Mental State Examination (MSE) Case Study

Mental State Examination (MSE) Case Study Lachlan Donnet-Jones Giving examples from the case study, how would you describe Amanda’s behaviour and appearance as set out in a Mental State Examination (MSE)? A Mental State Examination (MSE) is defined as â€Å"[a] medical examination comprising the systematic evaluation of the mental status of the patient† (Dorland, 2011). A MSE evaluates many characteristics of a patient including appearance, psychomotor behaviour, speech, thinking and perception, emotional state including affect and mood, insight and judgment, intelligence, sensorium, attention and concentration, and memory (Dorland, 2011). The initial segments evaluated during a MSE are appearance and behaviour. It is important to note the patient’s appearance as this can provide useful information into the level of self-care, daily living skills and lifestyle of the patient. Behaviour is important to record as it can provide much insight into the patient’s emotional state and attitude. A MSE is an important process in determining a patient’s capacity to make [or not] independent health care decisions and provide the necessary support to better the patients welfare (Volicer, 2011). Appearance: The initial insight into Amanda’s appearance occurs as the paramedic crew arrive, finding her ‘sitting upright, looking dazed and anxious with shortness of breath’. It is apparent that Amanda appears distressed, confused and anxious enough to cause her to become dyspnoeic (shortness of breath) (Shiber and Santana, 2006). Amanda is a young woman with dyed, untidy and matted hair who presents with a poor level of personal hygiene and self-care. Amanda has many facial piercings, her pupils are extremely dilated and her arms are covered in sores. Subsequent to Amanda’s arrival at the emergency department (ED) she appears very tense and her facial expressions change rapidly from smiling to terrified. Amanda’s mother re-counted that Amanda ‘comes home dishevelled and dirty’, and that she has ‘lost a lot of weight’. Behaviour: Following the handover to the clinician at the hospital, it is observed that Amanda appears to be suffering a level of psychomotor agitation as she is ‘very tense†¦ pacing up and down the corridor wringing her hands’. Amanda appears unable to focus, demonstrated by abnormal and erratic eye movements, ‘her eyes stare intensely either into the ceiling above or at staff members’. Amanda appears to be suspicious of and distrust staff members as she distances herself as much as possible from any physical contact and enters the room ‘like she’s about to enter a trap’. During the interview Amanda screams ‘They’re everywhere. Everywhere†¦under my skin!’. Amanda appears to be experiencing tactile hallucinations, she believes there is something beneath her skin, when there is not. Amanda also appears to be experiencing auditory sensation (voices) without an authentic (real) stimulus i.e. auditory hallucinations. This is seen as she looks up at the ceiling yelling ‘Shut up shut up shut up!!!!!! then distressed, proceeds to scream and hold her ears as if to block a loud noise’ and furthermore, ‘Why am I here!!! You won’t tell her anything will you?’. Amanda talks about ‘her’, which may be referring to her mother, but it may also be referring to someone else. Define cognition and then briefly discuss how we might interpret how both Amanda’s thought content and thought form are disturbed? Cognition is defined as ‘the mental processes by which a person acquires knowledge.’ Among these are reasoning, creative actions and solving problems (Marcovitch, 2009). Cognition is an essential in determining what we think and how we think. In an MSE, thought form and thought content are used to gain an understanding of the patients thinking, specifically how they think (form) and what they are thinking of (content) (Trzepacz and Baker, 1993). Thought form is the quantity, rate, tempo and logical coherence of a person’s thoughts. The thought form may include highly irrelevant comments, frequent changes in topic and pressured or halted speech (Kaufman and Zun, 1995). In contrast, thought content refers to selective attention (focus on a selective topic), preoccupation or exaggerated concern (obsessions, compulsions and hypochondria) and distorting or ignoring reality (illusions, hallucinations and delusions) (Trzepacz and Baker, 1993). During Amanda’s interview a number of sentences allude to disturbed thought content such as ‘You know don’t you? You know it’s in my veins!’ and ‘Every one of us is falling – the whole planet is falling!’. Amanda’s exclamations are examples of unsubstantiated thinking and are possibly part of an illusion. The thought form of such exclamations is disorganised, hastily changing from one topic to another, â€Å"they’re in my veins†, â€Å"the whole planet is falling!†, ‘Shut up shut up shut up!!† and ‘Forgive me! Forgive me!’. While the specific idea changes there is a recurrent theme to Amanda’s thought content, disastrous, guilty and fearful situations that are beyond her control. It is evident based on the irrelevant topics and unsubstantiated thinking observed in Amanda’s speech that her thought content is disturbed. Amanda’s thought form also appears distu rbed demonstrated by the ‘flight of idea’s’ she experiences and her inability to focus on a relevant topic within the context of the situation (Trzepacz and Baker, 1993). 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? Listening is defined as ‘a complex process that encompasses the skills of reception, perception and interpretation of input.’ (Stein-Parbury, 2013). As opposed to hearing, listening is consciously chosen, one must be paying ‘active attention to what is being said’ (Stein-Parbury, 2013). Additionally there are two terms for listening, active and passive. Active listening is effective listening. It requires concentration to process words into meaning which in turn leads to learning. Hearing, or passive listening, is one of the five senses a human possesses, it is simply perceiving sound (vibrations) via the ear. Hearing alone is a subconscious process and happens automatically. A nursing research paper provides a succinct definition of the difference between hearing and listening. Hearing is ‘being there’ for patients whereas listening is ‘being with’ patients (Fredriksson, 1999). In order to conduct effective active listening and exchange information with patients a clinician needs to possess the required listening skills. There are five categories of listening skills; perceiving; interpreting; recalling; and attending and observing, which will be discussed in relation to Amanda’s case (Stein-Parbury, 2013). Observation from the clinician is important in Amanda’s case as much information can be learnt simply from observing Amanda’s behaviour. Observing involves paying careful attention to what is expressed and how it is expressed (Stein-Parbury, 2013). Non-verbal cues such as facial expression, eye contact, body posture and movements ‘[convey] emotional and relational information [Henry et al. 2012] that can inform the clinician of Amanda’s feelings and emotional state. The clinician notices that Amanda is ‘wringing her hands from time to time’, which may suggest she is feeling nervous and anxious. This is an example of observation, by paying careful attention to Amanda’s non-verbal cues (hand wringing) the clinician has an increased awareness of Amanda’s feelings. Amanda’s eyes ‘stare intensely either into the ceiling above or at staff members’, the clinician may interpret this as a sign of distrust and suspicion. Using this knowledge the clinician recognises the absence of trust and can address this in his response to build rapport. Although observing and interpreting the patient’s non-verbal cues is important, it is equally important for the clinician to provide their own non-verbal cues for the patient to interpret. This is referred to as attending. A common mnemonic used for this is SOLER (Sit squarely, Open posture, Lean forward, Eye-contact, Relaxed) (Egan, 2002). Encouragement such as quiet murmuring (e.g. â€Å"Mmm†) and head nodding is also used to show attentiveness and openness, allowing the patient to feel understood. Despite many methods of encouragement and understanding the clinician may still find barriers with particular patients. In Amanda’s case some barriers may include Amanda’s apparent lack of awareness to her environment, she may be unable to listen or acknowledge the clinician, such as when she is staring at the ceiling. Amanda’s hallucinations can potentially disrupt or prevent any congruent conversation and distort her responses. Observation and attending are important skills in listening as they are ‘fundamental in establishing effective relationships’ (Stein-Parbury, 2013). Using listening skills to develop a comprehensive understanding of Amanda’s situation the clinician can respond accordingly in a manner that matches Amanda’s needs. 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. Hungerford (2011) defines therapeutic communication as ‘a communication technique utilised by a health professional to engage with a person and enable them to achieve personal change’. It is essentially the face to face communication between clinician and patient that aims to enable positive change in the patient. An anxious patient such as Amanda can be difficult to manage, especially in the presence of bystanders or relatives who are distressed, in Amanda’s case it is her mother. While Amanda’s mother may mean well, she is most likely contributing to Amanda’s anxiety. Rather than aiding health professionals she is hindering their ability to reduce Amanda’s anxiety as she ‘[is] constantly obstructing and getting in their way causing interruptions’. In addition to increasing Amanda’s anxiety, health professional’s attention may be taken away from Amanda and focused on calming the mother down. This has a negative impa ct of the patient’s well-being, increasing the time it takes to de-escalate the situation and decrease the patient’s anxiety. Amanda’s mother’s constant interruptions have a negative impact of the patient’s well-being. For example, ‘She is not right; she is really unwell’ as heard from Amanda’s perspective is escalating the situation, making Amanda feel worse than she has too and increasing her anxiety. A potential method to avoid relatives increasing patient anxiety is to separate them. The paramedics separate them during transport, taking Amanda in the ambulance where she can receive further care that is needed, and Amanda’s mother via police. At the ED Amanda’s mother continues to interrupt clinicians. To remove the potential of increasing Amanda’s distress, the clinician interviews Amanda alone. Although Amanda’s mum provided important information it was beneficial to interview Amanda alone. In a situation where a relative is distressed and interferes with treatment it is most appropriate to kindly separate them from the patient, take them to another area where they can calm down and perhaps have a drink or some food. 