This study guide is about the importance of assessment in mental health nursing. Use it to create essays on the significance of assessment in psychiatric nursing.
Introduction to the Importance of Assessment in Mental Health Nursing Essay
The report will focus on a 54-year-old woman who is suffering from serious depression and will explore the necessity of assessment in Mental Health nursing. Depression, according to the Department of Health (DoH, 2010), is a mental illness characterized by poor mood, feelings of dissatisfaction, weariness, self-blame, and suicidal thoughts. The Health of the Nations Outcome Scales (HoNOS) evaluation scale will be discussed, as well as the rationale for utilizing it. The patient’s profile and the practice context will be explored briefly.
To safeguard the patient’s identity, the scale will be used on the patient, and the patient’s and hospital’s data will not be published, as per the Nursing and Midwifery Code of Conduct (NMC, 2008). As a result, the name used will be fictional. In connection to the patient’s future care planning requirements, the assessment process, as well as the engagement of the service user, family, and caregiver, and the input of the multi-professional team, will be highlighted. The advantages and disadvantages of the scale will be discussed. It will be prepared a summary of the interaction with the evaluation scale.
Definition of Assessment
What is assessment?
Wolters et al. define assessment as “the initial phase of the nursing process” (2010 p.36). She defined it as the process of gathering, organizing, assessing, and documenting details concerning a patient’s well-being, whereas Varcarolis (2011) defined it as an interview that evaluates a patient’s mental state. The National Institute for Clinical Excellence (NICE 2009) guidelines emphasize early access to psychological assessment and treatment for persons with mental health issues.
Importance of Assessment in Mental Health Nursing
Why are assessments significant in mental health?
Assessment is necessary because health care providers must be aware of the physical, social, psychological, and cultural aspects of the patient’s life, according to Wolters et al (2008). An assessment is performed to gather information in order to establish a complete history of the patient, identify issues, and provide a nursing diagnosis and appropriate treatment plan Varcarolis (2010 pp. 4-5).
The Department of Health (DoH) emphasized the need of doing an assessment since people with mental health issues may also have physical health issues, such as poor eating. Assessments facilitate evaluation for vital signs such as a urinary tract infection, temperature, weight, pulse, respiration, and blood pressure is essential (Harris, 2002).
Assessment is also significant because health care providers need to know about the patient’s intellectual performance: what they are thinking, their emotions, their values and beliefs, and most importantly, ‘what they could do next,’ such as commit suicide or self-harm ( Barker (2009p.) Any changes in the patient’s family relations or lifestyle may be revealed during an assessment.
The Health of the Nations Outcome Scales (HoNOS)
What is HoNOS mental health?
The HoNOS tool was initially published in 1996, and it is still being reviewed to enhance its validity (The Royal College of Psychiatrists 2000). The tool is made up of 12 items with a 5-point scale that are completed by experts in a matter of minutes after a patient’s assessment, admission, and discharge. The scale is divided into four sections, with 1 to 3 indicating behavior, 4 and 5 indicating impairment, 6 to 8 indicating severity of symptoms, and 9 to 12 indicating social functioning.
The scale rates many elements of mental health on a scale of 0 to 4, with 0 indicating “no issue,” 1 indicating “small problem requiring no action,” 2 indicating “mild problem but certainly present,” and 3 indicating “moderately severe problem.” The total score ranges from (0) being best to (48) being (worst) British Journal of Psychiatry 2002). 4 denotes serious to extremely severe issue, 9 implies the expert does not know, and the total score ranges from (0) being best to (48) being (worst).
The rationale for selecting this assessment tool is to enhance my experience as a student nurse and to gain a more in-depth understanding of this instrument’s application in this placement area, as well as its widespread use in mental health settings.
