Assessment in the Mental Health Setting - Essay Example

?ASSESSMENT IN THE MENTAL HEALTH SETTING Assessment in the Mental Health Setting Introduction Assessment is an important part of health care. For most health care professionals, their practice starts with assessment; the quality and effectiveness of their practice also often depends on an accurate and efficient assessment process. Assessment is the first stage of the nursing process and begins with the collection of information about a patient (Hinchliff et al, 2003). In a broad sense, assessment is the foundation of nursing care and is a continuous process that nurses apply in their delivery of care (Ryrie and Norman 2010). Barker (2004) also identifies assessment as an estimation of a person’s character, and as a “decision making process based upon the collection of relevant information, using a formal set of ethical criteria, that contributes to an overall estimation of a person and his circumstances”. However it has been suggested that mental health nursing profession should integrate the broad principles of recovery approach into every aspect of nursing practice including that of assessment (DH 2006). Furthermore, a number of standardised assessment tools has been developed to support nurses further in fulfilling their professional task in clinical measurement and also in providing “a general outline or the presentation of the person at a particular point in time” (Barker 2004). This essay will now identify, using evidence-based practice, a formal assessment tool used in the assessment of a patient in an acute inpatient assessment ward during a recent clinical placement. Relevant references will be cited to support statements and conclusions; appendices will also be provided to give a sample of the assessment tool used during the placement. In accordance with the Nursing & Midwifery Council’s Code of Professional Conduct (2002) guidelines, certain parts of this original essay such as the patient history will be omitted to maintain confidentiality and protect anonymity. The setting is an acute inpatient ward and a mixed gender unit. It provides a safe environment for assessment, treatment and therapeutic work helping to secure the full spectrum of mental health conditions designed to promote recovery as stated by the Department Of Health (2006). In this essay, I will pay attention to the use of the assessment instrument: Becks Depression Inventory (BDI). This inventory is basically composed of a series of queries conceptualized to measure the intensity and severity of patients with a diagnosis of mental health disorders (Polgar, 2003). The long form covers 21 questions which are meant to evaluate a specific symptom manifest among people with depression. The shorter form is composed of seven questions and is meant to be carried out by primary care givers (Polgar, 2003). This assessment tool was originally meant to evaluate and monitor depression among patients in the mental health setting and is now widely used as a measure and evaluation tool for patients with potentially depressed symptoms. I am fully aware of ethical issues on consent and so I gained a valid and informed consent of the patient in accordance with the NMC provisions (2002, section 3). The patient was made aware that this work would be confidential (NMC, 2002, section 5). To protect her identity, she will be referred to as Helen in this paper. Helen is 65 years old and was diagnosed with bipolar disorder. She is currently in the acute mixed gender ward for assessment and treatment. For the past several years she has been admitted on and off into the ward similarly for depressed symptoms, and sometimes for manic symptoms. Rationale in selecting one type of assessment tool Using one type of assessment tool is crucial to the delivery of nursing care. The single assessment process applied to the patient helps to ensure that “older people’s needs are accurately assessed without needless duplication across different agencies” (Hall, 2006, p. 255). Choosing one assessment process helps ensure the patient receives appropriate, effective, and timely health interventions; and that the patients themselves would also be involved in the assessment process – in expressing their preferences and concerns in relation to their condition. Using only one assessment tool, as opposed to multiple tools prevents duplication and waste (Hall, 2006, p. 256). It can also avoid times when patient would be bounced from one health professional to another in the application of several assessment tools. Moreover, using one process is an advantage in the care process – and “patients do not have to continually answer the same questions asked by different health and social care professionals, unless there is a valid reason for asking questions again” (Hall, 2006, p. 255). In effect, using one assessment tool is more beneficial for both the patient and the health provider, bringing about a patient-centred approach to care. Evidence based practice is after all very much based on what would benefit the patient – based on his preferences and personal circumstances. Assessment process During the application of Beck’s depression inventory (BDI) on Helen, the long form was first applied. This form included 21 questions with four possible answers. Each answer was then given a score from zero to three based on severity of symptoms. As a primary care provider, a version of the inventory included seven self-reported items which relate to the symptom of major depressive disorder spanning the period of over two weeks. The individual questions included in the BDI were meant to evaluate the patient’s mood, pessimism, sense of failure, guilt, suicidal ideation, irritability, social withdrawal, fatigue, weight loss, and loss of libido, among others. The first thirteen items evaluated the psychological nature of the patient, and items 14 to 21 evaluated the physiological aspects. After the test, the sum of the BDI scores was totalled and such scores were used to measure the severity of the patient’s depression. Since the patient already has a history of