Assessment in psychiatric mental health nursing
By: Sheila L. Videbeck
Assessment is the first step of the nursing process and
involves the collection,
organization, and analysis of information about the client’s health (American
Nurses Association
[ANA], 2000).
In psychiatric mental health nursing, this process is often
referred to as a psychosocial assessment, which includes a mental
status examination. The
purpose of the psychosocial assessment is to construct a picture of the client’s
current emotional state, mental capacity, and behavioral function. This assessment
serves as the basis for developing a plan of care to meet the client’s needs.
The assessment
is also a clinical baseline used to evaluate the effectiveness of treatment
and interventions or a measure of the client’s progress (ANA, 2000).
FACTORS INFLUENCING ASSESSMENT
Client Participation/Feedback
A thorough and complete psychosocial assessment requires active client participation. If the client is unable or unwilling to participate, some areas of the assessment will be incomplete or vague. For example, the client who is extremely depressed may not have the energy to answer questions or complete the assessment. Clients exhibiting psychotic thought processes or impaired cognition may have an insufficient attention span or may be unable to comprehend the questions being asked. The nurse may need to have several contacts with such clients to complete the assessment or gather further information as the client’s condition permits.Client’s Health Status
The client’s health status also can affect the psychosocial assessment. If the client is anxious, tired, or in pain, the nurse may have difficulty eliciting the client’s full participation in the assessment. The information that the nurse obtains may reflect the client’s pain or anxiety, rather than be an accurate assessment of the client’s situation. The nurse needs to recognize these situations and deal with them before continuing the full assessment. The client may need to rest, receive medications to alleviate pain, or be calmed before the assessment can continue.Client’s Previous Experiences/Misconceptions About Health Care
The client’s perception of his or her circumstances can elicit emotions that interfere with obtaining an accurate psychosocial assessment. If the client is reluctant to seek treatment or has had previous unsatisfactory experiences with the health care system, he or she may have difficulty answering questions directly. The client may minimize or maximize symptoms or problems or may refuse to provide information in some areas. The nurse must address the client’s feelings and perceptions to establish a trusting, working relationship before proceeding with the assessment.Client’s Ability to Understand
The nurse also must determine the client’s ability to hear, read, and understand the language being used in the assessment. If the client’s primary language differs from that of the nurse, the client may misunderstand or misinterpret what the nurse is asking, which results in inaccurate information. A client with impaired hearing also may fail to understand what the nurse is asking. It is important that the information in the assessment reflects the client’s health status; it should not be a result of poor communication.Nurse’s Attitude and Approach
The nurse’s attitude and approach can influence the psychosocial assessment. If the client perceives the nurse’s questions to be short and curt or feels rushed or pressured to complete the assessment, he or she may provide only superficial information or omit discussing problems in some areas altogether. The client also may refrain from providing sensitive information if he or she perceives the nurse as non-accepting, defensive, or judgmental. For example, a client may be reluctant to relate instances of child abuse or domestic violence if the nurse seems uncomfortable or non-accepting. The nurse must be aware of his or her own feelings and responses and be able to approach the assessment matter-of-factly.References
Sheila L. Videbeck, 2005, PsychiatricMental Health Nursing,
second edition
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