Case Study that will Illustrate the Importance of Assessment in Mental Health Nursing
Chichi is a 54-year-old lady who is divorced with two children whom she has little contact with. She was brought in by the police under section 136 which turned into section 3 of the mental health act (1983). Chichi has tried to commit suicide by drowning herself. She has a long history of suicide ideation influenced by her major depression and is known to the in-patient units and community mental health team.
Most medical interventions seem to have failed. Chichi was admitted early this year in an acute in-patient hospital which is a 23 bedded adult ward with single en-suite rooms for male and female patients aged between18-65 years. The service provides care for patients who are suffering from mental problems that need medium periods of in-patient care. The team is comprised of the ward matron, the manager, two deputy managers, nurses, support workers, psychiatric doctors, the community mental health team, and an administrator.
Analysis of the Case Study
The police had to supply all of the information on the patient’s suicidal attempt in order for the evaluation to be effective. As Varcarolis (2006, p 5) noted, as part of the evaluation, a ‘lot of information from the police had to be obtained,’ therefore a therapeutic connection was developed. The therapeutic connection between the nurse and the patient, according to Williams and Wilkins (2010), should be built on trust, reciprocating respect, expression of empathy, and power-sharing. To establish a strong connection with the patient, time was spent with him. Progress notes and earlier evaluations were used to read the patient’s notes.
The multidisciplinary team helped me learn more about the patient by exchanging information at handovers, ward rounds, and review meetings, where they reviewed the best interventions, zoning, and medicines for the patient. The home treatment team, social workers, and care coordinator were other members of the team that participated to the evaluation process because they were the professionals involved in the patient’s care prior to admission. Chichi didn’t want any of her relatives to become involved.
Before the interview, the evaluation was prepared and planned in order to stimulate future improvement in the working relationship. Agreement is a crucial aspect in all phases of care and treatment, according to the Department of Health (2010), thus verbal consent was obtained from the patient and the purpose for the interview was given to the patient. She was informed that she was under no obligation to participate in the interview and that her decision was solely her own.
The consent document was signed by the mentor who was present throughout the interview (Appendix A). A quiet room on the ward, distant from the ward’s noisy activity, was chosen. The room was set up to foster excellent eye contact, sitting, and having open posture, as well as maintaining a comfortable atmosphere to encourage the patient to relax and participate in the evaluation process. Egan is a character in the film Egan (1998). The patient was served a cup of tea and complimented on her appearance, which helped her feel more at ease.
To make the procedure easier, the questions were asked at random. Chichi was questioned about her mood. She delivered her speech with tears in her eyes and failed to establish eye contact. She expressed her desire to die, and the only thing keeping her from doing so was the anxiety of not knowing how her children would cope. Chichi’s feelings were mirrored back to her in order to demonstrate that the item understood her. Chichi confessed that losing contact with her children was one of the causes for her melancholy and suicide attempts when questioned about her social life. Riley (2008) defined communication as the ability to send and receive messages.
It was critical to recognize what needed to be said and to find the appropriate time to convey it. Despite her anguish, the patient was responsive to all of the queries. The fact that the questions were kept brief encouraged her to talk and provided excellent feedback. It was critical to ensure that the questions were received correctly since this allowed the patient to provide accurate replies.
Varcarolis (2010, p 24) stated that observing the patient’s ‘non-verbal cues’ can assist in determining which questions to ask in order to avoid upsetting the patient. The patient was comfortable and involved during the exam because of the therapeutic connection that had been developed. It took around twenty minutes to complete the evaluation. The patient was thanked for participating and asked if she had any questions.
Because of the gravity of her suicidal attempt, the patient received a 4 on question 2, which is classified as behavioural. Women with personality disorders self-harm, according to McRory (2007), and roughly 4% of these instances are among the top five causes of acute medical hospitalizations. Because she had no difficulties with violent or disruptive behavior, as well as drinking or taking illegal substances, the patient received a 0 on number 1 and number 3.