depression, owing to her bipolar disorder, the test was scored differently for her. For clinically depressed individuals, those scoring from 0 to 9 are considered to be in the minimal depressive state; for those scoring 10 to 16, they were deemed to be mildly depressed; for those scoring 17 to 29, they were considered to be moderately depressed, and for those scoring 30 to 63, they were considered to be severely depressed. After applying the scoring system for Helen, her total scores manifested at 31, making her severely depressed. The BDI was also used to assess the family and her caregivers. A similar process and test was applied to the family members and her caregivers and the scoring was based on cut-off score of 10 indicating mild depression; 11 to 16 for mild to moderate, 20 for moderate to severe and 30 reflecting severe symptoms among the patient’s family (Rivera, 2009, p. 195). For families who are unable to cope with the daily challenges of caring for the patient and of interacting with their depressed family member, they often also manifest depressed symptoms. Based on the BDI as applied to this family, Helen’s primary caregiver, who is also her youngest 22 year old daughter, is also depressed. She scored 12 in the BDI scale which translates to moderate depression. Helen’s sister who also is her part-time caregiver is also depressed, scoring 9 on the BDI scale; this translates to mild depression. Her other family members are not depressed and are not manifesting any symptoms of depression. They are however anxious about Helen’s condition. And this is a normal and expected feeling in this case. The multidisciplinary team was used in the assessment process through the utilization of their expertise and knowledge in relation to the patient’s mental and physiological health. “The assessment form was designed by the team as a whole and allows the assessing practitioner to represent the different multidisciplinary perspectives” (Carl, Layzell, and Christensen, 2007, p. 147). The multidisciplinary team also met regularly in order to discuss the patient’s problems and to coordinate treatment plans (Noffsinger, 2009, p. 320). Regular meetings resolved staff conflicts and discussed the specific assessment from each health professional. Multidisciplinary teams help ensure that the assessment process is comprehensive and accurate; it helps ensure that the perspectives taken in the patient represents accurate details for eventual accurate interpretation. Outcomes of the assessment Based on the assessment, Helen is considered to be in the depressive phase of her bipolar disorder. Based on the BDI, she is severely depressed. She therefore needs to undergo extensive cognitive behavioural therapy and antidepressant medication intervention. She needs to undergo extensive cognitive behavioural therapy or CBT. CBT is a combination of the cognitive and behavioural therapies (Patient.uk, 2011). These therapies are often combined with each other because people’s behaviour is often a reflection of how we think about certain situations. The emphasis on the cognitive and the behavioural aspects of therapy can be different and it would largely depend on the mental issue being resolved. In some instances, there may be a need to focus on behavioural therapy when dealing with obsessive compulsive disorder because the issue is the repetitive ways of doing things (Patient.uk, 2011). In treating depression, experts often recommend a focus on the cognitive aspects of treatment. For Helen, this is also a prudent action because her depression stems from her thoughts and her cognitive processes. Kenny and Williams (2007, p. 617) highlight the importance of cognitive therapy among depressed patients. These authors point out how cognitive therapy can teach patients to disengage from the cognitive processes and thoughts which may cause them to be vulnerable to depression. Their study also revealed that for depressed patients undergoing cognitive therapy, they also manifested significant changes from depressed states to normal and near-normal levels of mood (Kenny and Williams, 2007, p. 617). The validity of the BDI was highlighted in the paper by Mystakidou (2007, p. 244) where the authors set out to evaluate the use of the scale among patients in a palliative care unit. The Hospital Anxiety Depression scale was administered alongside the BDI and other measures and variables including performance status. All in all significant correlations were seen between BDI and performance status, gender, and family status (Mystakidou, 2007, p. 244). In effect, the study proved the importance of using the BDI in evaluating depression in long-term care facilities. In the case of Helen, the BDI works well for her because it also measures the impact of repeated and prolonged admissions in long-term mental health facilities. The BDI assessment ensures that the range of her depression was assessed in line with her bipolar depression and with her admission into the mental health facility. The BDI is also an important consideration for assessing and evaluating depression in Helen’s case because assessing the severity of the depression can also help direct the type and level of intervention needed to address the depression. In a paper by Hesse, (2006, p. 417), the author sought to evaluate the stability and associations with ongoing drug use in patients under opiate treatment not abstaining from illicit drugs. The author was able to establish that there was a significant difference seen between intake score and follow-up score (Hesse, 2006, p. 417). BDI became a predictor of drug use severity and follow-up. For those manifesting higher severity in depression, they also showed higher levels of drug use. In the case of Helen, using the BDI is a useful assessment tool because it helped establish the degree of the patient’s need for therapy. Since, she is already in the more severe stages of depression, it is important for the health professionals to consider more aggressive interventions for depression. The future plan for her care must therefore be hinged on the results of the BDI. It gives the