Mental State Examination (MSE) | Case Study

Mental State Examination (MSE) | Case Study Ellie Fitz-Gerald Giving examples from the case study, how would you describe Amanda’s behaviour and appearance as set out in a MSE? A mental state examination (MSE) is used to assess an individuals mental capacity and reasoning at the time of an interview. It couples a number of cognitive domains in an attempt to characterise a person’s mental state (PCDCBP, 2011). The first domain of a MSE is a visual assessment of the patient, non-judgementally describing an accurate appearance of the patient including as many details as possible. These aspects include but are not limited to age, gender, build, posture, grooming, hygiene, heath levels, signs of drug use, hair style and colour and ethnicity. Behaviour is another non-judgemental assessment of the patient’s behaviour in general, but also a description of eye movement and eye contact, body movement and any gestures that are made. This is often coupled with an interpretation of the patient’s reaction to their current situation; examples may include descriptions such as being cooperative, hostile, withdrawn or suspicious (PCDCBP, 2011). Appearance: Amanda is a young woman with dyed blue and pink hair, which is mattered and unkempt. She has a number of piercings in her nose, eyebrow and lip. Her arms are covered in sores and her pupils are dilated. On paramedic arrival, they described that Amanda was â€Å"sitting upright appearing dazed and anxious†. In the cubicle on arrival to ED, she appeared very tense. Later in the cubicle, Amanda is smiling and then quickly appears terrified. Amanda’s mother has reported that â€Å"she [Amanda] comes home dishevelled and dirty. She has lost a lot of weight†¦Ã¢â‚¬  Behaviour: Amanda’s behaviour over the course of the case study could be described as erratic, often shifting between states of anxiety, happiness and terror. On arrival of the paramedics, Amanda was described as â€Å"anxious and short of breath†. In the cubicle at the ED, Amanda was pacing up and down the corridor and wringing her hands occasionally, responding quickly to any stimulus by staring intensely at the ceiling or at staff members. A description of her eye sight involved her manner and gaze alternating â€Å"between being intrigued to afraid to hostile†, coupled with difficulty remaining still. Amanda was hesitant to be touched, and noted to be constantly picking at sores. Later, Amanda was later happy and quickly turned to terror and despair. Amanda is described by her mother in these examples; â€Å"Amanda hasn’t been herself since dropping out of university†¦Ã¢â‚¬ , â€Å"She has lost contact gradually with nearly all of her friend an d become increasingly isolated†, â€Å"Over the last three months her behaviour has become increasingly odd and erratic†, â€Å"goes out, sometimes for days at a time†, â€Å"talking loudly to herself in her room†¦over the past week she has been shouting†¦but there was no one in her room with her.†, â€Å"Last night she burst out of her bedroom and screaming incomprehensibly at her father then stopped suddenly and went back into her room.† Define cognition and then briefly discuss how we might interpret how both Amanda’s thought content and thought form are disturbed? According to Miller and Wallis (2009), cognitive or executive control, or cognition, refers to the ability to coordinate thought and action and direct it toward obtaining goals. Cognition is important in planning and sequencing complex events of behaviour, as well as prioritizing goals (Miller and Wallis, 2009). Thought content and processing is a somewhat subjective insight into cognitive capacity. For example, thought process can be a description of a patients thinking and a characterisation of how a patient’s ideas are communicated. The speed of thought is how quickly a patient changes ideas, known as ‘flight of ideas’ (Snyderman and Rovner, 2009). An example exhibited by Amanda is in the ED cubicle where she had asked the clinician â€Å"You wont tell her anything will you?†, quickly progressing through a series of thoughts from â€Å"you know don’t you?† to â€Å"They’re everywhere† to â€Å"The whole planet is falling† and then â€Å"Shut up shut up†. Additionally, thought form is another domain which could be described as goal-directed or conversely, disorganised. These terms carry descriptors, describing whether a patients thoughts are logical, tangential (quickly diverging, as shown through Amanda’s haphazard thought progression), circumstantial (unsupported thinking) or loosely associated (Snyderman and Rovner, 2009). Amanda displays a number of disorganized thought categories, stating â€Å"Everyone of us is falling – the whole planet is falling† is a description of both unsupported thinking, and potentially an illusion Amanda is experiencing. Another interpretation of disordered thought is that of intrusive thoughts or obsessive ideas. As severity of mental health illness increases, patients may exhibit delusional thinking (a false belief not held by peers that persists despite evidence to the contrary), hallucinations (false perception of sensory stimuli) or illusions (a misperception of real life) (Mar tin, 1990). Amanda illustrates both hallucinations and illusions. Amanda seems to demonstrate hallucinations through multiple spoken phrases: â€Å"They’re everywhere. Everywhere†¦under my skin†, â€Å"Shut up, shut up†¦Ã¢â‚¬ , â€Å"Can’t you hear what they’re saying?! All the children have been hurt†. Taken together, Amanda’s thought content and process appears compromised. Briefly explain the differences between hearing and listening. Choose two skills of listening and discuss how you would use these skills to effectively communicate with Amanda. What are some of the barriers you might face in the process? Hearing is the process of physiological receiving and processing sounds, without being fully attentive or actively concentrating on what is being said. This is passive listening. In contrast, listening is an active process, paying attention to what is being said, constructing meaning from, and in addition, often responding appropriately to what has been said using astute observation (Purdy and Borisoff, 1997). Listening is necessary for the health professional as it involves more than simply sending and receiving words, and can validate the patient’s emotions and promote an understanding between patient and health professional. Hearing on the other hand does not continue or encourage interaction. Listening can be enhanced by actively applying numerous measures. Two of these are providing non-verbal cues and picking up on the non-verbal cues of the patient. Providing non-verbal cues to Amanda would encourage a non-judgemental and mutual understanding environment, often involvin g the implementation of an acronym SOLER (Sit squarely, Open posture, Lean forward, Eye-contact, Relaxed) (Egan 2002). In addition to this, nodding the head and quiet murmurs as encouragement also aids active listening, this may assist in making Amanda feel better understood, and potentially play a role in reducing her defensiveness to a medical situation. Secondly, picking up on non-verbal cues from the patient is critical in making them feel understood. A health professional should endeavour to pay careful attention to what the patient is expressing and how they are displaying these emotions. This may manifest through facial expression, body posture, movements or excessive/poor eye contact and illustrate a patient’s emotion or frame of mind (Egan, 2002). In Amanda’s situation, recognizing that she is in distress by verbally acknowledging it may led to some kind of mutual understanding and rapport building between Amanda and the health professional. Some barriers to t his include Amanda’s current inability to adequately perceive her environment correctly. Amanda does not seem as aware of her surroundings and stares often at the ceiling. She may be inattentive to the non-verbal postural cues by the health professional aimed to place her at ease. Her responses may be skewed and irrational, and the potential hallucinations that she may be experiencing are external to any verbal communication that can resolve her distress. Define therapeutic communication. Using case study examples, explain the difficulties involved in communication when managing a complex scene that includes an anxious patient who presents in the emergency department with a distressed and demanding relative. Therapeutic communication occurs between a health professional and a patient, which considers a patients experienced emotion and explores the meaning and potentially faulty cognition in an attempt to resolve them. It is often formal, purposeful and structured, with a long term goal to produce a desired change (Plutchik, 2000). Managing patient anxiety in a scenario with a demanding relative has its challenges. When paramedics have arrived to the scene of Amanda, her mother is quite distressed, yet Amanda is highly anxious, â€Å"The mother is constantly obstructing and getting in their way causing interruptions†. The assertiveness of Amanda’s mum may obfuscate the ability of the paramedics to create a therapeutic relationship with Amanda in order to de-escalate the situation. Furthermore, this may worsen the anxiety experienced by Amanda. Moreover, attention may be given to the mother in order to place her at ease. One manner to reduce this difficulty is to try to separ ate the parties. In the ED, this dynamic may result in similar difficulties, and the presence of a demanding relative in this context could potentially result in Amanda having difficulty communicating additional information due to her anxiety. Although in the case study Amanda’s mum is not particularly difficult, in the scenario where a distressed and demanding relative was present in the ED and hindering patient treatment the best course of action would be to kindly ask them to take a seat in the waiting area. If the distressed relative is being quite difficult