Mental Health Nursing - Assessing Mental Health
A physical exam is often part of mental health assessments to rule out physical issues. This may include blood tests and urine tests as well as brain scans.
Psychologists employ a variety of tools to assess mental health. These tools be anything from pencil and paper test forms to more in-depth interviews or self-completed questionnaires via mail.
Affect and mood
Mood and affect are the most important components of the mental health examination (MSE) and are the first thing to be observed by a medical professional. They define a patient's general emotional tone. It can be anything from sadness to happiness or irritability and anger. The patient's mood can be measured by facial expressions, overall behavior and reaction to external or internal stimuli. smiling at an absurd joke or crying over the loss of a loved one).
Affect is a feeling that is only temporary, whereas mood is a state of sustained emotion. It is usually described as either euthymic (normal) or dysphoric, meaning depressed. However, psychiatrists must be careful not to mix the two since they have different definitions and are affected by a range of factors.
While the MSE is a useful diagnostic tool however, it isn't always easy to interpret based on a subjective patient reports. The process of asking patients to share their experiences during the past few weeks is more helpful than relying on just the observations of a doctor. A recent study found that a significant proportion of symptoms, which includes those grouped together under the same disorder category, vary between assessment tools. This could be due the different emphasis on emotional, cognitive or physical symptoms, as and also the different time periods and frequency of reporting symptoms.
It is possible that the MSE is based solely on self-reporting which could be biased. A patient who has anxiety and a headache is likely to report lower scores than a patient reporting only headache. Furthermore there is a tendency for patients to minimize negative feelings and overestimate the severity of positive emotions.
The affect and mood of a person have a direct impact on thought content, which can influence decision-making, interpersonal behaviour and physical performance. They can be influenced by fatigue, stress, social interactions, global events, hormones and the weather. A positive mood can boost creativity and mental energy. A negative mood can cause confusion and decrease concentration. A thorough and careful mental health assessment must consider the patient's mood and affect as well as the underlying factors.
Thought content
Examining the way a patient thinks is one the most important aspects of a mental state examination. Evaluation of thoughts and their content. The thought process is the logic, coherence and organization of the patient's thoughts. Normal thought processes are rational and focused on a goal. Thought processing can be altered when a person suffers from mental health issues. Examples include hallucinations, delusions and loose associations.
A mental state examination also evaluates insight and judgement. Insight is being able to recognize problems. Judgment is the ability of making a well-considered decision after receiving information. Both are impaired in several mental health conditions, such as depression and schizophrenia. Patients with impaired insight or judgment is more likely to hurt themselves or others. For example if they are at risk of burning their house down the sensible judgment would tell them to leave the building immediately. However, someone with impaired judgment might suggest staying in the building and attempting to put the fire out.
The thoughts of a patient encompasses their themes, subject matter, and beliefs. Examiners will comment on the clarity, connection and content of a thoughts of the patient. They will note tangential thoughts or circumstantial ones, and in the event that the patient's thoughts diverge (digressions away from the subject of the conversation). They will also comment on the pace of a person's thoughts, including whether they appear fast or slow.
Other important aspects to consider are whether the patient's thoughts are compatible or not in line with their surroundings. A person suffering from depression could be able to hear angry voices, whereas those suffering from schizophrenia might experience an illusion that a calm voice is speaking. The patient should be asked about any suicidal or homicidal thought. Although they are not common but they could be life threatening and should be considered in every mental health assessment.
Watching
The ability of nurses to observe is vital in the mental assessment. They will conduct a thorough examination of the appearance, behavior and any strange beliefs or perceptions (such as hallucinations or delusions), mood, and aspects of cognition (including attention to orientation, attention memory, and orientation). The mental status exam for nurses also includes monitoring the movement. This includes any physical movement like eating, drinking and brushing teeth.
The Observation component of the mental health examination is crucial in determining if the patient poses a risk to themselves or others. This is accomplished by determining whether the patient appears be moving in a deliberate manner that suggests they are about harm themselves or another person.
A detailed evaluation of the thought-based content is also accomplished by observing the patient during the interview and determining the preoccupations. It is crucial to determine if the patient is having suicidal or homicidal ideas and to determine if they're having delusions.
Global assessment of functioning (GAF) is which is a numerical score ranging between 0 and 100, measures the capacity of an individual to function in daily life along with their capacity for coping with stressors. The GAF is a crucial part of the mental status exam and assists in guiding the treatment decisions.
It is important to be aware that observing a patient's behaviour can cause distress and it is crucial that the procedure is carried out in a way that does not cause anxiety for the patient and doesn't make them feel uncomfortable. It is crucial that the patient be fully informed of the purpose of the observation and the duration of the process.
Nursing observation is an important skill that should be an integral element of the nursing process. However, it should be remembered that patients may be dissatisfied with the quality of observation and if they cannot reach an agreement with the staff, they should have access to an advocate service that can represent their needs and help their discussions on their care. This should be an integral element of the local observation policy and practice, with the involvement of user groups to ensure that patients are included in the creation of written information and staff training for this aspect of governance in the clinic.
Questioning
Many people have a difficult time talking about their mental health issues, but loved ones will often be able to recognize when something is wrong. They can also help the person to seek an assessment. These assessments are broad and cover a wide range of subjects such as mood, appearance, memory, thinking process and more. A mental health professional could also inquire about the person's personal life. They will ask them what they feel and what has happened recently.
The test consists of an evaluation of the cognitive capacity that focuses on a person's ability to think clearly and retain information. The test subject may require the person to complete simple tasks such as focussing on a list or objects, remembering lists or completing math problems. The test will also test the person's ability to make sound decisions and make good judgments. The test determines a person's insight which is their understanding of their illness and how it affects them.
The person's attitude toward others, himself and the illness is also an important part of a mental evaluation. The tone of voice, the facial expressions, and body expressions of a patient could convey anger, depression, or a feeling of powerlessness. It is important to check whether the patient appears to seek help or accepting their condition.
In more serious situations, an assessment of mental health might include a thorough examination of the patient's mental state, which may involve hallucinations or even illusions. These conditions can be dangerous and even fatal.
In general an assessment of mental health must be holistic and consider the person's relationship to their social life. Health professionals can employ photographs, music, art, or any other assessment tool to better understand the individual. They should also talk about the challenges that led the person to seek help, and reassure that there is nothing wrong with seeking out a mental healthcare professional.