Introduction
Within this essay, I will critically analyse an OSCE I undertook, which has increased my awareness, and challenged my understanding in assessing the holistic needs of a service user (John), referred by his GP, whilst incorporating a care plan using the Care Programme Approach (CPA). By utilising this programme and other sources of current literature, I hope to demonstrate my knowledge and understanding in relation to this skill as well as identifying areas with scope for learning.
Available Tools
There are many tools for assessing mental health needs of patients at pre- and post-intervention on various scales including Beck Depression Inventory (BDI), Spielberger State Trait Anxiety Inventory (STAI), Standardised Psychiatric Interview (SPI) and Zung Self-Rating Depression Scale (ZSDS) to obtain outcome data apart from CPA. The BDI and the ZSDS are the main self-administered instruments for the assessment of depression (Beck et al., 1961; Beck and Steer, 1987, Spielberger, Gorsuch &Lushene, 1970, Zung and Durham, 1965).
Chosen Tool
I could have used any of the above tools each of which have its own strengths and weaknesses but the CPA is a recommended National Standard Framework for Mental Health, introduced in 1991, to supply a framework for effective mental health care and to safeguard all service users (SU) by appropriate assessment and review ((DOH 1999; DOH 2008, Gamble, 2005). The CPA defines the specialist mental health services, care co-ordination approach used for assessment planning and reviewing of service users, based on person centred care planning but it is time consuming, in practice and paperwork. It does not habitually relate to prisoners and in-patients, it only applies to patients with complex ...
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.... (2002) Basic Concepts of Psychiatric Mental health Nursing. 5th ed, Philadelphia: Lippincott William & Wilkins.
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Spielberger, C. D., Gorsuch, R.L., and Lushene. R.E. (1970). Manual for the State-Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologists Press
The Beck Anxiety Inventory is a 21-item scale that measures the severity of self-reported anxiety in adults and adolescents. The inventory was created by Aaron T. Beck and his colleague, Robert A. Steer, at the Center for Cognitive Therapy, University of Pennsylvania School of Medicine, Department of Psychiatry. The most recent edition was published in 1993 by The Psychological Corporation, Harcourt Brace & Company in San Antonio, TX. The first edition was published in 1988. The 1993 edition recommends different scoring guidelines than previous editions. There is only one form and one manual as part of the Beck Anxiety Inventory (BAI). To purchase the BAI in 2010, the manual and 25 scoring sheets would cost $110.00. This information is from the Pearson Assessments website.
Varcarolis, E. M., Carson, V. B., & Shoemaker, N. C. (2006). In Foundations of Psychiatric Mental Health Nursing (p. 283). St. Louis: Elsevier Inc.
The Beck Depression Inventory-II (BDI-II) is the latest version of one of the most extensively used assessments of depression that utilizes a self-report method to measure depression severity in individuals aged thirteen and older (Beck, Steer & Brown, 1996). The BDI-II proves to be an effective measure of depression as evidenced by its prevalent use in both clinical and counseling settings, as well as its use in studies of psychotherapy and antidepressant treatment (Beck, Steer & Brown, 1996). Even though the BDI-II is meant to be administered individually, the test administration time is only 5 to 10 minutes and Beck, Steer & Brown (1996) remark that the interpretive guidelines presented in the test manual are straightforward, making the 21 item Likert-type measure an enticing option to measure depression in appropriate educational settings. However it is important to remember that even though the BDI-II may be easy to administer and interpret, doing so should be left to highly trained individuals who plan to use the results in correlation with other assessments and client specific data when diagnosing a client with depression. An additional consideration is the response bias that can occur in any self-report instrument; Beck, Steer & Brown (1996, pg. 1) posit that clinicians are often “faced with clients who alter their presentation to forward a personal agenda that may not be shared.” This serves as an additional reminder that self-report assessments should not be the only assessment used in the diagnoses process.
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Rather than preparing graduates in education or consulting as previous graduate nursing programs had done, this program educated psychiatric-mental health nurses as therapists with the ability to assess and diagnose mental health issues as well as psychiatric disorders and treat them via individual, group, and family therapy (ANA, 2014). Thus, the Psychiatric Mental Health Clinical Nurse Specialist (PMH-CNS), one of the initial advanced practice nursing roles (Schmidt, 2013), was born. After Community Mental Health Centers Act of 1963 led to deinstitutionalization of individuals with mental illness, PMH-CNSs played a crucial role in reintegrating formerly institutionalized individuals back into community life (ANA, 2014). PMH-CNSs have been providing care in a wide range of setting and obtaining third-party reimbursement since the late 1960’s. In 1974 a national certification for PMH-CNSs was created (APNA, 2010). Subsequently, PMH-CNSs began to be granted prescriptive privileges in the Pacific Northwest in the late 1970s, that practice has now spread to 37 states and the District of Columbia (APNA,
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The Beck Anxiety Inventory was designed by Aaron T. Beck and is self report scale that consists of 21 items. The items are short and straightforward, making it easy to read and comprehend. All items are related to anxiety and describe a symptom of anxiety that is rate on a four point likert scale according to severity. The answers range from 0-3 and the responses range from “not at all” to “severely; I could barely stand it” and all items are added for a total score. The instructions on the test ask for the respondent to “indicate how much you have been bothered by each symptom during the past week, including today, by placing an X in the corresponding space in the column next to each symptom” (Dowd, 2008). The assessment is intended for adolescents and adults and can be administered individually or in a group setting. An additional copy of the inventory test is also available in Spanish. It was originally created from a sample of 810 outpatients of that were predominately affected by mood and anxiety disorders and research on the original development is described as informative and thorough.
NASMHPD. (2014, Accessed April 27). Retrieved from NATIONAL ASSOCIATION OF STATE MENTAL HEALTH PROGRAM DIRECTORS: http://www.nasmhpd.org/About/AOMultiStateDisaster.aspx
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Mental health in nursing fraternity refers to a range of experiences and situations that a particular person can feel both physically and mentally. Mental health is a general term which incorporates a continuum from the most severe disorders to a variety and common mental health problems and mild symptoms of different intensity and duration. (Thomas, 2016) The clear definition of mental health can be attributed to one’s life context and experience. It is usually influenced by religious beliefs, social class race, gender as well as experience of family life.