Mental health assessments and ethics PDF

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Mental health assessments: What is mental health: - Mental health affects everyone - Not a life sentence - Depression - Spectrum - Schizophrenia What is mental illness?

When tthere is a level of mental distress it can lead to mental illness If you know what is making you distressed then we can treat it When the symptoms are established then mental illnesses arise M.S.E: allow you to assess the individual - focus on just on the mental state of the individual The MSE has the following general elements, which are further divided into subheadings: 1) General Appearance 2) Psychomotor behaviour 3) Mood and affect 4) Speech 5) Cognition 6) Thought Patterns 7) Level of Consciousness -

Initial or while assessment takes an hour to complete

Session outcomes: - Analyse BATOMI a mental state examination - Using BATOMI demonstrate an ability to complete a mental state examination -

M.S.E is based on the time you sit with the person infront of you not the past situations

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BATOMI – good enough tool to guide our practice through the M.S.E. Put BATOMI as you guiding tool but if there is other tool used in placement then can use that

Assessment: - Reason for referral - Previous mental health and medical history - Developmental/psychosocial/relationship history - Resik assessements - Assessment of strength

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Sipiratual assessment Cultural assessment As culture is important and what builds an individual – and important in terms of assessment to consider the culture. High risk of mis-diagnosing people

Batomi: 1. Behaviour: 2. Appearance and affect/mood: - Tattoo - Hair or colour – is it combed or messy - Clothing style - Grooming – cleanliness e.g. odor - Height, weight, body shape - Mobility - How old someone looks compared to their chronological age Affect: - The observable behaviour that represents the expression of an emotion e.g. constricted, blunted, flat - Usually consistent with mood Mood: - A subjective feeling of emotion that colours the perception of the mowrld - E.g. depression – they will say they are feeling low, what you see is that they should look low i.e. body position wil be consistent with what they say Inconsistent: when there mood doesn’t match with the way they say i.e. say they are feeling low but saying it in a very active way. 3. Thought/cognition: Speech: - Tone of voice - Flow and rate of speech i.e. rapid, slow, staccato - Volume e.g. softly spoken, loud - Clarity e.g. pressured - Defects e.g. stammering, stuttering Thought process: - Retarded vs racing thoughts - Goal directedness: circumstanility, tangential, thinking, thoughts blocking Thought content: Delusions: - Grandiose - Paranoid - Persecutory - Somatic - Nihilistic - Religious

- Bizarre - Poverty - Systemised Thought: - Thought insertion - Thought withdrawl - Thought broadcasting - Magical thinking - Ideas of reference - Ideas of influence - Illusions - Hallucinations – auditory, visual, tactile 4. Orientation – check place, time, person 5. Memory/motivation: Memory: - Immediate - Short term - Long term Motivation: - Passive - Ambivalent - Future plans/goal directed - Motivated 6. Intellectual functioning/insight Intellect: - Concentration - Attention - General knowledge - Simple calculations - Abstruct/ concrete thinking - Comprehension Insight: - An individuals awareness of their illness or situation - Understanding of current symptoms - Ability to perceive and understand the cause and nature of own and others situation - Variable e.g. and individuals maybe aware of a problem but may believe someone else is to blame

Behaviour: - Eyecontact – good eye contact (is the person looking when your talking to them) - There are cultures that eye contact is rude – so some people might look at the floor but would be listening - Have to be aware of a persons culture Body language:

Personal space: - Spaces around the person Motor activity: - If people keep moving there feet - If they keep looking to the wall or holding ear - These should be written in aseessment Goal directed:

Spiritual; - Concept of god - Sources of strength and hope - Religious practices - Meaning and purpose - Wairua Cultural: - Cultural safety - Non-verbal patterns of communication - Etiqyette and social customs - Nutrition assessment - Sleeping assessment - Pain assessement - Medication assessment - Family

Ethics: Ethical considerations, regulations and knowledge: ethical and legal safety: Session aims: v Explore/revisit definitions of ethics and their application in mental health nursing contexts v Evaluate legal & ethical issues which impact on clients and service providers within the context of mental health. v We will thus examine ethical considerations/regulations and knowledge related to ensuring ethical and legal clinical safety. Defining ethics: - Is about doing the good thing and right thing v Behaviour or conduct that is good or bad, right or wrong. v Moral principles that govern a person’s behaviour v Includes moral values, principles, standards of behaviour, morality. v Nursing ethics – a branch of applied ethics related to nursing and integral to professionalism. v Closely related to medical ethics such as beneficience, non-malficience, respect & autonomy. Formal definitions: ‘The domain of nurses’ moral behaviour, actions, decisions and ethical decision making, in response to conflicts of moral decision making.’ (NZNO, Code of Ethics 2010). ‘Ethical activity is thought and action based on the values, moral principles and ideas of professional practice.’ (NZNC, Code of Conduct 2009). Why they are needed? Ethics and Professional Practice v A profession needs a definition of its roles and processes to ensure quality and knowledge production v Consumers (the public) expect credibility and trust from the nursing profession v Nursing is guided by law, ethical principals (code of conduct) and public image - If we don’t have something to guide our practice we will be all over the place - Ensures that we work within our scope Codes of ethics for nurses: International Code of Ethics for nurses (Revised 2012) v Nurses have four fundamental responsibilities: to promote health, to prevent illness, to restore health and to alleviate suffering. v Nursing has a respect for human rights, including cultural rights, the right to life and choice, to dignity and to be treated with respect.