to handle other tactics include asking relative to go and get an item such as a drink for the patient, which would require that they leave the area. If the relative continues to cause disruption to the patient care they must be informed that if they cannot allow the healthcare team to complete their care for the patient they will be removed from the area/hospital. What are the key components of an effective handover between health professionals from different disciplines? Discuss the important considerations of patient handover in regards to objective information and confidentially. A clinical handover is the transfer of professional responsibility, accountability, clinical information and patient to another set of health professionals on a permanent or temporary basis. In order for an effective handover to occur, numerous considerations must take place. First, the handover should have clear leadership. Second, there should be support for the handover process to come from all levels of the medical team. Third, adequate information regarding the patient and the current situation and future direction should be provided if applicable. Fourth, tasks must be prioritised, further care plans put in place and unstable patients are reviewed in a rapid manner (AMA, 2006). A qualitative study on paramedic and emergency department handovers showed that paramedics wish for a consistency in the terminology used, a shared understanding of the team members in each of the roles of health professionals, and a standardized approach to handovers, such as a predetermined format whic h is flexible and recognises professional judgement and experience (Owen et al. 2009). A problem arises when considering the objectiveness of information that is acquired from various sources. In order to address this, health professionals should speak non-judgementally, and take note of what was observed, as opposed to spoken by the patient, or reported by a significant other in terms of incidents. These processes maintain some level of objectiveness. Confidentiality is a necessary and critically important obligation and law-binding role of all health professionals. One manner to protect confidentiality would be to initiate handover in an area whereby members of the public cannot overhear. Reference List AMA (2006) Safe handover: Safe patients: Guidance on clinical handover for clinicians and managers. Australian Medical Association. Kingston, ACT, Australia. Egan, G. (2002) The skilled helper: a problem-management and opportunity-development approach to helping. 7th edition. Pacific Grove, California: Brooks/Cole. Miller, EK, and Wallis, JD (2009) Executive Function and Higher-Order Cognition: Definition and Neural Substrates. In: Squire LR (ed.) Encyclopedia of Neuroscience, volume 4, pp. 99-104. Oxford: Academic Press. Martin, DC (1990) Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition., Butterworth Publishers Owen, C, Hemmings, L, Brown, T (2009) Lost in translation: Maximizing handover effectiveness between paramedics and receiving staff in the emergency department, Emergency Medicine Australasia, 21: pp. 102-107. PCDCBP (2011) Understanding the Mental State Examination (MSE): a basic training guide. Palmerston Association Inc. Subiaco, WA. Plutchik, R (2000) Emotions in the practice of psychotherapy: Clinical implications of affect theories. American Psychological Association. Washington, DC, US. pp. 149-168. Purdy, M and Borisoff, D (1997) Listening in everyday life: A personal and professional approach. Second Edition. University Press of America Inc. LLanham, Maryland. Snyderman, D and Rovner, BW (2009) Mental Status Examination In Primary Care: A Review. Am Dam Physician, 15(80): pp. 809-814. 1

Healthy Lifestyles Essay

Health lifestyles, in turn, are ways of living that promote good health and longer life expectancy as stated in the assignment. Health lifestyles that promote good health and longer life expectancy would be one where the person has contact with doctors and takes care of themselves completely. While going to the doctors and taking care of oneself is extremely important so is taking care of ourselves outside of the health care system. We have to eat a proper diet and exercise. Most importantly the person has to be able to stick with it and drink water to make sure that they are hydrated and do not get sick from exercising. The person also needs to get adequate amounts of rest. I think that one theory that would support this point of view would be the theory of the â€Å"Looking- Glass Self† (Cockerham, 2012). Cooley ´s concept of the looking glass self-states that each person grows when they interact with other people (Cockerham, 2012). How we look at ourselves comes from how other people perceive us. Actually, how we see ourselves does not come from who we really are, but rather from how we believe others see us. The reason I say that is because most people see themselves how others see them. Or what they think others see them as. In my opinion that is what