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 confidentiality (8). A clinical handover is ‘the transfer of professional responsibility and accountability for some or all aspects of care for a patient, or group of patients, to another person or professional group on a temporary or permanent basis’ (National Patient Safety Agency, 2014). The aim of the handover is to establish effective communication of clinical information during patient transfer from the care of one health professional to another. There are numerous steps or processes involved in an effective handover. First, the clinician sending information needs to show strong leadership. Second, any members of the medical team involved in the care of the patient prior to or subsequent to the handover should have an active role in the handover. Third, a multifaceted quantity of information involving the patients past, current and future care should be provided. Finally, the fourth step is to ensure patients that are not stable are quickly reviewed, further care is planned and the tasks are prioritised appropriately (AMA, 2006). Patients expect that confidentiality is respected and personal information is treated with utmost care. Confidentiality is an important legal obligation of health professionals. Delicate and sensitive information regarding patient care should not be discussed in potentially compromised areas, ideally in private quarters away from the public. A final factor to consider during patient handover is the level of objective information. Objective information is fact-based, measurable and observable, as opposed to subjective information which is based on personal opinions, interpretations and judgement (Hjà ¸rland, 2007). Health professionals are required to avoid relaying information that is judgemental, opinion and subjective as this form of information can lead to misinformed health professionals which consequently creates poor or inappropriate patient care (Hemmings and Brown, 2009). References AMA (2006) Safe handover: Safe patients: Guidance on clinical handover for clinicians and managers. Australian Medical Association. Kingston, ACT, Australia. Dorland, (2011). Mental Status Examination. In:  Dorlands illustrated medical dictionary, 20th ed. Philadelphia, USA: Elsevier Health Sciences. Egan, G. (2002). The skilled helper: a problem-management and opportunity-development approach to helping. 7th edition. Pacific Grove, California: Brooks/Cole. Fredriksson, L., 1999. Modes of relating in caring conversation: a research synthesis on presence, touch and listening. Journal of Advanced Nursing 30, 1167-1176. Hemmings, C Owen L, Brown, T 2009. Lost in translation: Maximizing handover effectiveness between paramedics and receiving staff in the emergency department,Emergency Medicine Australasia, 21, 2, pp. 102-107, Academic Search Complete, EBSCOhost, viewed 4 May 2014. Henry, S.G., Fuhrel-Forbis, A., Rogers, M.A.M., et al., 2012. Association between nonverbal communication during clinical interactions and outcomes and outcomes: a systematic review and meta-analysis. Patient Education and Counselling 86, 297-315. Hjà ¸rland, B. (2007). Information: Objective or subjective/situational?. J. Am. Soc. Inf. Sci., 58:1448–1456. doi:10.1002/asi.20620 Kaufman, D. and Zun, L. (1995). A quantifiable, Brief Mental Status Examination for emergency patients.The Journal of emergency medicine, 13(4), pp.449456. Marcovitch, H. (2009). Cognition. In:Blacks Medical Dictionary, 42nd ed. A C Black. National Patient safety Agency, (2014). As cited inSafe handover: safe patients. London: British Medical Association, p.7. Shiber, J. and Santana, J. (2006). Dyspnea.Medical Clinics of North America, 90(3), pp.453-479. Stein-Parbury, J. (2013).Patient and person. 5th ed. Sydney: Elsevier Churchill Livingstone. Trzepacz, P. and Baker, R. (1993).The Psychiatric Mental Status Examination. 1st ed. New York: Oxford University Press. Volicer, L. Mahoney, E. Hurley, A. 2011 Mental status measurement: Mini-mental state examination inEncyclopedia of nursing research, Springer Publishing Company, New York,

Performance Appraisal Essay

Performance appraisal is a universal phenomenon with the organization is making judgement about one is working with and about oneself. It serves as a basic element of effective work performance. Performance appraisal is essential for the effective management and evaluation of staff. It aims to improve the organizational performance as well as individual development. Performance is an employee’s accomplishment of assigned work as specified in the critical and as measured against standards of the employee’s position. The term â€Å"Performance Appraisal† is concerned with the process of valuing person’s worth to an organisation with a view to increasing it. EXERCISE : STEP 1: Divide participant in group of 3. STEP 2 : Let them to select upon themselves a manager, an employee and an observer. STEP 3 : Assign each group with one scenario to begin with. STEP 4 : Each scenario will take approximately 5 min to play. STEP 5 : manager and employee has to take part in play and observer has to write down the Observations. STEP 6 : Observer has to focus on following questions – †¢ What worked? †¢ What didn’t? †¢ How did the â€Å"manager† shows caring during the play? †¢ How did the â€Å"employee† react to a caring approach? †¢ Was the manager candid with the employee? How? †¢ How did the employee react to the candid approach? †¢ Did a collaborative effort surface? Describe