Assessment and Decision Making in Mental Health Nursing

Sandra Walker, Diane Carpenter, Yvonne Middlewick

• Publisher: Learning Matters
• Year: 2013
• Print ISBN: 9781446268209, 9781446268193
• eBook ISBN: 9781446293775
• Edition: 1
• Topic: Medicine
• Subtopic: Psychiatry & Mental Health

Assessment is an essential part of mental-health nursing and as such a core learning requirement for pre-registration nursing students. Getting assessment right is essential for the nursing student in order for them to become an effective practitioner. Many books on assessment are very theoretical. This is a practical, hands-on guide to the assessment process, underpinned by the latest evidence. The book explains the core principles through running case studies, so that readers can see how each decision they make impacts on the person in their care.

Key features:

• Assessment principles are applied across a variety of modern nursing settings that you may find yourself working in as a registered nurse
• Each chapter is linked to the relevant NMC standards and Essential Skills Clusters so you know you are meeting the professional requirements
• Activities throughout help you to think critically and develop essential graduate skills.

 

 

Chapter 1

Introduction to assessment principles

Sandra Walker and Diane Carpenter

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NMC Standards for Pre-registration Nursing Education

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This chapter will address the following competencies:

Domain 1: Professional values

5.	All nurses must fully understand the nurse’s various roles, responsibilities and functions, and adapt their practice to meet the changing needs of people, groups, communities and populations.

Domain 2: Communication and interpersonal skills

1.	All nurses must build partnerships and therapeutic relationships through safe, effective and non-discriminatory communication. They must take account of individual differences, capabilities and needs.

Domain 3: Nursing practice and decision-making

3.	All nurses must carry out comprehensive, systematic nursing assessments that take account of relevant physical, social, cultural, psychological, spiritual, genetic and environmental factors, in partnership with service users and others through interaction, observation and measurement.
3.1	Mental health nurses must be able to apply their knowledge and skills in a range of evidence-based individual and group psychological and psychosocial interventions, to carry out systematic needs assessments, develop case formulations and negotiate goals.

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NMC Essential Skills Clusters

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This chapter will address the following ESCs:

Cluster: Organisational aspects of care

9.

People can trust the newly registered graduate nurse to treat them as partners and work with them to make a holistic and systematic assessment of their needs; to develop a personalised plan that is based on mutual understanding and respect for their individual situation promoting health and well-being, minimising risk of harm and promoting their safety at all times.

By entry to the register:

12.	In partnership with the person, their carers and their families, makes a holistic, person centred and systematic assessment of physical, emotional, psychological, social, cultural and spiritual needs, including risk, and together, develops a comprehensive personalised plan of nursing care.

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Chapter aims

By the end of this chapter you should be able to:

• define assessment in mental health nursing;
• begin to understand the process of assessment in mental health nursing;
• begin to demonstrate an awareness of your own preconceptions and how these might impact on the assessment process;
• list basic principles that apply to the assessment process;
• understand the purpose of assessment in mental health practice.

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Introduction

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Case study

Barbara is a 60-year-old woman who was admitted to an emergency department following a large paracetamol overdose. A practitioner from the resident mental health liaison team carried out a mental health assessment once it was clear that Barbara was in no physical danger from her overdose.

The practitioner took Barbara to a private room and asked questions about the situation that had led to the overdose, the intention of her actions, her mental state, and her social situation and risk. During the assessment Barbara showed no signs of mental ill health and described no symptoms. She explained that she had a new job where her boss had expected her to take a computing exam that terrified her and that, rather than talking to her boss, she took the overdose. She regretted what she had done and no longer felt suicidal.

The assessment took about 45 minutes and the practitioner and Barbara worked together to make an action plan so that Barbara could address the issues that had led to the overdose in the first place. These included practising being more assertive so that she could explain the situation to her boss should it recur. Barbara did not require any formal follow-up from mental health services but her GP was informed.

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The mental health (MH) assessment is a very important aspect of mental healthcare. It is essential in allowing us, as healthcare providers, to find out what people need. Care plans, treatment delivery and services are all based around patient need, and assessment is one of the primary ways we have to help us decide what people need. Getting this process right is extremely important and learning to carry out assessments is something you will need to do as mental health student nurses. If the practitioner had not assessed Barbara in the case study above, the outcome could have been very different; perhaps assumptions may have been made regarding her risk, which could have led to her being admitted to a psychiatric unit for further assessment and which would have been a costly and unnecessary course of action, as well as distressing for Barbara.

The purpose of this chapter is to introduce you to the principles, practicalities and purpose of an MH assessment. You will begin to explore your own assumptions and preconceived ideas about other people and how these impact on the assessment process. The reasons for assessment will become clear and you will be able to relate the theory directly to your practice through the activities and case studies.

The chapter will first look at assessment in general terms, then at assessment as part of the mental health nursing process along with the purpose of assessment in mental health settings. We will consider the practical aspects of carrying out an assessment, look at when and why we might assess and think about informal and formal assessment in mental health.

What is assessment and how does it fit in the nursing process?

On a day-to-day basis we regularly assess for risks, opportunities and gains. We look both ways before crossing the road and assess the speed of oncoming traffic, weighing up the likelihood of being knocked down if we step into the road, before deciding to cross; we assess the likelihood of a positive response before asking someone out on a date; we assess the likelihood of food poisoning before ordering fish from the menu; we assess the likelihood of someone bursting into tears before asking them if they feel OK. In all these cases we consider past experiences, the current situation, the history of the case and available information, and then predict outcomes before deciding on the action most likely to lead to the desired outcome. These ‘assessments’ may take place in a split second, perhaps without our being aware that we are actually undertaking such a process at all.

When we make an assessment in mental health nursing, however, it requires a conscious and deliberate approach. So it is helpful to consider what assessment actually means, especially within mental health nursing.

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Activity 1.1

Reflection

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• Spend a few minutes thinking about what assessment means for you.
• Write a short definition.

Consider your answers in light of the discussion below.

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The Penguin English Dictionary defines ‘assessment’ as:

1.	Determine the rate or amount of.
2.	To make an official valuation of.
3.	To estimate the quality or worth of, to evaluate.

Oxford Dictionaries Online define ‘assessment’ as the action of assessing someone or something and ‘assess’ as:

1.	Evaluate or estimate the nature, ability or quality of.
2.	Calculate or estimate the price or value of.
3.	Set the value of a tax, fine etc. for (a person or property) at a specified level.

How closely does this match your definition of assessment in Activity 1.1; and how does this compare to assessment in mental health nursing?

Barker (2004) defines assessment as:

The 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.

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Activity 1.2

Critical thinking

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• Consider the above definitions and apply them to Barbara in the first case study. Note down any conflicts you might see.

Consider your answer in light of the discussion below. An outline answer is also provided at the end of the chapter.

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The practitioner assessing Barbara would have asked questions to find out if she had been suicidal and if she still had any suicidal intent. From the answer to these questions the practitioner would have been able to estimate the risk of Barbara taking another overdos...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Contents
• Foreword
• About the authors
• Acknowledgements
• Introduction
• 1 Introduction to assessment principles
• 2 Engaging the person
• 3 Types of assessment
• 4 Challenges to assessment
• 5 Principles of decision making
• 6 Outcomes of assessment
• 7 Consequences of assessment
• References
• Index