DISCUSS FIVE CLINICAL INTEVENTIONS FROM MENTAL HEALTH PRACTISE Module Title: Collaborative Practice in Nursing (Mental Health) 12SB Module Code: NM703
Appendix One: Synopsis
This assignment is based upon a dementia patient I have encountered whilst on placement within a community mental health team. I shall discuss five interventions used to facilitate this patient in functioning in his everyday life; expanding on the fifth intervention which I feel has been the most beneficial and interesting. I’m going to focus purely on non pharmacological interventions, although this service user is on medication. The service user lives within a care home.
The Memory Clinic - Initial Assessment
The service user was referred to the Memory clinic by his GP to test his memory and thinking due to a series of recent memory losses and depression. The NICE guidelines (2007) state the first point of referral of someone with suspected dementia should be a memory assessment service such as the Community Mental Health Team (CMHT) or a Memory clinic.
The role of the Mental Health nurse at the Memory clinic was to assess, provide a diagnosis and help them come to terms with this life changing illness. As stated by Clark (2003) the service user is at the centre of the treatment, with emphasis on helping them understand the disease, adjust to the changes in their life style and suggest options for treatment.
As cited by Page (2003) Memory clinics are outpatient services for people with milder forms of Dementia (Lindesay and Morris 1999). They offer an assessment for diagnosis, an opportunity for the service user to share their stories of recent memory losses and hopefully develop a trusting, therapeutic relationship between the nurse and the service user.
The service user had become increasingly dependent on his daughter and had been forgetting events such as appointments. The service user admitted during the assessment that he had been feeling confused and frustrated. It was explained to him he would need further assessments such as the Mini Mental State Examination (MMSE) and physical assessments to test for all the types of dementia. The service user and his wife was put at ease and reassured when they were told they are medications and therapies that he can use in order to help him cope.
Mini mental state examination (MMSE)
One of the first assessment tools used by the Community Mental Health Nurse (CMHN) at the Memory clinic was the MMSE questionnaire to check the service user’s level of mental impairment.
The MMSE is a commonly used questionnaire testing a person’s mental abilities and how severe the symptoms might be; this is done through asking a series of questions. The test ranges from recognizing objects to identifying the current year. It is based on point scoring of 0 - 30, looking particularly at the person’s memory, attention and language. (www.nhs.uk/Conditions/Dementia/Pages/Diagnosis). The service user got below the point threshold scoring 20; therefore it was apparent he had moderate cognitive impairment.
It has been suggested that the MMSE is a poor screening test, particularly for early detection because people have different levels of education and may not be able to read or write, and in Britain not everyone is English speaking or would know certain history/culture. Innes and Capstick suggest that information derived from these types of assessment tools may tell us very little about a person’s ability to attach meaning to social situations, respond to them and express aspects of selfhood (Innes and Capstick, 2001). This particular service user was English speaking and educated.
The NICE guidelines (2007) state that those interpreting the scores should take full account of other factors known to affect performance,...