Understanding of Patients

Understanding of Patients

Understanding of psychiatric patients is very important in mental health nursing. So a psychiatric and nursing assessment is necessary. A psychiatric assessment is a process of gathering information about a client from a person within a mental health service, with the purpose of making a diagnosis. The assessment is usually the first stage of a treatment process, but psychiatric assessments may also be used for various legal purposes.

Nursing process is defined as a systematic, continuous and dynamic method of providing care to clients.

Steps in Nursing Process

·  ASSESSMENT: collection of all the data that are adequate and relevant.

·  DIAGNOSIS: Analyzing the data and find out the diagnosis.

·  PLANNING: Developing a care plan according to the need of the client

·  IMPLEMENTATION: implementing the actions to restore the physical and mental health

·  EVALUATION: Evaluating the client’s response for nursing actions taken.

Methods of Assessment in Psychiatry

·  History taking

·  Mental status examination

·  Neurological examination

·  Physical examination

·  Laboratory investigations

·  Psychological tests

History Taking

History taking includes, patient’s identification data, presenting complaints, history of present illness, past history of medical, surgical, and psychiatric, family history,Personal history, birth history, developmental history, occupational history, marital history and personal habits.

Mental Status Examination

Mental status examination­ includes general appearance, behaviour, speech pattern, mood, delusion, changes in perception like hallucination and illusion. And also assessment of higher mental functions of consciousness, attention, concentration, memory, orientation, intelligence and insight about illness.

Neurological Examination

Neurological examination for cranial nerve functions to be assessed.

Physical Examination

Physical examination includes head to foot assessment of the client.

Laboratory Investigations

Suggested for all psychiatric admissions. Complete haemogram, blood chemistry, serology studies, thyroid functions test, HIV antibody, urine analysis, imaging studies like chest x-ray, CT / MRI and also EEG and ECG.

Psychological Test

Usually conducted by clinical psychologist.

Documentation

Assessment information is documented in the nursing registers

Moreover, documentation is recognized by legal authorities