Mental Health Nursing - Assessing Mental Health
A physical examination is typically part of mental health assessments to rule out physical conditions. This could include urine tests, blood tests tests or even brain scans.
Psychologists also utilize a variety of tools to assess mental health. These range from pen and paper test forms to in-depth interviews or self-complete questionnaires sent to you by post.
Mood and affect
The doctor will first observe the patient's mood and affect. They define a patient's general emotional state. It can be anything from sadness to happiness or irritability and anger. The effect can be analyzed by facial expressions, overall attitude and reaction to external or internal stimuli. You can express your feelings by smirking at the joke or crying when you lose a beloved one.
Affect is a short-term emotion while mood is a more sustained emotional state. It is typically described as euthymic, dysphoric, or normal (meaning depressed). However, psychiatric professionals should be cautious not to confuse the terms because they have different definitions and are influenced by a variety of factors.
The MSE is a helpful tool for clinical diagnosis however it is difficult to interpret based on the subjective report of a patient. It is therefore important to ask patients how they have felt over the past few weeks, rather than using only the observation of a physician. A recent study found that a significant proportion of symptoms, even those grouped together within the same disorder category, vary between assessment tools. This could be due to the different emphasis placed on emotional or cognitive symptoms, as well as the different time periods and frequency in reporting symptoms.
It is possible that the MSE relies solely on self-reporting which could be biased. Patients who report both anxiety and headache is likely to report a lower score compared to one who reports only migraine. Furthermore, there is an inclination for patients to minimize negative feelings and overestimate the severity of positive emotions.
The affect and mood of a person directly affect thoughts and can affect decision-making, interpersonal behaviour, and physical functioning. They are affected by fatigue, stress and social interactions. In actual fact, a positive mood has been proven to boost creativity and thinking power. However, a mood that is negative can decrease concentration and cause confusion. A thorough and careful mental health evaluation must be able to consider the patient's mood and affect as well as the other factors.
Thought content
One of the most essential elements of a mental status exam is assessing how a patient thinks. Particularly, it is assessing thought process and thought content. The thought process is the coherence, logic and structure of a patient's thoughts. A normal thought processes is goal directed and logic-based. In IamPsychiatry , however, thought processing is distorted. Examples include hallucinations, delusions and loose associations.
A mental health assessment also assesses the quality of insight and judgement. Insight is the ability to identify that there is a problem, and judgement is the ability to make a rational decision when presented with information. Both can be impaired in many 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. If they are in danger, their sensible judgement would suggest leaving the home immediately. A person with impaired judgment may suggest that they stay in the building to try and get rid of the fire.
The content of a patient's thoughts encompasses their themes, subject matter, and beliefs. Examiners will evaluate the clarity, relevance and content of a patient's thoughts. They will be able to identify tangential ideas or circumstantial ones, and when a patient is digressing (digressions off from the main topic of the conversation). They will also provide feedback on the speed at which someone is thinking, for example, if they seem to be faster or slower.
Other important aspects to consider are whether the patient's thoughts are congruent or incongruent with their surroundings. A person suffering from depression could hear voices of anger, while someone suffering from schizophrenia may experience the illusion that a peaceful voice is speaking. A patient should be questioned about any suicidal or homicidal ideation. They are not common, but they can be life-threatening and should be considered in every mental health assessment.
Watching
The ability of nurses to observe is vital in a mental assessment. They include a careful review of behavior, appearance, any unusual beliefs and perceptions (such as hallucinations or delusions) mood, and aspects of cognition (including attention to orientation, attention memory). A nursing mental status examination also includes observing the ability to move, which includes physical movement, such as eating drinking, eating, brushing teeth or using the toilet, as well as taking off shoes.
The Observation element of the mental state examination is a crucial aspect of determining if a patient may pose an imminent risk to themselves or others. This is determined by assessing whether the patient appears to be moving deliberately in a way that suggests they are in danger of harming themselves or anyone else.
A detailed assessment of the thought-based content is also made by monitoring the patient during the interview and determining thoughts and concerns. It is particularly important to determine if the patient has any suicidal or homicidal thoughts and to determine if they're experiencing delusions.
Global assessment of functioning (GAF) is which is a numerical score ranging between 0 and 100, evaluates the ability of an individual to function in daily life and their capability of coping with stressors. The GAF is an important component of the mental health exam and assists in guiding treatment decisions.
It is important to be aware that observing the behavior of a patient can cause anxiety and it is essential that the process is conducted in a manner that doesn't 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 and the length of time it will take.
Nursing observation is an essential skill that should be an integral part of the nursing process. However, it must be noted that patients might disagree with the level of observation and if they are unable to reach an agreement with staff, then they should have access to an advocate service that can represent their needs and help their discussions on their care. This should be part of local policy and practice, with the involvement and the support of user groups.
Questioning
Many people are reluctant to discuss their mental health issues, but their family members can often detect if something is not right. They can also assist the person to get an assessment. These assessments be a variety of subjects such as mood, appearance and thought process. In addition to these tests, the mental health professional will also ask the individual questions about their personal life, including what's been happening recently and what their emotions have been like.
The assessment also includes a cognitive assessment, which focuses on the person's ability to think clearly and retain information. The test subject may require the person to complete basic tasks, such as focussing on a list or objects, remembering lists or completing math problems. The test can also be used to assess the individual's judgment and ability to make good choices. The test measures a patient's awareness, which is the understanding of their illness and how it affects them.
Another vital aspect of a mental health assessment is the person's attitude towards other people, himself and the illness. The tone of voice, the facial expressions, and body language of a patient can signal depression, anger, or a feeling of helplessness. It is also important to determine whether the patient appears to be seeking help or is content living with their health condition.
In more serious instances an assessment of mental health may 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). These conditions can be harmful and even fatal.
A mental health assessment should be comprehensive and look at the person's relationship to their world. A health professional may employ art, music, photos or a variety of assessment tools using electronic technology to better understand the person and their unique view of the world around them. They should also talk about the challenges that led the person to seek help, and reassure them there is nothing wrong with seeing an expert in mental health.