Mental Health Nursing - Assessing Mental Health
A physical exam is often included in mental health assessments to rule out physical issues. This may involve blood work, urine tests or brain scans.
Psychologists employ a variety of tools for assessing mental health. These tools can be anything from pencil and paper test forms, to in-depth interviews or self-completed questionnaires via mail.
Mood and affect
The doctor will first be aware of the patient's mood and emotional state. They define the patient's general emotional tone, which can range from happiness to sadness, or anger to anger. Affect can be measured by watching facial expressions and demeanour 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 a feeling that is temporary, while mood is a long-lasting emotion. It is usually described as euthymic (normal) or dysphoric, which translates to depressed. Professionals in psychiatry must be careful to avoid confusion between the terms because they are different in their definition and are affected by various factors.
The MSE can be a useful instrument for diagnosing clinical conditions, but it is difficult to interpret based on a subjective patient report. It is therefore helpful to ask patients how they have been feeling over the last few weeks, as opposed to relying solely on the observations of doctors. Recent research has revealed that assessment tools differed in their ability to detect a substantial part of symptoms. This included those that were grouped under the same disorder. This can be due to the differing emphasis on cognitive, emotional or physical symptoms as and also the different duration and frequency of symptom reporting.
It is possible that the MSE relies on self-reporting, which can be biased. Patients who report both a headache and anxiety is likely to report lower scores than those who report only migraine. Patients tend to minimize negative emotions while exaggerating positive feelings.
The affect and mood of a person have a direct impact on thoughts, which can influence the way we make decisions, our interpersonal behavior and physical functioning. They can be influenced by fatigue, stress, social interactions, world events, hormones, and weather. A positive mood can boost creativity and mental energy. However, a mood that is negative can affect concentration and cause confusion. A thorough and careful mental health evaluation must take into account the patient's mood as well as affect and the other factors.
Thought content
Assessing how the patient thinks is one of the most crucial aspects of a mental state examination. Particularly, it is assessing thought process and thoughts. The term "thought process" refers to the logic, organization and coherence of a patient's thought processes. A normal thought processes is focused and logical. In many mental health disorders however, the thought process is distorted. Examples include hallucinations, delusions, and loose associations.
A mental state examination also evaluates insight and judgement. Insight is being able to recognize the presence of a problem. Judgement is the process to make a well-considered choice after receiving information. Both are affected by several mental health conditions such as depression and schizophrenia. If a patient is impaired in judgment or insight is at greater risk of harming themselves or others. If they are in danger, their sensible judgement would tell to leave the house immediately. However, a patient with impaired judgment might decide to stay in the building and attempting to put the fire out.
Thought content refers to the subject matter, themes and beliefs that a patient has. Examiners will assess the clarity, connection and content of a thoughts of the patient. They will take note of any tangential or circumstantial thoughts, and whether the patient has flights of ideas (digressions from the subject of conversation). They will also comment on the speed of a person's thoughts, for instance, whether they appear fast or slow.
It is also crucial to determine if the patient's mood is in line with the environment in which they live. For instance, a patient who is depressed might hear voices that sound angry and threatening, while someone suffering from schizophrenia could have a hallucination of a calm and soothing voice. The patient should be questioned about any homicidal or suicidal ideation. Although these are rare, they can be life threatening and should be taken into consideration in every mental health assessment.
Observation
The observation skills of nurses play an important role in an assessment of mental health. They include a careful examination of appearance, behavior as well as any peculiar beliefs or perceptions (such hallucinations or delusions) mood, cognition (including attention, memory, orientation). A nursing mental status examination also incorporates observation of mobility, which includes any physical movement, such as eating drinking, eating, brushing teeth or using the toilet, as well as wearing shoes.
The Observation component of the mental state examination is a crucial aspect of determining whether or not a patient may pose a risk to themselves or others. This is determined by assessing whether the patient appears be acting in a way that suggests they're about harm themselves or another person.
In addition, a comprehensive assessment of thought content is done by keeping track of the patient throughout the interview and determining their preoccupations. It is crucial to determine whether the patient is experiencing suicidal, homicidal or delusional thoughts.
Global assessment of functioning (GAF), a numerical rating from 0 to 100, combines the ability of an individual to function in daily life with their ability of coping with stressors. The GAF is a key part of the mental health examination and aids in making the treatment decisions.
It is important to recognize that observing the behaviour of a patient can cause anxiety. Therefore, it is essential that the procedure is conducted in a manner that does not cause discomfort or feel intrusive. It is also crucial that the patient is aware of the reason for the observation as well as the length of time it will last.
Nursing observation is a vital ability that should be a central part of any nursing program. However, it must be noted that patients might disagree with the level of observation. If they cannot reach an agreement with the staff, they should have access to an advocate service which can represent their interests and support their discussions on their care. This should be part of local policy and practice, with the participation and the support of groups of patients.
Questioning
Many people have a difficult time talking about their mental health problems, but loved ones are often able to tell the signs that something is not right. They can also help the person to seek an assessment. These assessments are broad and cover a variety of topics including appearance, mood as well as memory, thinking process and more. A mental health professional could also inquire regarding the person's personal life. They'll ask them what they've been feeling and what's happened in the last few days.
The test also includes a cognitive test that focuses on the ability of the person to think clearly and recall information. The test taker may be asked to complete basic tasks, such as keeping their attention on a list of objects or words and recollecting lists of basic information or solving math problems. The test may also test the ability of the individual to make sound decisions and make good judgments. The test measures a patient's perception, which is their knowledge of their condition and how it affects them.
Another crucial aspect of the mental health assessment is the patient's attitude towards the world, himself and his illness. The tone of voice, facial expression and body language can indicate hostility, anger or depression, or a feeling of insecurity. It is also important to determine whether the patient appears to be seeking help or is content living with their illness.
In more serious instances the assessment of mental health could include a thorough examination of the patient's thinking which could include illusions or hallucinations. These conditions can be extremely dangerous and even deadly.
A mental health assessment should be holistic and examine the person's interactions with their environment. A health professional may employ images, music, art or a variety of electronic assessment tools to help understand the person and their unique perspective on the world around them. They should also talk to the person about the challenges that have caused them to seek help and assure them that there is nothing wrong with visiting an expert in mental health.