Mental Health Nursing - Assessing Mental Health
A physical exam is often included in mental health assessments to rule out any physical conditions. This can include urine tests, blood tests testing, or even brain scans.
Psychologists use a variety of instruments to evaluate mental health. assessment in mental health can be anything from pencil and paper test forms to more in-depth interviews or self-completed questionnaires for postal mail.
Affect and mood
Mood and affect are among the most important elements of the mental state examination (MSE) and are the first things to be viewed by the medical professional. They define a patient's general emotional tone. This can vary from joy to sadness or anger and irritability. Affect can be assessed by watching facial expressions and manner of speaking as well as the response to external or internal stimuli (e.g. smiling at a joke or crying at the loss of a loved one).
Affect is a temporary emotion while mood is a more long-lasting emotional state. It is generally described as euthymic, normal, or dysphoric (meaning depression). However, psychiatrists must be careful not to misunderstand the terms because they have different definitions and are affected by a variety of factors.
While the MSE is a valuable tool for clinical use however, it isn't always easy to interpret based on a subjective patient report. The process of asking patients to share their experiences during the past few weeks is more effective than relying solely on physician observations. A recent study found that a large proportion of symptoms, even those that are grouped within the same disorder category, differ between assessment tools. This could be due to the different emphasis on emotional, cognitive or physical symptoms as and also the different duration and frequency of reporting symptoms.
It is also possible that the MSE relies on self-reports which could be susceptible to bias. For example, a patient who reports anxiety and headaches will likely have a lower score than someone who has only a headache. Patients tend to minimize negative emotions while exaggerating positive feelings.
The mood and the affect of a person can have a direct impact on the content of thought. This can impact the way people make decisions, their interpersonal behavior and physical function. They are influenced by fatigue, stress social interactions, world events, hormones and the weather. In fact, a positive mood has 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 take into account the patient's mood and affect as well as the other factors.
Thought content
The ability to determine how a patient thinks is one of the most important aspects of a mental state examination. Specifically, evaluating thought process and thought content. The thought process is the coherence, logic, and organization of a patient's thoughts. Normal thought processes are focused and rational. Thought processing can be altered in a variety of mental health conditions. Examples include delusions, hallucinations and loose associations.
A mental state examination also examines judgment and insight. Insight is the ability to spot problems. Judgment is the capability of making a well-considered decision after receiving information. Both can be impaired by several mental health conditions such as schizophrenia and depression. If a patient suffers from impaired judgment or insight in any way, they are at a higher chance of harming themselves or others. If they are in danger, their rational judgment would advise them to leave the home immediately. A patient with impaired judgment might suggest they stay in the house to try to get rid of the flame.
Thought content is the topics, subject matter, and beliefs that a patient holds. Generally, examiners comment on the clarity, relatedness and content of a patient's thinking. They will be able to identify tangential ideas or circumstantial ones, and in the event that the patient's thoughts diverge (digressions off from the main topic of the conversation). They will also comment on the speed of a person's thoughts, including whether they appear fast or slow.
Other important aspects to consider are whether the patient's thoughts are congruent or incongruent with their surroundings. Patients suffering from depression may hear angry voices, whereas someone suffering from schizophrenia may have the illusion that a peaceful voice is speaking. The patient should be asked about any suicidal or homicidal thoughts. These are uncommon, but could be life-threatening and should be taken into consideration in every mental health assessment.
Observation
A nurse's observation skills are essential to a mental health assessment. They include a careful examination of appearance, behavior, any unusual beliefs or perceptions (such delusions or hallucinations) and mood cognition (including attention, memory, orientation). A mental health assessment for nursing also includes observing mobility, which includes any physical movement, such as eating, drinking, brushing teeth or using the toilet, as well as taking off shoes.
The observation component of the mental status exam is an essential element of determining whether the patient could pose an imminent risk to themselves or others. This is done by assessing if the patient appears to be acting in a way that suggests they're about harm themselves or another person.
A detailed evaluation of the thought content is also done by monitoring the patient during the interview and determining preoccupations. It is crucial to determine whether the patient has suicidal, homicidal, or delusional thoughts.
Global assessment of functioning (GAF) is which is a numerical score ranging from 0 to 100, measures the capacity of an individual to function in daily life and their capability of managing stressors. The GAF is an essential part of the mental health examination and assists in making the treatment decisions.
It is crucial to be aware that observing an individual's behavior can cause distress and it is crucial that the procedure is carried out in a manner that does not cause anxiety for the patient and does not be uncomfortable for them. It is also vital that the patient is fully informed about the purpose of the observation and the length of time it will take.
Nursing observation is an important ability and should be a key part of the nursing process. However, it must be remembered that patients may not agree with the degree of observation. If they are unable to come to an agreement with staff, then they should be able to access an advocate service that can represent their needs and help their discussions on their care. 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 creation of written information as well as staff training for this aspect of governance in the clinic.
Questioning
Many people have a difficult time talking about their mental health problems However, loved ones will often be able to recognize the signs of something being wrong. They can also assist the person to obtain an assessment. These tests can be conducted on a variety of topics, including mood, appearance and thought process. A mental health professional may also ask questions about the person's personal life. They will ask what they have been feeling and what's happened in the last few days.
The test consists of a cognitive evaluation which focuses on an individual's ability to think clearly and retain information. The person could be asked to complete basic tasks such as focusing on a list or objects, remembering lists or completing math problems. The test may also test the person's ability to make sound decisions and use their judgment. The assessment determines a patient's insight which is their understanding of their illness and how it affects them.
The attitude of the patient towards others, himself and the illness is an important part of a mental evaluation. The patient's tone of voice, facial expression and body language can convey anger, hostility depression or a feeling of powerlessness. It is crucial to determine whether the patient appears seek help or accepting their condition.
In more serious instances an assessment of mental health might include an assessment of the patient's thinking that could include 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 dangerous and even life-threatening.
In general the mental health assessment should take a holistic approach and examine the person's relationship to their social environment. A health professional could use images, music, art or a range of assessment tools that are electronic to better understand the person and their unique view of the world around them. They should also talk to the person about the issues that led them to seek help and assure them that there is nothing wrong with seeking out a mental health professional.