v Nursing care is respectful, unrestricted by considerations of age, colour, creed, culture, disability or illness, gender, sexual orientation, nationality, politics, race or social status. v Nurses render health services to the individual, the family, the community and coordinate their services with those of related groups.(International Code of Ethics. www.icn.ch)

NZ Nursing Council: The NZNC Code of Conduct identifies 8 guiding principles based on values underpinning professional conduct. It is not a code of ethics. 1. Respect the dignity and individuality of health consumers 2. Respect the cultural needs and values of health consumers 3. Work in partnership with health consumers to promote and protect their well-being 4. Maintain health consumer trust by providing safe and competent care 5. Respect health consumers’ privacy and confidentiality – very important 6. Work respectfully with colleagues to best meet health consumers’ needs 7. Act with integrity to justify health consumers’ trust 8. Maintain public trust & confidence in the nursing profession Codes of ethics for nurses: New Zealand Nurses Organisation Code of ethics for nurses (2010) includes… v Autonomy (self determination) – independence, freedom v Beneficence (compassion, action to help others, doing good) v Non Maleficence (avoidance of harm or hurt) – actions we do are based to do no harm v Justice (fairness in distribution of resources) – to be fair v Confidentiality (privacy) v Veracity (truthfulness) v Fidelity (faithfulness, loyalty,advocacy, keeping a commitment) v Guardianship of the environment and its resources v Being professional Other writers add… Paternalism (making decisions for the patient based on what we believe is in their best interest) NZNO focus on relationships: Nursing takes place in a series of unique relationships with others within which ethical practice is located: v Nurse-client relationship v Nurse-colleague relationship v Nurse-organisation relationship v Nurse-societal relationship

NZCMHN Standards of Practice : standard six v Standard Six: The mental health nurse’s practice reflects relevant policies, legislation, ethical standards and codes of conduct v Rationale : Professional accountability involves an obligation to recognise socially and professionally mandated policies and to maintain legal and ethical standards. v Practice outcomes - Standard six is being met when: v 1. Mental Health Nursing practice is congruent with relevant policies and legislation. v 2. Mental Health Nursing practice reflects accepted ethical standards and relevant codes of conduct and practice. v 3. The Mental Health Nurse upholds the rights of people with mental health issues, their families/whānau and communities. NZCMHN STANDARDS OF PRACTICE: standard six (a) Knowledge The Mental Health Nurse demonstrates an understanding of: 1. Current local, national and international mental health policies and legislation relevant to Mental Health Nursing practice. 2. Ethical standards and principles related to Mental Health Nursing. 3. Codes of conduct relevant to Mental Health Nursing practice. 4. Principles of informed consent. (b)Skills The Mental Health Nurse: 1. Practises in accordance with legislation relevant to the mental health practice setting. 2. Identifies the relevance of health policies to practice. 3. Utilises a framework for ethical decision making and practises in accordance with legislation, policies and codes of conduct. 4. Identifies the implications of relevant codes of conduct. 5. Participates in reviews of clinical practice and service delivery. (c) Attitudes The Mental Health Nurse: 1. Accepts accountability for own practice. 2. Respects professional obligations resulting from legislation. 3. Values ethical reflection and review of professional practice. 4. Respects the views of people with mental health issues and family/whānau in reflecting on professional practice. Different perspectives involved: Public  Fear of mental illness  Public perceptions of mental illness  Stigmatisation  Tax payers money  Expectations of mental health services

Government legislation  Privacy Act  Mental Health Act  Health Practitioners Competence Assurance Act  Human Rights Act  Crimes Act  Children and Young Persons Act  Code of rights – Health and Disability Commission Different perspectives involved: Consumer  Ethical Regulation and Consumer movement  Client rights  Recovery movement  Advocate for increased involvement in service provision and policy development Registered Nurse  reflect on practice  reason ethically  know codes of practice  know legalities  regulate your own philosophical and ethical beliefs What then creates an ethical dilemma?: v A tension is experienced between two conflicting values v A sense of “unease” is felt v Alternative perspectives in research may add tension v Contrary opinions, can be expressed by a range of people v Policy or legislation clashes can leave the nurse conflicted v Reality is not always tidy compared to theory v Pressure/influence from other sources can worsen the dilemma v Some issues are not ‘black or white’ – but are often ‘grey’ v Moral beliefs and values when challenged become a dilemma v Opposite moral viewpoints can cause tension within teams v Understanding an ethical dilemma involves self awareness v Efforts to accommodate client wishes cancreate a dilemma for the nurse Ethics in mental health: Identify three areas you think relate to ethics in mental health Age & consent Seclusion Restraint Consent Intimate relationships Client competence

Harm reduction Compulsory Medication Social injustice Electroconvulsive therapy Mental Health Act Coercion Professional boundaries Community vs In-patient care Family involvement Care & protection Complimentary therapies Contraception Ethical issue example: The Mental Health (Compulsory Assessment and Treatment ) Act (1992) v In what way can this legislation constitute an ethical issue or dilemma? v What contributes to it being an issue? v Who decides it is an issue? v What is done about this issue?...