Assessment of a depressed patient in at a keen level of mental illness could perhaps be one of the most significant jobs that a registered mental health nurse should deals within their vocation. The significance of achieving the accurate information at this decisive level presents the little scope for mis-acquisition. Sullivan (1990) evidently appraises that the outcomes of a deprived appraisal or misapprehension of a patient appearance can guide to a patient not accepting the treatment they required at a significant level through to the ratio of a casualty due to non admittance to mental health examination. With this information in mind, it becomes crucial that the mental health nurse is proficient in conducting an assessment. The skill of identifying and reporting the most in depth account of the presenting facts, for continual involvement of the multi disciplinary team, and initialization of the care plan and care pathway program, remains the benchmark for a true professional (Lancester, 2000).
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This account reflects on such practice whilst witnessing an assessment at an acute unit. It will, analyses and reflect on the skills used to assess the bio-psycho-social needs of the patient and will include references gained from extensive reading to clarify evidence based practice and draw also from the academic study related to the subject of assessment. In compliance with the Nursing and Midwifery Council, code of conduct, (2002), Relating to client confidentiality, the names and locations of people involved to have been changed, and for the purpose of this account the client will be called Mary.
The Gibbs model (1988), exclusively presented by Jasper M (2003), as a reflection paradigm as it gives the author an opportunity to make a well-organized report of the scenario, and viably provides that true reflection in practice has occurred during its research. Mary is a 58-year-old woman that presented herself to the acute unit, after an incident of self-harming due to depression (diagnosed from 10 years). He had informed the admitting nurse that she is not taking any food and does not talking with anyone for any reason, even she would take off her incontance pads, and they would be thrown on the floor and she would scratch and legs until they were black and blue. It can arguably be stated that there are two major type i.e. major depressive disorder and dysthymiac disorder.
Major depressive disorder, also known as major depression, is distinguished by a blend of indications that interfere with a person’s capability of eat, sleep, work, study, and enjoy once-pleasing behaviors. Major depression is hindering and thwarting a person from operating general purpose activities. An affair of major depression may take place only once in a person’s aeons, but more usually, it persists all the way to a life of a person.
Dysthymic disorder, is also known as dysthymia, is distinguished by long-term (two years or longer) but less harsh indications that may not hinder a person but can thwart one from acting usual or working well as the patient in the study have stopped eating and does not responding to her day to day activities. People with dysthymia may also practice one or more affairs of major depression within their lifetimes.
While working on Mary’s condition, I found that she only reacts in her necessities, but the method to attain attention is very awful. She would lash out with the doctors and other staff of the medical unit and sometimes gave them a stern response in their assessment job. Assessment can be described as the evaluation of the client’s biological psychological and sociological needs. However, most importantly it must be the detailed and precise record of what happened and what answers were given to often very structured form of psychological questioning. Thompson and Mathias (2000) similarly describe the process as acquiring information about a person or situation that may include a description of the person’s wants and ambitions.
If we talk about the general issues causing of depression, we cannot find a single issue reasoning of depression. Sometimes, it probably results from a dissimilar interaction of biochemical, genetic, psychological and environmental issues. Mary was undergoing with some of the mentioned factors, which motivates her to this level of depression.
Different school of thoughts specifies that depressive illnesses are disorders of the mental issues. Brain-imaging tools, for example, magnetic resonance imaging (MRI), have reveled that the brains of people who have depression look special than those of people without depression. The divisions of the brain liable for changeable thinking, mood, sleep, appetite and activates materialized to work unusually. Additionally, appropriate neurotransmitters, compounds that brain cells utilize to converse, emerges to be out of equilibrium in life. However, these illusions do not provide why the depression has been raised.
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Most of the forms of depression tend to run in families, signifying a genetic connection. Tsuang (1990) describes though, depression can arise in people without family background of depression in addition. Genetics research specifies that jeopardy for depression outcomes from the pressure of multiple genes performing together with ecological or other aspects (Tsuang, 2004).
Additionally, trauma, loss of a loved persons a hard connection, or any traumatic condition may motivate a depressive affair. Subsequent depressive affairs may happen with or without an apparent motivation factor. In the case of Mary the occurrence of depression is from another factor. She does not find a caring deal from her ancestors and fall into depression. This thing led her towards the uncommon behavior with other people surrounding to her. She found her as a lonely soul and always treats everyone as a devilish person. After having good care from the staff members and nurses in the unit, she is now turning back to life, and now she reacts to content her necessities (Beaglehole, 2000).
The process of maintaining eye contact was further used to examine his ability to do the same. Nelson Jones, (2002) mentions that the inability of patients to maintain pro longed eye contact would indicate he may be in a withdrawn state or feels uncomfortable in his condition. Barker (1997) further stated that being over enthusiastic about eye contact could cause an aggressive or confrontational experience. The use of this method was appropriate as the assessment progressed. The nurse tried summarized the interview in a clear language that Mary could understand, but as she is not communicating in any way the nurse phrased the report on the previous assumption. She further gained his acknowledgement that her interpretation was a true reflection of his feelings and thoughts at this time, and afterwards the nurse guided to take Mary to nursing home, that will be good for her to necessities more than this unit. Nelson-Jones (2002) said that this process gives the patient a clear feeling of acknowledgement by another of their deepest feelings while aiding the recovery process.
The skills used in Mental Health assessments have been identified and discussed in this paper and it emphasis the use of a holistic approach at all times in the work of the Mental Health Nurse. One size does not fit all in the profession of Mental Health Nursing and although many tools and strategies are used throughout the process the skill of treating each person as an individual, with their own set of needs and concerns should remain paramount at all times. The assessment witnessed demonstrated that combining these skills promote a good rapport with the patient and most importantly getting a full picture that can be interpreted and shared with the multi disciplinary team for the onward process of the care pathway approach.
I have learnt that being non-judgemental and assessing the current situation at presentation is a key attribute in the skill of assessment. It becomes difficult when the client does not respond or react of any query or conduction, likewise, in the case of Mary. I have further reflected that it becomes necessary sometimes to help a patient with a question by the use of inter personal skills and effective non-verbal stimuli in order to allow them to express their feeling, sometimes at a rather difficult stage in their life. It is only by academic research and observed practice based experience that I will be able to develop these skills. I have further learnt that people in crisis need continual assistance and support through their acute phase. The first experience of the initial assessment has a large bearing on the way and the time it takes them to make improvements in their health.
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