it? Different scenarios are : Scenario 1 : Was it that important? Manager : You’ve missed the three of those meetings during the last two quarter. Employee : But I thought they were optional. I’ve been missing meetings all week†¦. I never realise it as a problem Manager : Well I am telling you now your attendance is mandatory. But that’s not the only reason you scored low in this category†¦.. You also been consistently coming to work late. Employee : But I am always here by 8:15. The switchboard doesn’t even open until 8:30. Manager : ( Ad lib from here, and see where it takes you! ) Employee : ( Ad lib from here, and see where it takes you! ) Scenario 2 : Are you done yet? Manager : I know you are working hard on this report I assigned, but you keep getting them to me late. I can’t prepare next year’s budget unless I know exactly how much money each contract brought in this year. So you are going to have to get them into me by tomorrow afternoon, Okay? Employee : Sorry, sometime I have trouble prioritizing†¦.. I didn’t realised they were that important. Manager : Well, they are important, and I need your report on time from now on. Okay? Employee : ( Ad lib from here, and see where it takes you! ) Manager : ( Ad lib from here, and see where it takes you! ) In that manner we can assign different scenario to different groups. STEP 7 : Now the manager and employee are going to provide with a paper and they were asked to write down the behaviour of one other in role play. ( In this way manager appraise their employees performance and employee appraise their managers performance. ) STEP 8 : Finally observer has to share his observation with others.

New Step by Step Roadmap for Fifth Grade Expository Essay Samples

New Step by Step Roadmap for Fifth Grade Expository Essay Samples If you wish to find out more about writing different forms of essays, check out other posts on our blog which is going to teach you the way to compose academic papers successfully. In the same way, a narrow topic won't have sufficient info to compose a productive essay. The Subject Is Essential to Your Success If you go for a subject that is not too suitable for an expository essay, your whole work may be in vain. Why Almost Everything You've Learned About Fifth Grade Expository Essay Samples Is Wrong Writing a high school essay if you've got the tips about how to do essay effectively. There are a lot of ways to compose an outstanding essay, however all expository essays follow the identical essential steps. While writing an essay, it's important to structure it correctly. Make certain each and every sentence of your essay is joined to the thesis. To help you make a productive essay outline here are tips that will be able to help you. The outline will function as a blueprint for your real essay. At times, you'll be asked to compose an expository essay outline. Composition of the essay is crucial to compose an effective essay. The very first portion of your essay ought to be an introduction. An essay must be clear and unbiased. How can you compose a fantastic argumentative essay. If you would like your expository essay to receive high grades and grab interest of the audience, you must always select the topic you want. An introduction is a significant portion of your essay, and that means you should spend plenty of time on its development. To get started writing your assignment you would want to run into an interesting and promising topic. Select your way of writing before you begin your essay. The essay ought to be written so that it's addressed to a particular circle of persons. Each expository essay is designed to recreate in the imagination of the reader a specific image. A fantastic expository essay supplies a comprehensive explanation to the reader. A good sample ought to be clearly written, well-structured, and create the essential points effectively. If you would like your essay to fulfill the requirements, you must always know which variation of the task to use. Good expository writing needs you to understand how to present and compose the info in the right format. Usually, you'll want to choose 1 method for each bit of expository writing. Focus on your language as it ought to be eerror-free Imagine your essay is a precious stone and produce all its faces shine using an easily readable and authentic language. Your analytical question is basically the notion that you would like to investigate in your essay. You need to make sure each bit of evidence within the body of your essay strengthens the concept of your thesis in some manner. You ought to be proficient in the topic, have an overall idea about the chosen issue and figure out how to get the best arguments to show your thesis. In this kind of essay, you should describe something without being metaphoric. It is critical to inspect the subject matter from several angles and perspectives before starting anything. Just continue reading and receive all the info you might require on the way. Additionally, there are times when you truly feel like you don't wish to write anything. For example, you might have a particular sort of essay to fulfill for an assignment that doesn't require that you choose a topic, or as detailed above, you presently have a subject in mind and has to decide on how best to present it and which essay format would be better to use. Remove all unnecessary information and make sure your text is centered on the subject. Developing a simple title will provide your essay direction, and a subject to concentrate on.

