Mental Health Nursing Assessment

Mental health nursing assessment Class Mental Health Created @Oct 6, 2020 12:10 PM Materials Property Type Lecture Week Three Why is assessment important? Assessment is something that we are doing constantly as we move through our lives Just as we are continually assessing in our lives, we should be continually assessing what is happening for the people we work with Assessment in mental health nursing Nursing process: assess, plan, implement, evaluate (Yura and Walsh 1978) Interpersonal process of finding out what has happened to a person and what they are currently experiencing . We are interested in What is happening inside the person: thoughts and feelings - What is happening in their social and physical environment We cannot know what someone else is experiencing, we need to make a best educated judgement based on a range of evidence Gathering the evidence Mental health nursing assessment Assessment formats can be formal or informal Informal might feel easier and more natural but open to our own biases Formal, structured, mitigates impact of person biases Sources of information are the person themselves, family/guardian/close friends, other professionals within the multi-disciplinary team Description Interviews observation - Logs and diaries Observations Measurement Rating scales - Questionnaires Interviews Advantages Simple and requires minimal resource Can be structured to facilitate note keeping Can help the person begin to make connections Disadvantages Analysis can be time consuming Might focus person too narrowly on one area of their life Increased awareness might increase distress Might get social desirability effect making people under-document occurrences eg of binge drinking Can be forgotten/incomplete leading to lack of information for assessment Questionnaires and rating scales Advantages Mental health nursing assessment 2 Provide quantifiable measure of the problem Can make comparisons between people, or for the same person over time e.g. to identify improvement/deterioration Theoretical basis of measures enables understanding of what is happening Disadvantages Structure can be experienced as preventing the nurse from responding flexibly as would occur in more conversational format Structure might not fit the experience precisely Some people don't like written format Observations Observe: How the person presents in interview - General observation of behaviours during period of impatient assessment Behaviour in family meetings or in groups Rarely objective; usually written up as evaluations/judgements Formal observations of those who are 'at risk' as part of their management Can provide alternative or objective perspectives Can help with wider picture - especially if include family and other professionals Can highlight tensions between staff and patient perspectives eg re the scale of the problem Can be experienced as exercise of power eg of staff or family over the person with mental health problems The importance of narrative Mental health nursing assessment Narratives allow people to Tell their story in their language Emphasise what is important to them Bring a range of past and present events together in a way that shows the listener how they have made sense of the connections between these Taking a history is therefore very important Interpreting the evidence Interpretation is key to understanding what the evidence means in respect to what the person might be experiencing or need Theories and conceptual frameworks provide us with an understanding of how things link to each other and are central to the meaning we reach the following assessment process For instance, if we conceptualise mental health problems as being located within the body as a biological phenomenon, then we will focus more on the experience and frequency of the symptoms than on the person's social network because the symptoms have more explanatory power in this model. This would equally lead to a particular treatment plan focused on medication and symptom control. However, if we draw on a psychosocial conceptual framework we will focus our attention on the interplay between the person's social network and relationships and their psychological experience, in our assessment and subsequent planning What influences our interpretation Our own cultural context We view things from within particular social and cultural positions in relation Mental health nursing assessment to gender, race, class, religion and so on Western or eastern belief systems - What is normal? Previous experience personal and professional Theoretical understandings and perspectives Cultural context of the service we are working in Care planning Care planning is a process that follows the nursing assessment conducted with the individual. The purpose of the care plan is to set out the care that will meet the needs identified in the assessment. If using a biopsychosocial model then the care plan would identify actions to support needs identified in each of these areas. For instance, the care plan might include activities aimed at increasing the person's sense of social connection by encouraging engagement with volunteering, education or community based groups. There might be referral to relevant psychological therapies, and medication management may also be part of the care plan (while the nurse would not be prescribing they play a role in monitoring adherence, side effects, educating about medication). The care plan should be constructed in partnership with the service user and should also involve, within the constraints of the service user's consent, any carers. Carers are generally very knowledgeable about the person they care for and can provide invaluable information during assessment. They are also often a key support for the person whilst living in the community and so it is important that they understand the formal care provision that is planned, as well as any medication including side effects. Watch this short video on involving carers in. care planning. The film describes one of the key barriers to carer involvement in care planning as confidentiality. What do you understand about your duty in relation to confidentiality? Reflecting on the scenario you have been working with, think about how you might include any carers in your assessment or care planning whilst continuing to respect patient confidentiality. As part of the assessment the level of risk posed by the individual to themselves via self-harm or self-neglect and others should have been assessed. A risk management plan may form part of the care plan. If the person is in crisis, or Mental health nursing assessment 5 experiences regular crisis, then there might also be a need for a crisis management plan. A person might also want to develop a Wellness Recovery Action Plan. This is a form of plan that is developed by the service user with support from others to enable them to identify common patterns in their mental health journey and therefore identify triggers to deterioration, as well as identifying what works in a crisis and to keep themselves well. This approach is recovery focused and was developed in the late 1990s. Mental state examinations The mental state examination (MSE) is a structured way of observing and describing a patient's current state of mind. This should not be confused with a MMSE (Mini-mental state examination), which is a formal assessment of cognition. It is meant to be an objective impression of mental functioning at a certain point in time. It is therefore a 'snapshot' of a patient's presentation during interview, assessment or interaction. As it is a snapshot and time-specific, someone's MSE may fluctuate from hour to hour. This would often be the case in someone with delirium. MSE is conducted at same time as other assessments and documented at the end either alongside a formal assessment or in a patient's progress notes. An MSE allows us to noting patient's own description of significant symptoms or experiences word for word While once considered the domain of medicine only, increasingly a variety of professionals are expected to be competent in documenting an accurate mental state examination (MSE) as part of their professional role. This is not expected of you. For your programme and stage of education, you should have a basic understanding of what it is, its various components and some of the vocabulary used to describe signs and symptoms. This often requires us to use a particular set of vocabulary that can seem jarring and complex. The MSE is structured under the following domains or headings; appearance behaviour mood & affect Mental health nursing assessment speech thought (process & content) perception cognition insight and judgement