Chapter 8 Assessment

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Chapter 8 Assessment
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Purposes of Psychosocial Assessment-the purpose
of questions is to obtain information about the
clients perception of the problem.

• To construct picture of clients current
  emotional state, mental capacity, and behavioral
  function
• To form basis for plan of care
• To establish clinical baseline to evaluate
  effectiveness of treatment and interventions

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Factors Influencing Assessment

• Client participation/feedback
• Clients health status
• Clients previous experience with and
  misconceptions about health care
• Clients ability to understand
• Nurses attitude and approach

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How to Conduct the Interview

• Provide a comfortable, private, safe environment.
• Obtain input from family and friends (with
  clients permission).
• Ask questions that are open-ended or closed-ended
  as needed.

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Content of the Assessment

• History
• General appearance and motor behavior-automatisms
  psychomotor retardation, waxy flexibility,
  neologisms(nurse How are your feeling? Client
  I feel, I kneel, do you steal?
• Mood and affect-Labile-exhibits
  unpredicably/rapid mood swings-depress, crying to
  euphoria
• Thought process and content-p. 155-Delusions,
  Idea of reference, loose association, etc. Ex
  Grandiosity-I am the president of the largest
  corporation. Everyone comes to me for advise.
• Assessment of suicide or harm toward others. If
  the client is having suicidal ideas, then
  assessment of lethality should follow.

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Content of the Assessment (contd)

• Sensorium and intellectual processes
  orientation, memory, ability to concentrate(Have
  client repeat the days of week backwards),
  abstract thinking(test what mental
  functions-proverbs) Intellectual
  functioning-What is similar about cow and
  horse?
• Sensory-perceptual alterations-hallucinations
  Illusion-sensory experience is misinterpreted but
  based on fact
• Judgment and insight-assess clients judgement by
  asking the client hypothetical questions-such as
  If you found a stamped addressed envelope on the
  ground, what would you do?
• Self-concept
• Roles and relationships
• Physiologic and self-care concerns

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Data Analysis

• Data analysis follows assessment. Nursing
  diagnoses are formulated for the nursing care
  plan. Depending on the setting, the assessment
  data can be analyzed to form an interdisciplinary
  treatment plan, a plan for home care, or whatever
  system for planning and documenting care is used
  by the agency.

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Psychological Tests

• Psychological tests are another source of data to
  use in planning care. Not all clients are given
  psychological tests.
• Intelligence tests evaluate cognitive abilities
  and intellectual functioning.
• Personality tests reflect self-concept, impulse
  control, reality testing, and major defense
  mechanisms. Personality tests may be objective
  (yielding a numeric score).
• Projective tests are unstructured and the results
  obtained by interview are interpreted by the
  psychologist

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Self-Awareness Issues

• Self-awareness is important for the nurse so that
  personal beliefs, attitudes, or feelings do not
  interfere with the objective assessment of
  clients.
• It may be uncomfortable to discuss areas such as
  suicidal ideas or sexuality issues, but it is
  important for the nurse to do so.
• Being open, clear, direct, and nonjudgmental are
  essential nurse behaviors it may be helpful to
  discuss feelings with a colleague if difficult
  issues are encountered in the assessment process.