Commonly Confused Words Tasteful and Tasty

The words  tasteful and tasty are closely related in meaning and both have favorable connotations, but these two  adjectives are not interchangeable. Definitions Tasteful means having or showing good taste (as in the tasteful decor of the theater). Tasty means flavorful or palatable—usually a reference to something that tastes good (a tasty dessert of pumpkin,  mashed yam, and boiled ginkgo nuts). The antonym of both  tasteful and tasty is tasteless. Examples of Tasteful On the one hand, there is Jay Gatsby, with his shadily acquired resources, his pastel clothes, and preposterous mansion; on the other hand, Tom Buchanan, with his familial inheritance, his tweeds, and his tasteful estate.(Gordon Milne, The Sense of Society. Fairleigh Dickinson University Press, 1977)This is not part of the taupe takeover of interiors or even the achingly chic Martha Stewart stories featuring quietly tasteful spaces with collections of drab ware and bowls of eggs in various shades of brown and blue.(Rita Konig, In the Home, Blah Is Beautiful. The New York Times Style Magazine, March 17, 2016) Examples of Tasty Jamie has easy-to-follow videos featuring recipes for  tasty  treats like 100-calorie poppadoms, which are thin and crispy snacks.(Jamie Oliver: The Celebrity Chef Helps His Youngest Fans. The Guardian, April 26, 2016)Len the local butcher slammed the door of his delivery van. Short, plump, and with a bald pink head, he often joked that he wasnt unlike one of his tasty homemade sausages himself.(Monica McInerney, The Alphabet Sisters. Ballantine, 2005) Usage Notes: Tasteful, Tasty, and Delicious Both adjectives are approving, though tasty usually applies to food and drink and tasteful to anything that shows good taste or is generally agreeable and attractive. The lunch was tasty, and the table arrangement was tasteful to go with it.(Adrian Room, Dictionary of Confusable Words. Routledge, 2000)These two adjectives relate to different senses of the word taste. Tasteful is applied to things that indicate good taste, in the sense of aesthetic discrimination; tasty is applied to things that have good taste, in the sense of flavour: tasteful furnishings - a tasty meal. Careful users maintain the distinction between the two words.(Martin H. Manser, Good Word Guide, 7th ed. Bloomsbury, 2011)Tasteful . . . refers to something that is made or selected with good taste. This especially applies to clothing and decor: We were all very surprised to see the modern bathrooms and tasteful surroundings.Tasty . . . generally refers to food with a pleasant taste: Mussels make a very tasty pasta sauce. However, a tasty bit of news means gossip.Delicious . . . means very pleasant to the taste or smell: What a delicious aroma coming from the kitchen—roast beef and Yorkshire pudding.(Graham Pointon and Stewart Clark,  Words: A Users Guide. Taylor Francis, 2009) Practice Exercise (a) Be sure to leave room for the _____ desserts, which include a chilled lemon soufflà ©, white chocolate and lemon mousse, tropical cheesecake, and crà ¨me brà »là ©e.(Jason R. Rich, The Business Traveler Guide to Orlando. Entrepreneur Media, 2008) (Answer: tasty)(b) When he spoke of Celia I cared not at all. Her pretty manners, the fresh flowers of her parlour, her marvelous needlework and her _____ sketches meant nothing to me. (Answer: tasteful)(Philippa Gregory, Wideacre. Touchstone, 1987)