
Appropriateness for Dx: This tool is meant for screening of individuals with social phobia and assignment of a severity score (Connor et al., 2000). The tool was created in congruence with DSM-4 but is consistent with the DSM-5 diagnosis of social anxiety disorder, minus some minor changes (Substance Abuse and Mental Health Service Administration [SAMHSA], 2016). Although the study is outdated, Duke University School of Medicine (2020) acknowledges that the tool is still relevant and utilized by their Anxiety and Traumatic Stress Program.
Response to Therapy/Treatment: The SPIN is appropriate for testing treatment response and through studies has proven sensitive to symptom changes over time. Changes in scores are able to determine treatment efficiency (Connor et al., 2000).
Psychometrics: The tool is self-administered and consists of 17 separate statements regarding problems a patient may exhibit if they have social phobia. The statement is then rated on how much it has bothered the individual in the last week, from ‘not at all’ (0) to ‘extremely’ (4). Any score over 21 is considered clinically significant. In the study, the assessment tool was able to effectively separate individuals with and without social phobia. Validity is strong in regard to detecting the severity of illness and is sensitive to symptom reductions during treatment. The scale shows significant correlation with the Liebowitz Social Anxiety Scale Test, The Brief Social Phobia Scale and The Fear Questionnaire social phobia subscale (Connor et al., 2000).
Limitations: Limitations exist in the tool’s alignment with DSM-4 instead of the more recent edition, although differences are very minor (SAMHSA, 2016). With a cutoff score of 19, sensitivity and specificity were good, but some individuals consider the cutoff score to be 15, in which these measures are weaker (Connor et al., 2000).
References
Connor, K., Davidson, J., Churchill, E., Sherwood, A., Foa, E., & Wisler, R. (2000).
Psychometric properties of the Social Phobia Inventory. British Journal of Psychiatry, 176, 379-386.