Mental Health Nursing - Assessing Mental Health
A physical examination is typically included in mental health tests to rule out physical issues. This may include blood tests and urine tests as well as brain scans.
Psychologists employ a variety of tools for assessing mental health . These tools can vary from pencil and paper test forms to more in-depth interviews or self-completed postal questionnaires.
Mood and affect
Mood and affect are among the most significant components of the mental health examination (MSE) and are the first things to be observed by a doctor. They are the general emotional state, which can range from happiness to sadness or irritability to anger. Affect can be assessed by watching facial expressions and attitude as well as reactivity to internal or external stimuli (e.g. smiling at the joke or crying over the loss of a loved one).
Affect is a short-term emotion while mood is a more sustained emotional state. It is usually described as being either euthymic (normal) or dysphoric, which translates to depressed. However, psychiatrists should be cautious not to misunderstand the terms because they have different definitions and are influenced by a variety of factors.
The MSE can be a useful tool for clinical diagnosis however it is difficult to interpret from the subjective report of a patient. Asking patients about their feelings in the last few weeks is more helpful than relying on only observations from a physician. A recent study showed that a large proportion of symptoms, which includes those that are grouped under the same disorder category, vary between assessment tools. This can be due to the different emphasis on emotional, cognitive or physical symptoms as and also the different duration and frequency of symptom reporting.
It is possible that the MSE relies solely on self-reporting which could be biased. A patient who reports both anxiety and headache is likely to have lower scores than those who report only migraine. Patients tend to minimize negative emotions while exaggerating positive feelings.
Affect and mood directly affect thoughts which influences decision-making, interpersonal behaviour and physical functioning. They are 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 meticulous mental health evaluation must be able to consider the patient's mood and affect as well as the underlying factors.
Thought content
One of the most important aspects of a mental state examination is assessing how the patient thinks. Assessment of the thought process and its content. The thought process is the coherence, logic, and organization of the patient's thoughts. Normal thought processes are rational and focused on a goal. Thought processing can be distorted in a variety of mental health conditions. Examples include hallucinations and delusions as well as loose associations.
Insight and judgement are assessed during a mental state test. Insight is the ability to recognize the presence of a problem. Judgment is the capability to make a rational decision after receiving information. Both are affected by various mental health conditions, such as depression and schizophrenia. If a patient is impaired in judgment and/or insight is at greater chance of harming themselves or others. For example if they are at risk of burning their home down 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 and get rid of the flame.
Thought content is the topics, subjects and beliefs that a patient has. Typically, examiners discuss the clarity, relatedness and quality of a patient's thinking. They will take note of any thoughts that are circumstantial or tangential and also whether the patient is having flashes of ideas (digressions from the topic of conversation). They will also comment on the pace of a person's thoughts, including whether they seem fast or slow.
Other important aspects to consider are whether the patient's thoughts are mood compatible or not in line with their surroundings. A patient with depression might hear angry voices, whereas those suffering from schizophrenia may experience a hallucination that a soothing voice is speaking. Ask the patient if they have any thoughts of suicide or homicide. They are not common, but they can be life-threatening and should be taken into account in every mental health assessment.
Watching
The observation skills of nurses are crucial in an assessment of mental health. They include a careful examination of appearance, behavior as well as any peculiar beliefs or perceptions (such delusions or hallucinations), mood, and cognition (including attention, memory and orientation). A mental health assessment for nursing also incorporates observation of mobility, which includes any physical movement, such as eating or drinking, brushing your teeth, using the toilet and wearing shoes.
The Observation element of the mental health exam is an essential element of determining whether a patient may pose the risk to themselves or others. This is accomplished by determining whether or not the patient is moving in a way that suggests that they are about to harm themselves or anyone else.
A detailed evaluation of the content of thoughts is also accomplished by observing the patient during the interview and determining preoccupations. It is crucial to determine whether the patient is experiencing suicidal, homicidal, or delusional thoughts.
Global assessment of functioning (GAF) which is which is a numerical score ranging between 0 and 100, evaluates the ability of the person to function in daily life along with their capacity for dealing with stressors. The GAF is a crucial component of the mental state exam and helps guide treatment decisions.
It is essential to be aware of the fact that observing an individual's behavior can cause anxiety and it is important that the procedure is carried out in a way that does not cause anxiety for the patient or make them be uncomfortable for them. It is also crucial that the patient is fully aware of the reason for the observation and the amount of time it will take.
Nursing observation is an essential skill and it must be a central part of the nursing process. It is essential to remember that patients may disagree about the extent of observation. If they cannot reach an agreement with staff, they should be able to use an advocate service that can represent their interests and assist in any discussions regarding their treatment. This should be a fundamental element of the local observation policy and practice with the involvement of user groups to ensure that patients are involved in the development of written documents and staff training for this aspect of clinical governance.
Questioning
Many people have a difficult to discuss their mental health issues however, family members will often be able to recognize the signs of something being wrong. They can also help the person take an assessment. These tests can be extremely broad and cover a wide range of topics including appearance, mood, thought process, memory and more. In addition to these tests, mental health professionals will also ask the person questions about their personal life, such as what's been happening recently and what their feelings have been like.
The assessment includes an evaluation of the cognitive capacity that examines a person's ability to think clearly and retain information. The person may be required to complete simple tasks such as focussing on a list or objects, recollecting lists or solving math questions. The test can also check the ability of the individual to make informed 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 toward others, himself and the illness is also an important part of a mental assessment. The tone of voice, the facial expressions, and body language of a patient can convey anger, depression or a sense of helplessness. It is crucial to determine whether the patient appears seek help or accepting their situation.
In more serious instances the evaluation of mental health could include a look at the patient's thoughts which could include hallucinations or even illusions. These conditions can be extremely dangerous and even deadly.
In general an assessment of mental health should be holistic and examine the person's connection to their social world. A health professional can use art, music or photos, or any other assessment tool to gain a better understanding of the person. They should also talk about the issues that led to the person to seek help, and assure them that there is nothing wrong with seeing a mental healthcare professional.