assessment process an orderly and academic basis for discussion and helps ensure that the patient’s care would be based on his personal needs and circumstances. Once again, this is the essence of evidence-based care. The BDI was also able to highlight the need to address her daughter’s and sister’s moderate and mild depression, respectively. It is important to address their mental health issues because their mental health often impacts on the patient’s progress in her treatment. In a paper by Morten, (2006, p. 417), the author set out to evaluate the prevalence of and to identify the different predictors of depression among family caregivers of cancer patients. The study covered about 310 caregivers with these caregivers being assessed for depression through the BDI. In the course of the study, the author was able to establish that most of the caregivers manifested high depression scores in the BDI, about 35% manifested very high levels of depression (Morten, 2006, p. 417). Moreover, the study also revealed that depression mostly manifested for women caregivers, for spouses of patients, for those in poor health, and for those who have poor adaptation skills. In effect, the author concluded that depression is highly likely among caregivers of cancer patients. Interventions to address depression must therefore be implemented, not just for the patients, but also for the caregivers. This study helps support the future plan of care conceptualized for Helen’s daughter and sister. Summary of the experience In applying the BDI as an assessment tool for this patient, I did not encounter much difficulty in assessing the patient and making an exact evaluation and analysis of the patient’s depression. I found out that using the BDI in evaluating the patient’s depression gave me a deeper and a more detailed picture of the patient’s mental health. The questions which were asked of the patient in the questionnaire gave me important insight into the patient’s mental state, how her daily activities were being impacted by her depression, and how her thought processes often affected her actions. The link between the cognitive and the behavioural became manifest through BDI. The BDI also gave me a chance to draw in more personal details from the patient – details which may not be present in other patients, but would have as much impact on the type and the quality of care planned and implemented in the patient’s behalf. The fact that the BDI can also apply to the patient’s caregiver is also an important benefit of the assessment tool. It also helps measure the impact of the patient’s condition on the caregivers – some may be deeply affected by it and may manifest with severe depression, and some others may not be as deeply affected by it and may manifest with no or with mild depression. Nevertheless, the BDI is an important tool in this assessment process because it allows for a dynamic testing process which can cover the patients and their caregivers – those who have had a history of mental health disorders, and those who have not been diagnosed at all for any mental disorder. The choice for the assessment of this patient – the use of BDI – was also beneficial in ensuring patient-centred or evidence-based care. There are currently various interventions which are available to the general population and to mental health patients. Through a patient-centred assessment process, patient-centred care can also be secured. Since the BDI provides specific circumstances which may be seen in some patients, and not seen in others, the interventions can be fashioned to fit the needs, the preferences, and the overall character of the patient. In the end, such type of care can help secure improved patient compliance in the treatment process. It can also help ensure a cooperative client, as well as a collaborative type of care. Works Cited Barker, P. (2004) Assessment in psychiatric and mental health nursing: in search of the whole person, London: Nelson Thornes Carr, E., Layzell, M., Christensen, M. (2007) Advancing Nursing Practice in Pain Management, London: Blackwell London Cognitive-behavioural Therapy (CBT) (2011) Patient.uk, viewed 21 January 2011 from http://www.patient.co.uk/health/Cognitive-Behaviour-Therapy-%28CBT%29.htm Department of Health (2006) Hall, J. (2006) Integrated Care Pathways in Mental Health, London: Elsevier Health Sciences Hesse, M. (2006) The Beck Depression Inventory in patients undergoing opiate agonist maintenance treatment, British Journal of Clinical Psychology, volume 45, number 3, pp. 417-425 Hinchliff S, Norman S, Schober J (1998), Nursing Practice and Health Care, 3rd edn, Arnold, London Kenny, M. & Williams, J. (2007) Treatment-resistant depressed patients show a good response to Mindfulness-based Cognitive Therapy, Behav Res Ther, volume 45, number 3, pp. 617–625. Mystakidou, K., Tsilika, E., Parpa, E., Smyrniotis, V., Galanos, A., & Vlahos, L. (2007) Beck Depression Inventory: exploring its psychometric properties in a palliative care population of advanced cancer patients, European Journal of Cancer Care, volume 16, number 3, pp. 244–250 Noffsinger, E. (2009) Running Group Visits in Your Practice, London: Springer Norman, I. & Ryrie, I (2004) The art and science of mental health nursing, London: McGraw-Hill International Nursing & Midwifery Council’s Code of Professional Conduct (2002), Code of Professional Conduct: Protecting the public through professional standards, London: London: NMC, sections 2-5 Polgar, M. (2011), Beck Depression Inventory, Encyclopaedia of Mental Disorders, viewed 20 January 2011 from http://www.minddisorders.com/A-Br/Beck-Depression-Inventory.html Rivera, H. (2009) Depression Symptoms in Cancer Caregivers: Depression Screening, Clin J Oncol Nurs, volume 13, number 2, pp. 195-202. Young Sun, R, Young Ho Yun, Sohee Park, Dong Ok Shin, Kwang Mi Lee, Han Jin Yoo, Jeong Hwa Kim, Soon Ok Kim, Ran Lee, Youn Ok Lee, & Nam Shin Kim (2008) Depression in Family Caregivers of Cancer Patients: The Feeling of Burden As a Predictor of Depression, Journal of Clinical Oncology, volume 26, number 36, pp. 5890-5895 Read More