Mental Health Nursing - Assessing Mental Health
A physical exam is often included in mental health assessments to rule out physical issues. These can include urine tests, blood testing, or even brain scans.
Psychologists also employ a variety of tools to assess mental health. These tools be anything from pencil and paper test forms, to in-depth interviews or self-completed questionnaires via mail.
Affect and mood
The clinician will first notice the patient's mood as well as their affect. They describe the patient's general emotional tone, which can range from happiness to sadness, or anger to anger. Affect can be assessed by looking at facial expressions and attitude as well as response to external or internal stimuli (e.g. smiling at an absurd joke or crying over the loss of a loved one).
Affect is a temporary emotion while mood is a longer-lasting emotional state. It is usually described as either euthymic (normal) or dysphoric, meaning depressed. Psychologists should be cautious to not confuse the two terms because they are interpreted differently and can be affected by many factors.
While the MSE is a useful tool for clinical use, it isn't always easy to interpret based upon subjective patient report. It is therefore important to ask patients how they have been feeling in the last few weeks, rather than relying on physician observation only. A recent study showed that a large proportion of symptoms, which includes those that fall under the same disorder category, differ between assessment tools. This could be due the differing emphasis on cognitive, emotional or physical symptoms, as and also the different duration and frequency of reporting symptoms.
It is possible that the MSE relies on self-report which could be susceptible to bias. For example, a patient who reports a headache and anxiety will likely report an lower score than a patient who reports only the sensation of a headache. Patients tend to minimize negative emotions while exaggerating positive feelings.
Mood and affect can have a direct influence on thought content. This can affect the way people make decisions, their interpersonal behavior and physical function. They are affected by stress, fatigue and social interactions. iampsychiatry can increase creativity and mental strength. A negative mood can reduce concentration and lead to confusion. A thorough and thoughtful mental health evaluation must consider the patient's mood as well as affect, as well as fundamental factors.
Thought content
Assessing how the patient thinks is one of the most crucial aspects of a mental state examination. Evaluation of thought process and content. The thought process is the logic, coherence and organization of a patient’s thoughts. Normal thought processes are rational and focused on goals. Thought processing can be altered in a variety of mental health conditions. Examples include hallucinations, delusions and loose associations.
A mental state examination also evaluates insight and judgement. Insight is the ability to identify that there is an issue, and judgement is the ability to make an informed decision based on information. Both can be impaired by various mental health conditions such as schizophrenia and depression. If a patient is impaired in judgment or insight is at greater risk of causing harm to themselves or others. For example, if they are at risk of burning their house down, sensible judgement would tell them to leave the building immediately. However, a person with impaired judgment may decide to stay in the building and attempting to put out the fire.
The contents of a patient's mind encompasses their subject matter, themes, and beliefs. Examiners will evaluate the clarity, relevance and content of a thoughts of the patient. They will also note any thoughts that are circumstantial or tangential or thoughts, and also if the patient is prone to having a flurry of thoughts (digressions from the conversation subject). They will also provide feedback on the pace at which a person is thinking, for example, if they seem to be faster or slower.
Other areas to be considered are whether the patient's thoughts are congruent or incongruent with their surroundings. For instance, a patient who is depressed may hear voices that are angry and threatening, while a person with schizophrenia might experience a hallucination of an ethereal and calm voice. Ask the patient if they have any thoughts of suicide or homicide. These are uncommon, but could be life-threatening and should be considered in every mental health assessment.
Watching
Nurses' observation skills are essential to the mental health assessment. They include a careful review of the appearance, behavior as well as any unusual beliefs or perceptions (such as hallucinations or delusions) mood, as well as aspects of cognition (including attention to the environment, orientation memory, and orientation). The nursing mental state exam also involves the observation of motility. This is any physical activity, such as eating, drinking, or brushing teeth.
The Observation component of the mental state exam is vital in determining if the patient is a danger to themselves or others. This is done by assessing whether the patient appears to be acting in a manner that suggests that they are in danger of harming themselves or someone else.
In addition, a comprehensive assessment of the content of thoughts is conducted by observing the patient throughout the interview and determining their preoccupations. It is essential to determine if the patient has any suicidal or homicidal ideas and to determine if they are experiencing thoughts of delusion.
A global assessment of functioning (GAF) is an assessment of a numerical score on a scale of 0 to 100 that combines a person's ability to function in daily life and their ability to deal with the stresses in their lives. The GAF is a key part of the mental state exam and assists in making the treatment decisions.
It is essential to be aware that observing a patient's behaviour could cause anxiety, and it is important that the process is conducted in a manner that does not provoke the patient and doesn't make them feel uncomfortable. It is important that the patient is fully aware of the reason for the observations and the duration of the procedure.
Nursing observation is a crucial skill that should be a key part of the nursing process. It is important to remember that patients may disagree about the level of observation. If they cannot come to an agreement with the staff, they must be able access an advocate service that can represent their interests and assist in any discussions about their care. This should be a part of local policy and practice, with the involvement and support of groups of users.
Questioning
Many people are reluctant to talk about their mental health issues, but family members can often discern when something isn't right. They can also assist the person take steps to get an assessment. These assessments can be very broad and cover a variety of subjects including mood, appearance as well as thought process, memory and many more. In addition to these tests, a mental health professional will also ask the person questions about their life, including what's happened lately and what their feelings have been like.
The assessment also includes a cognitive assessment that is focused on the ability of the person to think clearly and remember information. The person may be required to complete basic 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 their judgment. The assessment determines a patient's insight which is their understanding of their condition and how it affects them.
Another important component of an assessment of mental health is the person's attitude towards the world, himself and his illness. The patient's tone of voice, facial expressions and body language can indicate anger, hostility depression or a feeling of powerlessness. It is important to check whether the patient appears seek help or accepting their situation.
In more serious situations the assessment of mental health might include a look at the patient's thoughts which could include hallucinations or illusions. These conditions can be dangerous and even deadly.
In general, a mental health assessment should take a holistic approach and examine the person's connection to their social environment. A health professional may use photographs, music, art or any other assessment tool to gain a better understanding of the person. They should also talk about the difficulties that prompted the person to seek help, and assure that there is nothing wrong with seeing a mental health professional.