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Mental Health Nursing - Assessing Mental Health
A physical examination is typically part of mental health assessments to rule out any physical conditions. This may involve blood work or urine tests, as well as brain scans.
Psychologists also utilize a variety of tools to assess mental health. They can use tests that are written on paper and pen to in-depth interviews or self-complete questionnaires for postal delivery.
Affect and mood
The clinician will first notice the patient's mood and affect. They describe the patient's general emotional tone that can range from joy to sadness, or even irritability to anger. The affect can be assessed through facial expressions, overall attitude and reaction to external or internal stimuli. You can express your emotions by laughing at the joke or crying when you lose a beloved one.
Affect is a temporary emotion while mood is a more long-lasting emotional state. It is typically described as euthymic, or normal, or dysphoric (meaning depressed). Psychiatric professionals should be careful to not confuse the two terms because they are defined differently and can be affected by many factors.
While the MSE is a helpful clinical tool but it can be difficult to interpret based on a subjective patient reports. Inquiring about the feelings of patients during the past few weeks is more helpful than relying on only physician observations. A recent study found that a large proportion of symptoms, which includes those that are grouped within the same disorder category, vary between assessment tools. This can be because of the different emphasis placed on emotional or cognitive symptoms, as well as the different the time intervals and frequency of the reporting of symptoms.
It is also possible that the MSE relies on self-reports which is susceptible to bias. For example, a patient who complains of a headache and anxiety is likely to report less than a person who describes only a headache. Patients tend to minimize negative emotions while exaggerating positive ones.
Affect and mood have a direct impact on thoughts which influences decision-making, interpersonal behaviour and physical performance. They can be influenced by fatigue, stress social interactions, world events, hormones and even the weather. In fact, a positive mood has been proven to increase the ability to think and be creative. However, a mood that is negative can decrease concentration and cause confusion. A thorough and meticulous mental health assessment must consider both the patient's mood and affect and the fundamental factors.
Thought content
Assessing how the patient thinks is among the most crucial aspects of a mental state examination. Particularly, evaluating thought processes and thought content. The thought process is the logic, coherence and organization of a patient’s thoughts. Normal thought processes are goal directed and logical. Thought processing may be altered in a variety of mental health conditions. Examples include hallucinations, delusions, and loose associations.
A mental status examination also evaluates insight and judgement. Insight is the ability to identify that there is a problem, while judgement is the ability to make a considered decision when presented with information. Both are affected by various mental health conditions like depression and schizophrenia. A patient with impaired insight or judgement is more likely to harm themselves or others. If they are in danger, their rational judgment would advise them to leave the premises immediately. However, a patient with impaired judgment may suggest staying in the building and attempting to put out the fire.
The thoughts of a patient includes their themes, subject matter, and beliefs. Examiners generally comment on the clarity, relatedness and content of a patient's thought. They will note any thoughts that are tangential or circumstantial and also whether the patient is having flashes of thoughts (digressions from the subject of conversation). They will also comment on a person's pace of thinking, for example, if they seem to be more or less fast.
Other important aspects to consider are whether the patient's thoughts are congruent or incongruent with their environment. For example, a patient who is depressed could hear voices that sound aggressive and threatening, whereas someone suffering from schizophrenia could be able to imagine the sound of a calm and soothing voice. Ask the patient if they have any suicidal or homicidal ideas. Although they are uncommon but they could be life-threatening and must be taken into consideration during every mental health assessment.
Watching
Nurses' observation skills are essential to the mental health assessment. They involve a thorough evaluation of behavior, appearance, any peculiar beliefs or perceptions (such hallucinations or delusions), mood, and cognition (including memory, attention and orientation). A mental health assessment for nursing also includes observing motility, including any physical movement, such as eating or drinking, brushing your teeth, using the toilet and wearing shoes.
Article of the mental health examination is a crucial aspect of determining if a patient may pose the risk to themselves or others. This is accomplished by determining if the patient appears to be moving in a deliberate manner that suggests they are about harm themselves or another person.
A detailed evaluation of the thought content is also accomplished by observing the patient during the interview and determining concerns. It is essential to determine if the patient is suffering from suicidal or violent thoughts and to determine if they're experiencing thoughts of delusion.
A global assessment of functioning (GAF) is an assessment of a numerical score on a scale ranging from 100 to 0 that measures the capacity of a person to perform in daily life and their capacity to handle the stressors in their life. The GAF is a key part of the mental state exam and helps guide treatment decisions.
It is important to be aware that observing an individual's behavior can cause distress and it is crucial that the procedure is carried out in a way that does not cause anxiety for the patient and does not make them feel uncomfortable. It is important that the patient is aware of the goal of the observations and the duration of the procedure.
Nursing observation is a crucial ability that should be a central part of any nursing procedure. However, it must be remembered that patients may disagree with the level of observation and if they cannot reach an agreement with the staff, they should have access to an advocate service that can represent their interests and assist their discussions on their treatment. This should be an integral part of local observation policy and practice, with the participation of user groups to ensure that patients are included in the creation of written information and staff training to support this aspect of governance in the clinic.
Questioning
Many people are reluctant to discuss their mental health issues, but their family members are often able to detect if something is not right. They can also help the person to get an assessment. These tests can be a variety of subjects that include mood, appearance and thought process. In addition to these tests, mental health professionals will also ask the person questions about their personal life, such as what has been going on recently and what their feelings have been like.
The test also includes a cognitive test, which focuses on the ability of the individual to think clearly and retain information. The person may be required to complete basic tasks, such as paying attention to a list of objects, memorizing lists or completing math problems. The test can also check the ability of the individual to make sound decisions and use their judgment. The test determines a person's insight which is their understanding of their illness and how it affects them.
The patient's attitude towards others, himself and the illness is an important aspect of a mental assessment. The patient's voice, facial expression and body language may convey anger, hostility or depression, or a feeling of powerlessness. It is important to observe whether the patient appears be seeking assistance or is accepting their situation.
In more serious instances, an assessment of mental health may include a look at the patient's mental state, which may involve hallucinations or even illusions. These conditions can be extremely dangerous and even fatal.
A mental health assessment must be holistic and examine the person's interactions to their world. A health professional may use images, music, or art or any other assessment tool to better understand the person. They should also talk to the person about the difficulties that caused them to seek assistance and reassure them that there is nothing wrong with visiting a mental health professional.