Mental Health Nursing - Assessing Mental Health
A physical exam is usually included in mental health assessments to rule out any physical conditions. This could involve blood tests or urine tests, as well as brain scans.
Psychologists use a variety of tools for assessing mental health. These range from pen and paper test forms to in-depth interviews or self-complete postal questionnaires.
Mood and affect
The affect and mood are the most significant components of the mental status exam (MSE) and are the first things to be viewed by the clinician. They describe the patient's general emotional state, which can range from happiness to sadness, or even irritability to anger. Affect can be assessed by looking at facial expressions and manner of speaking as well as the reactivity to internal or external stimuli (e.g. smiling at a joke or crying at the loss of a loved one).
Affect is an emotion that is only temporary, whereas mood is a state of sustained emotion. It is usually described as euthymic (normal) or dysphoric, which translates to depressed. However, psychiatric specialists should be cautious not to misunderstand the terms as they have varying definitions and are influenced by a variety of factors.
While the MSE is a useful diagnostic tool however, it isn't always easy to interpret based upon 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 revealed that a significant percentage of symptoms, even those that are grouped within the same disorder category, vary between assessment tools. This could be due to the different emphasis on cognitive, emotional or physical symptoms as and also the different duration and frequency of reporting symptom reports.
It is possible that the MSE is based solely on self-reporting, which can be biased. Patients who report both anxiety and headache is likely to have a lower score compared to a patient reporting only a migraine. In independent mental health assessment , there is the tendency for patients to minimize negative feelings and overestimate the severity of positive emotions.
Mood and affect can have an impact on the content of thought. This can impact the way people make decisions, their interpersonal behavior and physical function. They can be affected by fatigue, stress and social interactions. Positive moods can boost creativity and mental energy. A negative mood can lead to confusion and reduce concentration. A thorough and thoughtful mental health assessment should consider the patient's mood as well as affect, as well as underlying factors.
Thought content
Assessing how the patient thinks is one the most crucial aspects of a mental state exam. Particularly, it is assessing thought process and thoughts. The thought process is the coherence, logic and structure of the patient's thoughts. Normal thought processes are logical and focused on a goal. In several mental health conditions however, the thought process is altered. Examples include hallucinations, delusions, and loose associations.
A mental state examination also examines judgment and insight. Insight is the ability to spot the presence of a problem. Judgment is the ability to make a rational decision after receiving information. Both can be impaired by several mental health conditions such as depression and schizophrenia. If a patient is impaired in judgment or insight in any way, they are at greater risk of causing harm to themselves or others. For example when they are at risk of destroying their home the sensible judgment would tell them to leave the house immediately. A person with impaired judgment might suggest they stay in the building to try to put out the fire.
Thought content refers to the topics, subjects and beliefs that a patient has. Generally, examiners comment on the clarity, relevance and the content of a patient's thinking. They will note tangential thoughts or those that are merely circumstantial, and when a patient is digressing (digressions away from the topic of the conversation). They will also provide feedback on the pace at which a person is thinking, such as if they seem to be faster or slower.
It is also important to determine if the patient's mood is similar to their environment. Patients suffering from depression may be able to hear angry voices, whereas a person suffering from schizophrenia might experience an illusion that a calm voice is speaking. A patient should be asked about any suicidal or homicidal thoughts. Although they are not common but they could be life-threatening and should be taken into consideration during every mental health assessment.
Observation
The observation skills of nurses play an important role in the mental health assessment. They will conduct a thorough examination of behavior, appearance, any unusual beliefs and 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 is also a way of monitoring the movement. This includes any physical movement, like eating, drinking and brushing your teeth.
The observation component of the mental state exam is essential in determining whether the patient poses a risk to them or others. This is done by assessing whether the patient is acting in a manner that suggests that they are in danger of harming themself or someone else.
A detailed assessment of the thought-based content is also done by monitoring the patient during the interview and determining the preoccupations. It is crucial to determine whether the patient is suffering from suicidal, homicidal, or delusional thoughts.
A global assessment of functioning (GAF) is an assessment of a numerical score on a scale of 0 to 100 that combines the ability of a person to perform in daily life along with their capacity to handle the stresses in their lives. The GAF is a crucial element of the mental state examination and helps to guide treatment decisions.
It is essential to be aware that watching the behavior of a patient can cause distress and it is important that the procedure is carried out in a way that does not provoke the patient or make them make them feel uncomfortable. It is also essential that the patient is fully aware of the reason for the observation as well as the length of time it will last.
Nursing observation is a vital skill that should be at the heart of any nursing program. However, it must be remembered that patients may not agree with the degree of observation. If they are unable to reach an agreement with staff, then they should be able to access an advocate service which can represent their interests and assist patients in any discussions about their treatment. This should be an integral element of the local observation policy and practice, including the involvement of user groups, to ensure that patients are included in the creation of written information and staff training to support this aspect of clinical governance.
Questioning
Many people are hesitant to talk about their mental health issues, but their family members are often able to detect if something is not right. They can also assist the person get an assessment. These assessments are broad and cover a wide range of subjects, such as mood, appearance as well as memory, thought process and more. In addition to these tests, mental health professionals will also ask the individual questions about their personal life, including what has been going on recently and what their feelings have been like.
The test includes an evaluation of the cognitive capacity that focuses on a person's ability think clearly and retain information. The person could be asked to complete simple tasks such as paying attention to a list of objects, remembering lists or solving math questions. The test can be used to test the person's judgment and ability to make good choices. The test measures a patient's insight which is their understanding of their illness and how it affects them.
The patient's attitude toward others, himself and the illness is an important part of a mental assessment. The tone of voice, facial expressions and body language may convey anger, hostility, depression or a sense of helplessness. It is important to check whether the patient appears be seeking help or accepting their condition.
In more serious cases the evaluation of mental health could include a thorough examination of the patient's thinking that may include hallucinations or even illusions. These conditions can be extremely dangerous and even deadly.
A mental health assessment must be holistic and focus on the person's interactions to their world. A health professional can use images, music, or art or any other electronic assessment tool to better understand the person. They should also talk about the issues that led to the person to seek help, and reassure that there is nothing wrong with seeking out a mental health professional.