Mental Health Nursing - Assessing Mental Health
A physical exam is usually part of mental health assessments to rule out physical conditions. This may involve blood work, urine tests or brain scans.
Psychologists utilize a variety tools to assess mental health. These range from pen and paper test forms to in-depth interviews, or self-complete questionnaires sent to you by post.
Mood and affect
Mood and affect are among the most significant components of the mental status exam (MSE) and are the first thing to be observed by a doctor. They define a patient's general emotional state. It can vary from joy to sadness or irritability and anger. The degree of affect can be determined by watching facial expressions and demeanour as well as the reactivity to internal or external stimuli (e.g. You can express your emotions by smirking at a joke, or crying when you lose a beloved one.
Affect is a feeling that is only temporary, whereas mood is a state of sustained emotion. It is often described as either euthymic (normal) or dysphoric, meaning depressed. However, psychiatric professionals must be careful not to confuse the terms since they have different definitions and are affected by a range of factors.
The MSE can be a valuable tool for clinical diagnosis however it is difficult to interpret from a subjective patient report. Inquiring about the feelings of patients during the past few weeks is more effective than relying on only the observations of a doctor. Recent research showed that the assessment instruments differed in their capacity to identify a significant portion of symptoms. This included those that were grouped under the same disorder. This can be due to the differing emphasis on emotional, cognitive or physical symptoms as well as differences in the duration and frequency of symptom reporting.
It is possible that the MSE relies solely on self-reporting which could be biased. For instance, a person who reports a headache and anxiety is likely to report a lower score than a patient who reports only an occasional headache. Patients tend to minimize negative feelings while exaggerating positive feelings.
The affect and mood of a person directly affect thought content, which can influence decision-making, interpersonal behaviour, and physical functioning. They are influenced by fatigue, stress social interactions, world events, hormones and the weather. In actual fact positive moods have been proven to boost creativity and thinking power. However, a mood that is negative can reduce concentration and lead to confusion. A thorough and careful mental health evaluation must be able to consider both the patient's mood and affect, as well as fundamental factors.
Thought content
Examining the way a patient thinks is one the most important aspects of a mental state exam. Assessment of thoughts and their content. The thought process is the coherence, logic and structure of the patient's thoughts. The normal process of thinking is goal directed and logic-based. Thought processing can be altered in several mental health conditions. Examples include hallucinations, delusions and loose associations.
A mental status examination also evaluates insight and judgement. Insight is being able to spot problems. Judgment is the ability to make a well-considered choice after receiving information. Both can be impaired by various mental health conditions such as schizophrenia and depression. Patients with impaired insight or judgement is more prone to harm themselves or others. For instance if they are in danger of burning their house down, sensible judgement would tell them to leave the house immediately. A patient with impaired judgment might suggest they stay in the building to try and get rid of the flame.
Thought content includes the subject matter, themes and beliefs that a patient has. Examiners will comment on the clarity, connection and content of a thoughts of the patient. They will take note of any thoughts that are tangential or circumstantial or thoughts, and also if the patient is having flashes of thoughts (digressions from the subject of conversation). They will also provide feedback on the speed at which someone is thinking, such as whether they seem to be more or less fast.
It is also essential to determine whether the patient's mood is in line with their environment. A patient with depression might be able to hear angry voices, whereas a person suffering from schizophrenia may experience the illusion that a peaceful voice is speaking. The patient should be questioned about any suicidal or homicidal thought. These are rare but can be life-threatening and should be considered in every mental health assessment.
Observation
The ability of nurses to observe is vital in a mental assessment. They include a careful examination of appearance, behavior and any unusual beliefs or perceptions (such hallucinations or delusions) mood, cognition (including attention, memory and orientation). A nursing mental status examination also involves observing mobility, which includes any physical movement, such as eating or drinking, brushing your teeth, using the toilet and wearing shoes.
The Observation component of the mental state exam is crucial in determining if a patient poses a risk to them or anyone else. This is accomplished by determining whether the patient appears be acting in a deliberate manner that suggests they are planning to harm themselves or another person.
A detailed evaluation of the content of thoughts is also accomplished by observing the patient during the interview and determining their preoccupations. It is essential to determine if a patient has any suicidal or homicidal ideas and to determine if they are having delusions.
Global assessment of functioning (GAF) which is a numerical rating between 0 and 100, measures the capacity of a person to perform in everyday life and their capability of managing stressors. The GAF is a crucial component of the mental state exam and helps guide treatment decisions.
It is important to recognize that observing the behaviour of a patient may cause anxiety. It is crucial that the process be conducted in a manner that does not provoke or feel intrusive. It is also essential that the patient is informed about the purpose of the observation as well as the length of time it will take.
Nursing observation is a crucial skill and it must be a central element of the nursing process. However, Iam Psychiatry should be noted that patients might not agree with the degree of observation. If they are unable to come to an agreement with the staff, they should be able to access an advocate service which can represent their interests and assist them in any discussions regarding their treatment. This should be an integral part of the local policy and practice with the involvement of user groups to ensure that patients are a part in the development of written information and staff training for this aspect of clinical governance.
Questioning
A lot of people are hesitant to talk about their mental health issues, but family members can usually detect if something is not right. They can also help the person to seek an assessment. These tests can cover a wide range of subjects such as mood, appearance and the thought process. A mental health professional may also ask questions regarding the person's personal life. They'll ask them what they have been feeling and what's happened recently.
The assessment includes an assessment of cognitive ability that examines a person's ability to think clearly and remember information. The person may be required to complete simple tasks such as focussing on a list or objects, recollecting lists or solving math questions. The test will also test the ability of the individual to make good decisions and use judgment. The test measures a patient's insight which is their understanding of their illness and how it affects them.
Another important component of the mental health assessment is the patient's attitude towards other people, himself and the illness. The patient's tone of expression, facial expression and body language can convey hostility, anger or depression, or a feeling of powerlessness. It is important to observe whether the patient seems to be asking for help or accepting their situation.
In more serious instances the mental health assessment might include an examination of the patient's mental state, which could involve hallucinations (false perceptions of sensory stimuli that are not real stimuli) or illusions (misperceptions of real stimuli). It is vital to be aware of the presence of these conditions as they can be extremely risky and even life-threatening.
A mental health assessment should be comprehensive and look at the person's interaction with their environment. A health professional could use photographs, music, art or a variety of assessment tools using electronic technology to help the person understand themselves and their unique perspective on the world around them. They should also talk about the challenges that led the person to seek help, and assure them there is nothing wrong in seeing a mental healthcare professional.