Doctor puts wrong person on the mental health institution. Have you ever heard this kind of news? To be honest, I haven’t. But, it is not impossible happen in other chances. Let’s think about it seriously. How doctors decided to puts a person in to the mental health institution? Well, I have one answer about that in this article.
Maybe in our mind, we are just guessing many possible answers. One answers maybe about standard. Yes, doctors have their own standard to put someone on the mental health institution and the standard based on the deep observation and interview. We call it mental status examination. Not only doctors have their own examination but nurses have it also. The difference is only in the point of view. Nurses concentrate their examination on the bio-psych-socio-spiritual condition of their patient. In this article, we will concentrate in nurse’s mental status examination as my specialty.
Mental status examination is a cross section of patient’s psychological life and nurse’s observation or impression at one point in time. Nurse does the examination with describing patient behavior an objective and non-judgmental manner. The result of the examination will reflect the patient current state. So, the examination must be new and up to date. Past histories will be the history data and we cannot use it to show the patient condition now.
Categories of the mental status examination divided by five major point. They are general description, emotional state, experiences, thinking and sensorium moreover cognition. Every category will show nurses skill in content and process communication with patient. However, nurses should not neglect cultural factors which influence every patient in communication.
General description of the patient will show you appearance, speech, motor activity and interaction during interview. Nurses will discover this data from the first time patient come to the hospital or contact with nurses. Nurses should use all his/her senses to get this data. The senses like eyes, noses, ears and so on must be optimal in the data gathering.
Emotional state in examination show mood and affect from the patient. Mood reflects the patient’s life situation and emotional state. Nurses can get the information through asking the question like “How are you feeling today?”. Nevertheless, it is different with affect. Nurses only use his/her ability to observe and make the observation. For the example, the patient with flat affect will show no responds and interests in the interview.
Experiences will show from the perception of the patient. Perception indicates valuable thing such a sensory stimulus. The result will show the degree of perception like illusion or hallucination. Hallucination is defined as false sensory impression or experiences. Illusion is false responses to a sensory stimulus. Nurse will get this information by asking “Do you ever see or hear things? “. Sometime nurses will find the patient who has experience “hearing” things or “seeing” things that the people around them cannot hear or see. Nurses should take notes for this finding because it shows how damage the patient’s brain.
Next is Examine how the patient things about object show you content and process of the patient mind. You must give patient appropriate question which will show you the patient mind in one shoot of question yet you not challenge to correct patient believe at the sometime. Though content, refer to the “what” of the patient’s think moreover though process is “how” of the patient’s self-expression.
Sensorium and cognition of the patient can be examined by level of consciousness; memory; level of concentration and calculation; information and intelligence; judgement and insight. We begin with level of concentration and calculation. Concentration as we know is the ability to pay attention during the specific time. In this case is during an interview. However, calculation the person’s ability to do simple math. Nurses can ask the patient do the counting from 1 to 20 rapidly or do simple calculation, such as 2 x 3 or 3 + 4. Whereas, Information and intelligent is difficult to observe. Nurses cannot judge this by one side of opinion. Nurses should refer to what Gardner told about multiple intelligent. The nurse should assess the patient’s last grade of schooling completed, general knowledge, and use of vocabulary. Judgement will involve making decision that constructive and adaptive. Nurses will give a case or situation and next the patient must give the answer for the question. The questions will explore the patient’s involvement in activities, relationship and vocational choices. For the example, what would you do if you entered your house and smelled gas ?.The last is insight. It is the patient understanding of the nature of one’s problem or illness. For the example, one of the patients explains about his illness. He says that his illness worsen because of his wife, he cannot cure his illness if he is not solve his problem with his wife.
Finally, the nurses must gather all the data from the observation and interview. All the data will be categorized and next will be used for make a nursing diagnose. If the data is not complete, nurses should come back and take the data from the patient. Because if the data do not complete, the right diagnose will not appear and if the nurse make mistake about diagnose, patient will sacrifice for this. Therefore, even it is doctors or nurses should do right and appropriate examination for the patient before they decide what they must do with the patient. Doctors do not make diagnose only by his/her feeling nor nurses. Appropriate mental status examination will lead doctors and nurses to the right patient’s cure and care.