encourages people to start living and eating the right things. Exercising because of their self-image and what they think that others think about them. The second theory would have to be the theory of health lifestyles. I am unsure if this is an actual theory or not. Cockerham’s theory basically states that individuals have the right to interpret their situation, as well as make choices. This is true, people do make their own decisions, however as he also pointed out that all social action takes place in contexts that imply both constraints and opportunities. By being able to choose to exercise, eat right and to see the doctor it is fully in that persons hand to live a healthy lifestyle. I would say reduce the amount of stress that you encounter especially if you know what causes you stress. Also exercise daily and eat healthy. The person should also get plenty of rest since sleeping too much or too little can worsen anyone’s mood. It is alway s a good idea to pace yourself when you are exercising though. You do not want to end up hurting yourself if you push yourself too hard in the beginning when you are just starting to exercise. The more you exercise the more your body will get used to it and you can exercise more and boost your endurance and stay healthy. I think there are eight (8) components to the model. They  would be 1.) Class circumstances/ age/ gender/ race and or ethnicity collectives living conditions 2.) Socialization Experience 3.) Life Choices, 4.) Life Chances (both 3 and 4 interplay) 5.) Dispositions to Act 6.) Practices, 7.) Alochol use, smoking, diet, exercise, checkups, seatbelts etc. 8.) Health Lifestyles (reproduction). I think that it is very effective even today. It still applies. The demographics and life choices makes sense when trying to get someone to be healthy. They are still as valid and relate to present day situations as it did when the model in the study of health behavior and healthy lifestyle was first done. References Cockerham, W. (n.d.). Medical Sociology (12th ed.). Upper Saddle River, NJ: Pearson Education, Inc.

The Surprising Details Regarding Dissertation Services Most People are not Aware Of

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A Delusion of Satan Great Insight Into the Past Essay

A Delusion of Satan was written in 1995 by Frances Hill, and published by Da Capo Press. Frances Hill, an accomplished writer and journalist from London, has been writing for a decent period of time. Aside from publishing two novels, Hill has written fiction reviews for The Time (London) and has worked as a reporter in in both New York and London. With such an accomplished journalist, reporter, and writer, we are due to receive a good read in A Delusion of Satan. Set in the Colonial American village of Salem in Massachusetts around the year of 1692, A Delusion of Satan opens by describing, in depth, the puritan lifestyle. Ranging from the social aspects, to the religious aspects, to the political aspects of puritan living, Frances†¦show more content†¦According to text, rather than admitting that they were in control of their own actions, Ann, Betty and Abigail also accused Tituba of â€Å"placing the hand of Satan upon them.† From this place, the downward spiral only steepens. Tituba confesses (it was a forced confession) to witchcraft, and by February of 1692, Betty and Abigail accused two more women, Sarah Good and Sarah Osborne, making three total accused â€Å"witches.† Accusations, examinations, and imprisonment continued, and by the end of April, 23 more people are jailed under accusations of witchcraft. â€Å"Salem was possessed.† This pattern continued for the better part of a year. Almost 30 died, and well over 100 spent months in prison. In January of 1693, however, all of this would change. Sir William Phips, governor of the Massachusetts Bay Colony, stepped in after his own wife was accused of witchcraft. He questioned the validity of all accusations and formed a new high court to try all accused witches. Of the many tried, only three were found to be â€Å"guilty.† This is where we start to see a rapid decline of the ordeal. With the formation of this new court, accusations held little weight until proven by Phips’s court. Additionally, Phips pardoned and ordered the release of all previously/remaining accused â€Å"witches† in May of 1693. So ends the Salem Witch Trials. Thirteen years later, in 1706, Ann Putnam makes an apology toShow MoreRelatedEssay Witchcraft Portrayed in Films6180 Words   |  25 Pagesof Christianity, during the third century of the Common Era. Chris tianity, following a monotheistic set of beliefs declared that any other representations of the Divine were incorrect, and that any other Gods were in fact demons from the legions of Satan. `Christianity succeeded, for a time, in making the Gods of the old religion the Devil of the new. (Crowley, Page 17) However, even with the political power of the conversion of Rome behind Christianity, it was having a hard time superimposing itself