Scores of 4 on non-accidental self-injury, on the other hand, were extremely significant and necessitated action. The patient received a 4 on question 7, which was concerning her low mood, but she did not have any additional mental or behavioral issues like hallucinations or delusions. She was classified as seriously depressed after scoring 4 out of a possible 12 on symptomatic difficulties due to feelings of shame and self-blame stemming from her divorce from her husband and her children’s separation.
Because of the severity of her depression, the score suggested that therapies were required. The patient’s social difficulties were addressed in questions 9, 10, 11, and 12. The patient received a 2 on question 10, which was a small issue that will only require modest assistance from the team. The patient then scored a 2 on question 12 because she was concerned about losing her work and having nothing to do.
A future care plan and requirements were developed, which included one-on-one observations of a patient’s locations, behavior, and mood changes, as well as staff monitoring for feelings of hopelessness. Electroconvulsive treatment will be initiated since it has been shown to help people suffering from serious depression RNC (2010). A course of antidepressant medication will be initiated in order to improve the patient’s mood and to monitor her compliance, effects, and side effects of the drug, as well as to urge the patient to communicate with her children, family, and friends.
Advantages and Disadvantages of HoNOS
What are the advantages and disadvantages of using HoNOS?
The instrument has both benefits and drawbacks. The instrument was great since it focused on her current challenges, making it the best approach to quantify her disease. I found the tool to be subjective, and there are discrepancies since various health care providers create different findings within 24 hours of admission, for example, the Home Treatment Team’s results might differ from the ward nurse’s results within 24 hours of admission. The tool’s benefit was that it was simple for the team to complete in a matter of minutes.
Sukhwinder et al. (1999) noted that HoNOS had moderate to good inter-rater and test-retest reliability among adult mental health patients, but McGilloway et al. (2000) questioned the tool’s validity because their study showed low HoNOS scores despite significant levels of morbidity in their group. Malcolm et al. (2000) backed the instrument, claiming that their findings showed it to be sensitive to differences in sickness type and severity, as well as between patient admission and discharge.
The task has extended my thinking on how to use the HoNOS. I conducted an assessment that was comprehensive in nature, rather than focused just on the patient’s current ailment. The development of a therapeutic connection with Chichi has made me feel more at ease when doing the evaluation. I was worried before the assessment, but the interview went well thanks to the mentor’s help. I’d like to be more confident in doing evaluations and spend less time doing so. My mentor, on the other hand, boosted my confidence by stating that my communication abilities had improved.
Frequently Asked Questions (FAQs)
1. What is the meaning of mental depression?
Depression, according to the Department of Health (DoH, 2010), is a mental illness characterized by poor mood, feelings of dissatisfaction, weariness, self-blame, and suicidal thoughts.
2. What is assessment in mental health nursing?
Wolters et al. define assessment as “the initial phase of the nursing process” (2010 p.36). She defined it as the process of gathering, organizing, assessing, and documenting details concerning a patient’s well-being, whereas Varcarolis (2011) defined it as an interview that evaluates a patient’s mental state.
3. Why is assessment important in mental health?
Assessment is necessary because health care providers must be aware of the physical, social, psychological, and cultural aspects of the patient’s life, according to Wolters et al (2008). Assessment is also significant because health care providers need to know about the patient’s intellectual performance.
4. What does the HoNOS LD measure?
The HoNOS tool was initially published in 1996, and it is still being reviewed to enhance its validity (The Royal College of Psychiatrists 2000). The tool is made up of 12 items with a 5-point scale that are completed by experts in a matter of minutes after a patient’s assessment, admission, and discharge.
The scale is divided into four sections, with 1 to 3 indicating behavior, 4 and 5 indicating impairment, 6 to 8 indicating severity of symptoms, and 9 to 12 indicating social functioning. The scale rates many elements of mental health on a scale of 0 to 4, with 0 indicating “no issue,” 1 indicating “small problem requiring no action,” 2 indicating “mild problem but certainly present,” and 3 indicating “moderately severe problem.”