Thepurpose and process of mental status Exam.
Themental status examination is a representation of the generalpatient’s psychological life. It is very important in evaluatingthe neurological, medical or psychiatric disorder of any patientwhich affects their emotion, thought and behavior. It helps indetecting changes in the patient’s intellectual thought,functioning, mood, content, affect and judgement. It acts as thebasis for future comparisons in evaluating the progress of thepatient with time.
Theprocess of mental status examination involves several steps duringwhich the nurse covers different areas. The nurse behind with simplyobserving the patient such as their facial expressions or theirclothing. The nurse should also ask specific questions especiallythose related to attention span and memory. The information obtainedis used with the subjective and objective data collected concerningthe patient. This data is obtained through laboratory test results,physical examination, description of the presenting problem, patienthistory, information obtained from caregivers, family and healthprofessionals.
Thedifferences between content and process when conducting a MSE.
Whenconducting a mental status examination, process is used to define howthe patient communicates. This may include their intuition, feelingsand the behaviors which come with the thought and speech. Contentrefers to the information which is communicated. Sometimes, theprocess and the content may be different, for example, a patient maysay that they are not depressed or sad yet they appear to be sad oreven cry when talking.
Thecategories assessed in a MSE.
Thisincludes speech, appearance, interaction during interview and motoractivity.
Thisincludes mood and affect.
Thisincludes the thought process and content.
Sensorium and cognition.
Thisincludes the level of consciousness, the level of calculation andconcentration, memory, intelligence and information, insight andjudgement.
Twothought content descriptors which I did not know.
Thoughtbroadcasting.This is the situation where a person believes that their thoughts arebeing spread or broadcasted to the outside world. This brings fear tothe person since they feel that they are threatened.
Depersonalization.This is the situation where a person feels that they have lostself-identity and they are being surrounded strange, different orunreal things. This feeling makes people feel as if they are notthemselves.
Twothought process descriptors which I did not know.
Neologisms.This is the use of new words during speech or the use of words whichthe patient creates by blending other words. In most cases, the wordsare not sensible to other people thus the nurse or the personinterviewing the patient may not understand them.
Wordsalad.This is the use of series of words which are not related at all. Thisbrings misunderstanding since the person interviewing the patientcannot understand what is told.
Theuse of MSE.
Ihave not yet conducted an MSE. However, I a very sure that this MSEdescribed here will be very helpful when used. This is because itcovers all the areas of patient and thus it will be very easy todetermine the problem and the extent to which it has affected thepatient.
Culturalcompetency as it pertains to nursing.
Culturalcompetency can be defined as the ability of the nurse to view everypatient as a unique person, considering fully the culturalexperiences of the patient and within the common developmentalchallenges context which is faced by everyone and the general socialenvironment.
Stereotypingis a fixed image or idea that a certain group of people have acertain thing or condition which in most cases is never the reality.In the medical field, it is perceived that black Americans are theones who suffer most of the psychiatric disorders. They are alwaysshown to have most of the undesirable conditions.
Whyit is important to do a self-assessment before working with apatient.
Thishelps the nurse to know whether the judgement they make concerningthe patient are true or they are based on their own perception andstereotyping. Sometimes the nurse may view the patient negativelythus wrongly diagnosing the patient’s condition.
Socialstigma associated with mental illness as a barrier for treatment.
Someethnic minorities who are already facing problems of discriminationand prejudice due to their group affiliation mostly suffer doublestigma whenever they are having mental illnesses. Since they arealready treated as rejected part of the society, suffering frommental illnesses may make them not to be treated. Since they do notbenefit from the mental health services, in most cases they may notseek medical services and in case they do, some may not accept therecommended treatment plans.
Civilrights that a person with a mental illness still retains.
The right to have a driver’s license.
The right to vote.
The right to own, and if they wish, dispose their property.
The right to marry, and if they wish, divorce.
Thedifferent types of commitment to a mental health facility.
This patient may be admitted if one is dangerous to oneself or to others.
The patient can also be admitted against their wish if they are mentally ill or if they need treatment.
They can also be admitted if they are not able to provide their own basic needs.
Patientrefusal to treatment in a mental health facility?
Apatient is free to refuse treatment in a medical facility if thetreatment plan is not in line with their culture or wishes. Thepatient may refuse to be treated or admitted in that hospital if theydo not like it. This is however allowed if the patient is proved tobe in a stable condition if they are not dangerous to themselves andto others, if they can provide for themselves, and if they are not ina critical condition which requires urgent treatment.
Whencan and should restraints or seclusion be used?
Seclusionand restraints should be used when the patient is seriously ill andcannot control themselves. It is most useful if the patients can harmthemselves or others. It can also be used when the patient cannotmake their own decisions or they cannot make a good judgment onthemselves.
Differenttypes of restraints and seclusion methods.
There is movement restriction where the patients are locked in rooms to prevent them from moving if they can disappear if theft free. This may also involve immobilizing their hands and feet if they are very active to prevent them from harming themselves.
There is decision restrictions where decisions such as the food to eat are made for them by the care givers.
Restrictions from activities such as access to work.
Restriction from the treatment of choice.
Instanceswhere seclusion or restraints should not be used.
Thepatient should never be subjected to seclusion or restriction if theyare stable and they can make their own decisions. If they can makethe right choices on their own and they are not dangerous tothemselves and to others, they can be set free.
Thisis a civil wrong committed on someone and the person should becompensated for it. Some examples of tort law are sexual contact withthe patient and breach of confidentiality. The patient can sue thenurse for these injustices.
Examplesof malpractice by nurses in a mental health setting.
Failure to refer a patient when the nurses cannot handle the condition to a more specialized facility.
Failure to report abuse if they witness another healthcare officer abusing the patient but do not report the cases to the relevant authorities.
Failure for the nurse to warn of victims who are potential to abuse.
When nurses misuse the prescription for psychoactive drugs.
MHdisorders that are listed as the top according to the WHO.
Percentageof the USA that has a serious mental illness.
Reasonsfor mentally ill people obtaining treatment.
Thegreatest reason why people do no access treatment is due to the highcosts involved. To curb this problem, the government should reducethe treatment cost to make it affordable to the people. Most peoplealso do not seek treatment since they believe they can handle theproblem on their own. Such people should be advised to visit thehospital to avoid incompetent treatment. Other people do not knowwhere to seek treatment. The ministry of health should do adequatecampaigns to educate the public on the hospitals they can seektreatment.
Stuart,G. (2013). Principles and Practice of Psychiatric Nursing (10th ed.)St. Louis, MO: Elsevier.