Mental Health Nursing - Assessing Mental Health
Mental health assessments often include a physical exam to rule out physical ailments. This could involve blood tests or urine tests, as well as brain scans.
Psychologists also use a wide array of tools to measure mental health. These tools can vary from pencil and paper test forms to in depth interviews or self-completed questionnaires via mail.
Mood and affect
The affect and mood are the most crucial elements of the mental state exam (MSE) and are the first thing to be observed by a doctor. They describe a patient's general emotional state. This could range from happiness to sorrow or anger and irritability. Affect can be assessed by observing facial expressions and overall demeanour as well as the reaction to external or internal stimuli (e.g. smiling at a joke or crying at the loss of a loved one).
Affect is a short-term emotion but mood is a more long-lasting emotional state. It is usually described as being either euthymic (normal) or dysphoric, meaning depressed. Professionals in psychiatry must be careful to avoid confusion between the terms, as they are different in their definition and can be affected by many factors.
The MSE can be a useful tool for diagnosing clinical problems however it is difficult to interpret based on the subjective report of a patient. It is therefore beneficial to inquire about how patients have been feeling in the last few weeks, as opposed to using only the observation of a physician. A recent study showed that a significant percentage of symptoms, which includes those that are grouped under the same disorder category, vary between assessment tools. This could be due the different emphasis placed on cognitive, emotional or physical symptoms as along with differences in time periods and frequency of symptom reporting.
It is possible that the MSE relies on self-reporting, which could be biased. For instance, a patient who complains of a headache and anxiety will likely have a lower score than a patient who reports only an occasional headache. Patients tend to minimize negative emotions while exaggerating positive ones.
The affect and mood of a person directly affect thoughts which influences decision-making, interpersonal behaviour and physical functioning. They can be influenced by fatigue, stress, social interactions, global events, hormones and the weather. A positive mood can actually boost creativity and mental energy. A negative mood can reduce concentration and lead to confusion. A thorough and thoughtful mental health evaluation must consider the patient's mood and affect, as well as other factors.
Thought content
One of the most crucial aspects of a mental state examination is to determine how the patient thinks. Particularly, it is assessing thought process and thoughts. The thought process is the coherence, logic, and organization of a patient's thoughts. Normal thought processes are goal directed and logic-based. In several mental health conditions, however, thought processing is distorted. Examples include hallucinations, delusions, and loose associations.
A mental health assessment also examines judgment and insight. Insight is the ability to recognize the presence of a problem, while judgement is the ability to make an informed decision based on information. Both are affected by several mental health conditions, like schizophrenia and depression. If a patient is impaired in insight and/or judgement in any way, they are at greater risk of harming themselves or others. For instance, if they are in danger of destroying their home and they have a good sense of judgement, it would be wise for them to leave the house immediately. A person with impaired judgment might suggest they stay in the building to try and put out the flame.
The content of a patient's thoughts encompasses the subject matter, themes and beliefs. Generally, examiners comment on the clarity, relatedness and the content of a patient's thinking. They will take note of any thoughts that are circumstantial or tangential, and whether the patient has flights of ideas (digressions from the conversation subject). They will also make comments on the speed of a person's thoughts, for instance, whether they seem fast or slow.
Other important aspects to consider are whether the patient's thoughts are mood compatible or not in line with their environment. A person suffering from depression could hear angry voices, whereas someone suffering from schizophrenia might experience the illusion that a peaceful voice is speaking. Ask the patient if they have any thoughts of suicide or homicide. Although they are not common but they could be life-threatening and should be taken into account in every mental health evaluation.
Observation
A nurse's observation skills are essential to an assessment of mental health. They involve a thorough evaluation of appearance, behavior as well as any unusual beliefs or perceptions (such hallucinations or delusions) mood, cognition (including attention, memory and orientation). A nursing mental status examination also includes observing motility, including any physical movement such as eating, drinking, brushing teeth, using the toilet and taking off shoes.
The Observation element of the mental state exam is an essential element of determining whether or not the patient could pose the risk to themselves or others. This is determined by assessing whether or not the patient appears to be moving deliberately in a way which suggests they may be threatening to harm themselves or anyone else.
In addition, a comprehensive thought content assessment is made by monitoring the patient throughout the interview and identifying their main concerns. It is crucial to determine if a patient has any suicidal or homicidal thoughts and to determine if they are having delusions.
Global assessment of functioning (GAF), which is a numerical score ranging from 0 to 100, combines the ability of a person to perform in everyday life and their capability of dealing with stressors. The GAF is a crucial component of the mental health examination and helps guide the treatment decisions.
assessment in mental health is crucial to be aware that observing the behavior of a patient can cause distress and it is important that the process is conducted in a manner that doesn't provoke the patient and doesn't be uncomfortable for them. It is important that the patient is aware of the goal of the observation and the duration of the procedure.
Nursing observation is a vital skill that should be a central part of any nursing process. It is important to remember that patients can disagree with staff about the extent of observation. If they cannot come to an agreement with staff, they should be able to use an advocate service that can represent their interests and aid them in any discussions about their care. This should be an integral element of the local observation policy and practice, with the participation 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
Many people are reluctant to discuss their mental health issues, however family members can usually detect if something is not right. They can also help the person to seek an assessment. These assessments can be very broad and cover a range of topics including mood, appearance and memory, thought process and much more. In addition to these tests, the mental health professional will also ask the person questions about their life, including what's been happening lately and what their feelings have been like.
The test also includes a cognitive test that is focused on the ability of the individual to think clearly and recall information. The person may be asked to complete a few basic tasks, such as focusing their attention on the list of objects or words as well as storing lists and lists for solving math problems. The test can also check the ability of the individual to make informed decisions and use judgment. The test determines a person's insight which is their understanding of their illness and how it affects them.
Another vital aspect of an assessment of mental health is the person's attitude toward others, himself and his illness. The tone of voice, facial expressions and body language may convey hostility, anger, depression or a sense of insecurity. It is also important to know whether the patient appears to be seeking help or resigned to living with their condition.
In more serious instances the mental health assessment may include an assessment of the patient's thinking that may include hallucinations (false perceptions of sensory stimuli that are not real stimuli) or illusions (misperceptions of real stimuli). These conditions can be harmful and even fatal.
A mental health assessment must be holistic and examine the person's interaction with their environment. A health professional could use images, music, art or a variety of assessment tools using electronic technology to help understand the person and their unique perspective on the world around them. They should also speak to the person about the difficulties that have caused them to seek help and assure them that there is nothing wrong with seeing an expert in mental health.