Orientation – Assessment (Nursing)

00:01 So if the patient is alert or awake enough to answer questions, you can assess their mentation by asking similar questions in a conversation and a non-threatening tone.

00:11 Okay, so if I'm trying to figure out what the patient's mentation is, I don't want them to know that's what I'm doing.

00:18 If it's an elderly person, that will seem very condescending to them if I'm answering in a very clinical questions.

00:25 So when we're talking about an orientation assessment or mentation, think conversation.

00:30 In fact, just remind yourself, if you wouldn't mind, just write the word conversation in here just as to trigger you to know that's what we're talking about.

00:39 Sometimes we give you the most awkwardly worded things to say in nursing school.

00:44 So I'm gonna show you how you can take some of those awkward statements and make them kind conversation that's gonna get you better information about your patients.

00:53 See, some of these are what we traditionally teach: What is your name? Where are you right now? Why are you here? What year is it? Who is the president? Yeah, see that puts you in this wierd relationship with your patient.

01:09 Let's talk through how you might be able to do that differently so you don't sound so authoritative.

01:14 See, the best care is given with trust and you wanna build a relationship with that patient.

01:20 You want them to know that you care about them as a person.

01:24 They'll respond to you better, they'll give you better information, they'll give you more information about what's going on with them and so you can advocate for them more effectively.

01:34 So let's break this down.

01:36 Instead of coming in to a patient's room and saying, "Hi, can you tell me your name or what is your name? I would say, " Good morning, my name is Rhonda. I'm gonna be your nurse for this shift." "My name is Rhonda, what's your name?" and that's a much friendlier opening than "What is your name?" I said, "Okay, now I have to ask you some questions, just regular routine stuff.

01:56 So they might sound silly to you, but would you mind if I ran through these questions with you?" And the patient will always say, "Sure.", usually they'll say, sure.

02:05 So you say, "Okay, I know this might be obvious but can you tell me where you are right now?" and they'll say, "The hospital." Say it with a smile, make eye contact with them, don't look at the clipboard, don't look at a computer.

02:17 Make direct eye contact with your patient, smlie at them, don't stand over them.

02:23 Sit down, come in and have a conversation with them before you touch them with your stethoscope, before you take a vital sign, make that connection first that says, "Good morning or good evening. I value you as a person so I want you to know that I am here for you I'm on your team and I wanna help you this shift." That's what you're communicating when you come in, sit down and take the time to look at them eye to eye.

02:49 So I said, I'm gonna introduce myself, I ask what their name is and then I tell them, "Hey, I'm gonna ask you some questions that you probably heard a thousand times since you've been here but would you mind if I ran through a couple of them now?" And then I ask them, "Can you tell me where you are right now?" instead of "Why are you here?" You say, "Hey, can you tell me a little bit about your story? What brought you to the hospital?" "What year is it?"- is a very odd question but I'll say, again you just introduce it, "Can I ask you what year it is and who is the president?" Those are some examples of how you take very clinical questions and just have a conversation with them.

03:27 Now, newborns are notoriously uncooperative of telling you what year it is or who the president is.

03:33 So we watch newborns and babies for their level of restlessness, moving around, lethargy.

03:38 We can't ask them straight orientation mentation questions.

03:42 So age does matter, you know it doesn't really work for tiny ones but for adults, these are generally the questions that are used.