The Clinical Assessment Process in the Psychiatric Practice - Assignment Example

This assignment will discuss the use of an assessment tool and the evaluation of its efficacy. It will provide the rationale for choosing it and it will describe the profile of the client chosen in the practice placement. A quality assessment is the cornerstone of an effective intervention, indicating the direction for treatment at the point of contact and a baseline to judge the effects of those interventions (Gamble & Brennan 2000) working with a serious mental illness. The purpose of the MMSE is to obtain a comprehensive cross sectional description of the patient’s mental state, which, when combined with the biographical and historical information from a psychiatric point of view, allows the clinician to make an accurate diagnosis and formulation (required for coherent treatment) mental health nurse.co.uk To meet the client’s needs, the nursing process must involve a holistic and an individualised approach to treat and to care for the client experiencing the mental distress (Baker 2003). According to Baker (2004) the assessment is the process of decision making based on the collection of relevant information that uses criteria to contribute to an overall estimation of the person and his or her circumstances. The assessment of an individual’s care, needs to be done in a holistic manner. The holistic assessment approach to care in mental health nursing does not only take into consideration the mental health needs of a patient but also the physical, social, and spiritual need (Beck et al 1988). The MMSE is an important part of the clinical assessment process in the psychiatric practice. It is a structured way of observing and describing a patient’s current state of mind, under the domain of appearance, attitude, behaviour, mood, speech, thought process, thought content, perception, cognition insight, and judgement. (http://en.wikipedia.org/wiki/mentalstate.examination) The assignment will emphasise the role of other health care professionals, carers, and family members. It will identify the strengths and weaknesses. It will also discuss the outcomes of the assessment and highlight the service user’s needs in relationship to future planning care. The conclusion will be based on knowledge and experience while using the assessment tool. For reasons of confidentiality and in line with the nursing and midwifery (NMC) code of conduct (2008) and the NMC guide for students of nursing and midwifery (2008) the client will be referred to as Mrs. Knight throughout this essay. For Mrs. Knight´s assessment, the minimental state examination tool was used. The MMSE tool was used because it is a tool that is frequently used in all elderly patients during a visit (whether or not another tool is used). It is the ideal instrument for screening the cognitive functioning of elderly patients (www.patient.co.uk) The setting is a practice placement with a community mental health team for the elderly, consisting of: psychiatrists; community psychiatry nurses; social workers; outreach support workers; team secretaries; specialists in clinical psychology; and, student nurses. The aim of the team is to provide an ongoing outreach support for the elderly with different mental illnesses, such as: dementia, depression, and schizophrenia. Some of these patients are in residential care, nursing homes, sheltered accommodations, and in their respective homes. Most mental health patients are in the community and they are often anxious and alone. Their needs are many but they receive very little treatment and attention compared to the general population. The elderly patients mostly depend on their children or other relatives as care givers. Mrs. Knight is an 85 year old female, diagnosed with a mild cognitive impairment and she lives on her own. She is a widow with two daughters who are extremely supportive. She was born and grew up on the Isle of Man. She was trained as a nurse and midwife and worked as a colonial nursing sister in West Africa. She had a very happy marriage before her husband passed away in 1979. Mrs. Knight smokes twenty cigarettes a day and she does not drink alcohol. She has no past history of mental illness or dementia. Mrs. Knight´s referral came through her General Practitioner (GP). In her letter, she reported that Mrs. Knight had been complaining of poor balance, loss of confidence, and also fed up with her poor short memory. She further wrote that she found it difficult to establish if her symptoms were dementia oriented or associated with depression. Her episode of dementia is accompanied with extreme verbal and physical aggressions towards her daughters and relatives. She stated that Mrs. Knight did not have any suicidal ideas or intentions. Mrs. Knight´s recent situation was discussed at the referral meeting. Having been known and assessed by the team members before, it was decided that she should be assessed again to know the severity of her dementia. It is also used to monitor Mrs. Knight´s progress as recommended in the Nice Guidelines. This assessment lasts less than15 minutes, although sometimes the assessment depends on the person being assessed. The assessment tool consists of 30 question items that total a score of 30 points. There are 7 dimensions used in the scale. They include an orientation for time, 5 points, an orientation for place 5 points, a registration 3 points, attention and calculation 5 points, a recall 3 points, language 8 points, and visual construction 1 point (reference). A score between 28 and 30 is considered normal, between 26 and 28 reveals signs of pre-dementia or mild cognitive impairment, between 20 and 26 is mild dementia, between 10 and 20 is moderate dementia, and less than 10 is severe dementia (Atkin 2008; p. 66). Mrs. Knight has been assessed with MMSE in the past, with a score of 25/30 losing 2 points in orientation in time and 3 points on recall. Her report says she was not able to name the prime minister and was unaware to identify current affair issues. There were doubts if the scores were accurate. It has been argued that sometimes the health care professionals cannot rely on the MMSE score alone and will use another assessment. Mrs. Knight is a lady of high intellect, which probably makes her preserve MMSE scores. Before administering the MMSE it is important to seek consent, make the patient comfortable, and establish a rapport with the patient (Folstein 1975). Essentially, all nursing actions invade a person’s privacy, and although most of these actions are considered necessary, and consent is given implicitly, it should not be taken for granted (Edwards 20??) While assessing, this nurse had an initial meeting to observe how Mrs. Knight communicated and identified her needs. Prior to the meeting, the mentor informed Mrs. Knight that a student nurse would be carrying out the assessment of her needs and would be supervised. Present at the meeting were Mrs. Knight, one of her daughters, and this nurse´s mentor who is the care coordinator. She seemed to have good self care and was cooperative. Her speech was spontaneous but repetitive. She seemed well and was able to express herself although she was embarrassed of not being able to find the right words or losing her trend of thought. She was not depressed and there were no strange behaviour, given her MMS score of 10/30 losing 4 points in orientation in time, month, and date, 3 points on recall, and 5 points on attention and calculation. It could not be determined if it was this nurse´s nerves that were getting in the way or the lack of interest that Mrs. Knight exhibited during the assessment. She was focused in telling her stories about her nursing days in West Africa. With the aid of the assessment tool and all the necessary intervention skills, the results showed the extent of her dementia as severe. According to the NICE Guidelines on anti dementia drug, the drug should be stopped if the MMSE scores fall below 10 points www.nice Mrs. Knight´s daughter became distressed by the fact that her mother could remember things that happened 40 years ago and could not remember recent events. This nurse felt obliged to talk to Mrs. Knight´s daughter and explain her findings. Parts of the Nice Guidelines encourage good communication between the care provider and people with dementia and family members. It is essential that people with dementia receive the information and support they require (Nice Guidelines). This was followed up by Rydon (2003) in a descriptive study. She/He stated that there are specific skills and knowledge that are important to a mental health nurse who is assessing and planning the care of patients. These skills are necessary to assure that assessments are done in a way that will meet the patient’s overall needs and improve the outcomes. The doctor cannot rely on the MMSE score alone. To ensure an accurate diagnosis, the GP normally does a general check up on the patient, such as, a full blood test to test general health and obtain a range of disorder or infection. Blood glucose tests, check the patient´s blood glucose levels for diabetes. The urine analysis is used to diagnose diabetes or kidney problems (www.nhs.uk.pathway). Read More