Mental Health Nursing - Assessing Mental Health
Mental health assessments usually include a physical exam to rule out physical problems. This could involve blood tests or urine tests, as well as brain scans.
Psychologists also employ a range of tools to evaluate mental health. These tools can range from paper and pencil test forms, to in-depth interviews or self-completed postal questionnaires.
Mood and affect
The affect and mood are the most significant elements of the mental state examination (MSE) and are the first to be observed by a medical professional. They define the patient's general emotional tone, which can range from happiness to sadness, or anger to anger. Affect can be assessed by looking at facial expressions and demeanour as well as the reaction to external or internal stimuli (e.g. smiling at an absurd joke or crying over the loss of a loved one).
Affect is a feeling that lasts only a few minutes but mood is a more sustained emotional state. It is generally described as euthymic, dysphoric or normal (meaning depressed). Psychologists should be cautious to avoid confusion between the terms because they are defined differently and are affected by many factors.
The MSE is a helpful instrument for diagnosing clinical conditions however, it can be difficult to interpret from the subjective report of a patient. Asking patients about their feelings over the past few weeks can be more beneficial than relying on just physician observations. A recent study showed that a significant proportion of symptoms, even those that fall under the same disorder category, differ between assessment tools. This could be due to the different emphasis on emotional, cognitive or physical symptoms as along with differences in time periods and frequency of symptom reporting.
It is also possible that the MSE is based on self-reporting, which may be prone to bias. Patients who report both anxiety and headache is likely to report lower scores than one who reports only migraine. Additionally, there is the tendency for patients to downplay negative emotions and overestimate the severity of positive ones.
Mood and affect directly affect thought content and can affect the way we make decisions, our interpersonal behavior, and physical functioning. They can be affected by stress, fatigue and social interactions. In reality positive moods have been proven to boost thinking and creativity. A negative mood can reduce concentration and lead to confusion. A thorough and careful mental health assessment must be able to consider both the patient's mood and affect as well as the other factors.
Thought content
Examining the way a patient thinks is one the most important aspects of a mental state exam. Evaluation of thoughts and their content. The thought process is the logic, coherence and organization of a patient’s thoughts. Normal thought processes are rational and goal-oriented. Thought processing may be altered in a variety of mental health conditions. Examples include hallucinations, delusions and loose associations.
Insight and judgement are evaluated during a mental status test. Insight is the ability to spot a problem. Judgment is the ability to make a well-considered choice after receiving information. Both are impaired in many mental health conditions such as schizophrenia and depression. If a patient has impaired judgment or insight, they are at a higher risk of causing harm to themselves or others. For example when they are in danger of burning their home down, sensible judgement would tell them to leave the house immediately. However, a patient with impaired judgment may decide to stay in the building and attempting to put the fire out.
Thought content includes the subject matter, themes and beliefs that a patient holds. Typically, examiners discuss the clarity, relatedness and the content of a patient's thinking. They will be able to identify tangential ideas or circumstantial ones, as well as in the event that the patient's thoughts diverge (digressions away from the topic of the conversation). They will also make comments on the speed of someone's thoughts, including whether they appear fast or slow.
It is also crucial to determine whether the patient's mood matches the environment in which they live. For instance, a person who is depressed may hear voices that sound angry and threatening, while a person with schizophrenia might experience a hallucination of the sound of a calm and soothing voice. Patients should be questioned about any homicidal or suicidal ideation. Although these are rare however, they can be life-threatening and must be considered during every mental health assessment.
Observation
Nurses' observation skills play an important role in the mental health assessment. They are a thorough review of the appearance, behavior as well as any unusual beliefs or perceptions (such as hallucinations or delusions) mood, and aspects of cognition (including attention, orientation memory). A nursing mental status examination also involves observing mobility, which includes any physical movement, such as eating drinking, eating, brushing teeth or using the toilet, as well as taking off shoes.
The Observation portion of the mental state exam is essential in determining whether the patient is a danger to themselves or others. This is done by assessing whether or not the patient appears to be moving deliberately in a way that suggests that they are in danger of harming themselves or someone else.
In addition, a detailed assessment of thought content is done by monitoring the patient throughout the interview and determining their main concerns. It is essential to determine whether the patient is suffering from suicidal, homicidal, or delusional thoughts.
A global assessment of functioning (GAF) is an assessment of a numerical score on a scale ranging from zero to 100 that evaluates the capacity of a person to perform in daily life with their ability to cope with the stresses in their lives. The GAF is an essential part of the mental state examination and assists in making treatment decisions.
It is important to understand that observing the behavior of a patient may cause distress. It is therefore important that the procedure is conducted in a manner that does not provoke or cause discomfort. It is also crucial that the patient is fully informed about the purpose of the observation and the length of time it will take.
Nursing observation is a crucial ability that should be the core of any nursing procedure. It is essential to remember that patients can disagree with staff about the degree of observation. If they cannot come to an agreement with staff, they should be able to access an advocate service that can represent their interests and aid them in any discussions about their treatment. This should be a fundamental part of local observation policy and practice, with the involvement of user groups, to ensure that patients are included in the development of written documents and staff training on this aspect of clinical governance.
Questioning
Many people are hesitant to discuss their mental health issues, however family members are often able to tell when something is amiss. They can also urge the person to take a look at an assessment. These assessments are broad and cover a range of subjects, including appearance, mood, memory, thought process and more. In addition to these tests, the mental health professional will also ask the individual questions about their personal life, such as what has been going on recently and what their emotions have been like.
The test also includes a cognitive test that is focused on the ability of the person to think clearly and retain information. The test subject may ask to complete a few basic tasks, such as focusing their attention on a list of words or objects and recollecting lists of basic information or solving math problems. The test can be used to test the ability of the person's judgement and to make good choices. The assessment determines a patient's awareness, which is the understanding of their illness and how it affects them.
Another vital aspect of the mental health assessment is the patient's attitude towards others, himself and his illness. The patient's tone of voice, facial expression and body language may convey anger, hostility or depression, or a feeling of helplessness. It is important to check whether the patient appears be asking for assistance or is accepting their situation.
In more serious instances the assessment of mental health might include a look at the patient's thoughts, which may involve hallucinations or even illusions. www.iampsychiatry.com can be dangerous and even fatal.
In general, a mental health assessment should take a holistic approach and look at the person's relationship to their social life. A health professional may use photographs, music, art, or any other assessment tool to better understand the individual. They should also talk about the issues that led to the person to seek help, and assure them that there is nothing wrong in seeing a mental healthcare professional.