Mental Health Nursing - Assessing Mental Health
Mental health assessments often involve a physical examination, to rule out physical conditions. This may include blood tests and urine tests as well as brain scans.
Psychologists also utilize a array of tools to measure mental health. These range from tests that are written on paper and pen to in-depth interviews, or self-complete questionnaires for postal delivery.
Affect and mood
Mood and affect are the most crucial components of the mental status exam (MSE) and are the first things to be observed by the doctor. They describe a patient's general emotional tone. It can range from happiness to sorrow or anger and irritability. Affect can be assessed by observing facial expressions and overall attitude as well as reaction to external or internal stimuli (e.g. smiling at an absurd joke or crying over the loss of a loved one).
Affect refers to an emotion that is only temporary, whereas mood is a long-lasting emotion. It is typically described as euthymic, or dysphoric, or normal (meaning depressed). However, psychiatric specialists should be cautious not to confuse the terms because they have different definitions and are affected by a variety of factors.
While the MSE is a useful diagnostic tool, it isn't always easy to interpret based upon subjective patient report. Inquiring about the feelings of patients in the last few weeks is more helpful than relying on only physician observations. A recent study found that a significant proportion of symptoms, including those grouped together under the same disorder category, vary between assessment tools. This could be due the differing emphasis on cognitive, emotional or physical symptoms, as well as differences in time periods and frequency of symptom reporting.
It is also possible that the MSE relies on self-report which could be susceptible to bias. For instance, a person who reports anxiety and a headache is likely to report a lower score than a person who describes only the sensation of a headache. Furthermore there is the tendency for patients to minimize negative emotions and underestimate the severity of positive emotions.
Affect and mood can have a direct influence on thought content. This can impact decision-making, interpersonal behavior, and physical performance. They are influenced by fatigue, stress, social interactions, world events, hormones and the weather. In fact positive moods have been shown to enhance the ability to think and be creative. Conversely, a negative mood can affect concentration and cause confusion. A thorough and careful mental health evaluation must take into account the patient's mood as well as affect, as well as fundamental factors.
Thought content
One of the most essential elements of a mental status examination is assessing how the patient thinks. Assessment of thoughts and their content. Thought process refers the coherence, logic and organization of a patient's thinking. The normal process of thinking is objective-oriented and logical. Thought processing may be altered in several mental health conditions. Examples include hallucinations and delusions as well as loose associations.
Insight and judgement are also assessed in a mental status exam. Insight is the ability to identify the presence of a problem, and judgement is the ability to make a considered decision when presented with information. Both are impaired in many mental health conditions like schizophrenia and depression. If a patient is impaired in judgment and/or insight in any way, they are at a higher chance of harming themselves or others. If they are in danger, their rational judgement would tell to leave the house immediately. A person with impaired judgment might suggest that they remain in the building to try to put out the flame.
Thought content refers to the topics, subject matter, and beliefs that a patient holds. Examiners will comment on the clarity, relevance and content of a thoughts of the patient. They will note tangential thoughts or those that are merely circumstantial, and when a patient is digressing (digressions off from the main topic of the conversation). They will also comment on the pace of a person's thoughts, such as whether they seem fast or slow.
It is also important to determine whether the patient's mood is similar to their surroundings. For example, a patient who is depressed might hear voices that sound angry and threatening, while those suffering from schizophrenia may have a hallucination of an ethereal and calm voice. Ask the patient if they are experiencing any thoughts of suicide or homicide. These are rare but can be life-threatening and should be taken into account in every mental health evaluation.
Observation
Nurses' observation skills play an important role in the mental health assessment. They are a thorough review of behavior, appearance, any unusual beliefs and perceptions (such as hallucinations or delusions) mood, as well as aspects of cognition (including attention to the environment, orientation, memory). A nursing mental status examination also incorporates observation of motility, including any physical activity like eating, drinking, brushing teeth, using the toilet and taking off shoes.
iampsychiatry.com of the mental state exam is crucial in determining if the patient is a danger to themselves or others. This is done by assessing whether or not the patient is moving deliberately in a way that suggests they are about to harm themself or someone else.
A detailed evaluation of the thought content is also accomplished by observing the patient during the interview and determining concerns. It is important to check whether the patient is suffering from suicidal, homicidal or delusional thoughts.
Global assessment of functioning (GAF), which is a numerical score ranging between 0 and 100, combines the ability of a person to function in daily life along with their capacity for coping with stressors. The GAF is a vital element of the mental state examination and helps to guide treatment decisions.
It is important to be aware that observing a patient's behaviour could cause anxiety, and it is essential to conduct the procedure in a way that does not cause anxiety for the patient and doesn't feel intrusive. It is also crucial that the patient is fully informed about the purpose of the observation and the amount of time it will last.
Nursing observation is a crucial skill that must be at the heart of any nursing program. It is essential to remember that patients can disagree with staff about the extent of observation. If they cannot reach a consensus with staff, they should be able to access an advocate service that can represent their interests and assist them in any discussions regarding their care. This should be a component of local policy and practice, with the involvement and participation of user groups.
Questioning
Many people are hesitant to discuss their mental health issues, however family members can often detect if something is not right. They can also assist the person take steps to get an assessment. These assessments are broad and cover a range of subjects, including appearance, mood as well as thought process, memory and many more. A mental health professional could also inquire about the person's private life. They'll ask them what they feel and what has happened recently.
The assessment includes an evaluation of the cognitive capacity which focuses on an individual's ability to think clearly and retain information. The test taker may be asked to complete basic tasks, such as keeping their attention on the list of objects or words and recollecting lists of basic information or solving math problems. The test will also test the ability of the individual to make sound decisions and use their judgment. The assessment also determines the patient's understanding, which reflects their understanding of their illness and its impact on them.
Another crucial aspect of the mental health assessment is the person's attitude toward others, himself and his illness. The patient's expression, facial expression and body language can convey anger, hostility depression or a feeling of helplessness. It is also important to note whether the patient is seeking help or resigned to living with their health condition.
In more serious situations the assessment of mental health might include a thorough examination of the patient's thoughts which could include hallucinations or even illusions. These conditions can be harmful and even fatal.
A mental health assessment must be comprehensive and look at the person's interactions with their social world. A health professional may use art, music or photos, or any other assessment tool to gain a better understanding of the individual. They should also discuss the issues that led to the person to seek help, and reassure them there is nothing wrong in seeing a mental health professional.