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Opinion

'I felt overwhelmed by the amount of new information and new experiences I was exposed to'

Niall found an innovative way of remembering everything he needed to complete mental state examinations

I am currently a first year student of mental health nursing at the University of the West of England, UK. The course includes two clinical placements a year and my first placement was on an adult acute in-patient ward serving an inner city area.

I had no previous experience of mental health nursing, but before starting the placement I had attended theory and practice modules and of particular interest to me was the subject of mental state examinations (MSE).

Generally carried out during an initial or intake interview, an MSE aims to combine a mental health practitioner’s objective assessment of a patient with the patient’s subjective account of their experience (Polanski and Hinkle, 2000). It is an important process as it provides the team caring for the individual with initial screening information which can be used to plan further assessment or care.

I was aware of the need to assess patients in a concise and time-efficient way, but also knew I needed to assess patients as people, with their own narrative, their particular experience of their mental health problem and their own complex needs.

As Barker’s Tidal Model proposes, treatment “begins and ends with a patient’s story” and it is thus important to write an MSE within the frame of reference of a patient’s experience using their language and terminology.

It is also important for the MSE to be written in a way that is accessible to other members of the team involved with a patient and takes into account their different approaches to care. The struggle for anyone carrying out an MSE is therefore to write in a language that is both true to a patient’s frame of reference while being understandable by the various professionals who will subsequently use this to plan care.

As a first year student experiencing an acute in-patient ward for the first time, I felt overwhelmed by the amount of new information and new experiences I was exposed to. As is generally the case for student nurses, the resulting anxiety prevented me from functioning to the best of my ability (Schmeiser and Yehle, 2001).

Although I have a masters in journalism and am well versed in interviewing techniques and reporting, I found it difficult to remember all the necessary information I needed to gather from a patient, especially while keeping the interview conversational.

In my previous studies I found mnemonics of great use and felt that a mnemonic would help me memorise key tasks associated with conducting assessments under pressure.

On the ward, I was asked to assist with writing patient notes at the end of each shift. I initially found it difficult to remember which observations I needed to include in my notes, but found that by rearranging the list of subject headings provided in the assessment and note-taking guidance by the local trust, I could form the mnemonic BASMATI (Behaviour, Appearance, Speech, Mood, Abnormal perceptions, Thoughts, Insight).

The subject headings were consistent with the MSE. I then developed this mnemonic to aid the process of remembering the various components necessary to carry out as holistic a MSE as possible.

During a study day in university I was encouraged to share the mnemonic with my class who gave me constructive feedback and added to it. Back on the acute in-patient ward, I showed it to the ward psychiatrist in order to gain his opinion and feedback; he asked me if he could keep a copy for his own use.

I am aware that in mental health services, the specific words used to define people’s experiences differ greatly, and I am unaware of all the different terminology in use. My aim as a new student was to be able to comprehensibly observe and contribute to assessment and record keeping while providing person-centred care.

BASMATI

B – Behaviour:

Present: eye contact, gait, tics, activity/arousal (hyperactivity/stupor), tremors, responding, sleeping and eating patterns, self soothing behaviours, behavioural predictors, sexual disinhibition etc…

Past: Previous substance abuse, anger management problems, violence, sexualised behaviour, criminal record etc…  

A - Attitude/rapport: warm, cooperative, uncooperative, hostile, guarded, suspicious, brittle, regressed etc…

A – Appearance: level of self care/cleanliness, skin colour, smell, clothing, signs of drug abuse and/or self harm etc…

S – Speech: Character: loudness, rhythm, intonation, pitch, articulation, quantity, rate, spontaneity, pressure of speech etc…

Content: Personal narrative, experience of their mental health problem, perceived needs etc…

MMood: how the person describes their mood eg. Euthymic, depressed, elated, anxious, angry, labile, suicidal ideation, deliberate self harm intent etc…

AAffect: how you perceive them: normal, blunted, exaggerated, flat, heightened, overly dramatic etc…

AAbnormal perceptions: Aural, visual, olfactory, tactile hallucinations, etc…

TThought:

Process: Flights of ideas, retarded/inhibited, erratic, disordered, repetitive/fixated/ruminating, blocked, knight’s move thinking etc…

Content: Delusions, overvalued ideas, obsessions, phobias and preoccupations, religious/spiritual beliefs etc…

IInsight and orientation: Judgment, orientation in time and place, capacity.

IInteractions: Interactions with other service users & staff (if in an inpatient setting) or members of their community or the general public (if in a community setting), past interaction with mental health and other services (police, social services etc…), important relationships eg. family, partner, children, social network etc…

 

Niall O’Loingsigh is a first year mental health nursing student at University of the west of England

Readers' comments (1)

  • I remember when I first started writing notes & doing MSEs, I was terrified & thought I would never get the hang of it. It's not quite second nature but I'm getting there! I think as you become more experienced you know what to look out for in assessments & then can just record all the information neatly within the framework of the MSE. Thanks for sharing this mnemonic, I'm going to use it on my next placement in a few weeks.

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