Fundamentals of Assessment

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Fundamentals of Assessment

• If you think communication is all talk, you have
  not been listening

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Roles that are inherent to assessing your client

• Perception
• Readiness
• Psychophysiologic processes
• Socioeconomic forces
• Educational level
• Adaptation

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Perception

• How you perceive yourself may be very different
  from how others perceive you.
• Your clients tend to perceive themselves in
  response to how you react to them.
• Do you perceive that they are dumb or smart,
  motivated or unmotivated, hopeful or hopeless,
  uncooperative or cooperative, a pain or a
  pleasure.

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Thoughts

• How do you think you would treat someone, in the
  context of teaching them a skill, if you
  perceived that they were unmotivated?
• How do you think your client would perceive
  themselves if, during the initial care of a new
  colostomy, you became physically ill or
  demonstrated negative facial expression?

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Your Perceptions

• Just as your clients perceptions are molded by
  physiologic, psychologic, sociologic and cultural
  history, so are yours.
• The world in which you live/grew up in, may be
  quite different from that of your client.
• How could this difference enhance or undermine
  your ability to teach the client?

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Perception

• You pay attention to what you believe is
  important.
• You neglect things that you do not value.
• It is easier for you to hear ideas that already
  fit into your belief system.
• It is easier to hear messages from those you
  respect.

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Listening and PerceptionWe Hear----

• What we expect to hear.
• What we want to hear.
• Other ways when the speaker acts mad, sad or
  scared.

• Through the perspective of our reference group.
• One way when the speaker acts friendly.

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Readiness for ListeningThe amount we hear is
more when

• We feel good
• It comes from a person on our level
• When an idea or speaker is important to us
• When an idea fits our beliefs
• When the message makes sense to us
• When we want to hear
• When we pay attention

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Readiness to Learn
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The ability to engage in a learning
activitydepends on

• Arousal/Motivation
• Relevant preparatory training
• Physiological maturation

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Motivation

• An aroused interest
• What is your clients confidence level?
• What are their perceptions of their chances for
  success?
• Do clients consider themselves instrumental in
  their own healing?
• What about support systems?

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Willingness to learn

• Is your client willing to learn behaviors that
  will have long term favorable consequences yet
  cause immediate discomfort?
• Are they willing to admit the hazards of their
  current lifestyle?

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Experiential Readiness

• What do they bring to the table?
• What do they already know?
• Why is this important?

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Psychophysiologic Processes
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Level of Wellness

• Remember Maslows hierarchy of needs?
• What was most important?
• Clients that are acutely ill are concerned with
  survival.
• Illnesses may also be accompanied by pain,
  confusion, disability, fear, etc.
• All are impediments to the learning process.

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Level of Wellness

• Medications may cloud judgment/perception.
• IS this a good time to teach the client?
• The only information of benefit to the client at
  this stage is what will relieve my fear, pain,
  discomfort, etc.

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McHattonEmotional adjustment to illness

• Impact loss of control, anxiety, despair
• Regression denial, flight, need for love and
  belonging
• Acknowledgement Self-negating statements and
  lack of confidence
• Reconstruction expression of need for
  self-actualization and realizing potential
• Sound vaguely familiar?

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SuchmanAdaptation to illness

• Symptom experience something is wrong
• Assumption of sick role Acts as if sick
• Medical care contact legitimizes illness by
  seeking help
• Assumption of dependent patient role
• Recovery (client is ready to resume normal
  role)here is where teaching would be most
  effective

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The environment

• Convalescence rarely happens in the hospital
• Home
• Home health clients need support, supervision and
  instruction

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Benefits of home

• Family
• Support system
• Typically interested in what will help them
  resume their normal life
• Recover and learn more quickly in their own
  territory

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Chronic illness vs. acute illness

• Remember experiential learningwhat the client
  brings to the table?
• Clients who have suffered from chronic illnesses
  may very well know more about their care than
  you.
• This is okaythe roles may be reversed.
• Take the opportunity to learn.

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Chronic

• Clients with chronic illnesses will have
  exacerbations and remissions.
• May grow weary, especially during an exacerbation
• Best time to teach is during the remission phase.

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Prevention and promotion

• There will be those clients interested in
  preventing illness who require teaching.
• People in good health are generally open to a
  wide range of health teaching.

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Socioeconomic Forces
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The haves and the have nots

• If you have money and emotional resources, you
  can purchase what you need to sustain you as you
  recover from your illness or you can purchase
  what you need to enhance what functions you have
  left.
• If you have no money and no emotional resources,
  you are at risk for not reaching your full
  potential.

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Socioeconomic factors in reverse

• Lets say that you have money and emotional
  resourcesthen you get sick.
• You can no longer work
• You could lose your insurance (depending upon the
  disease..HIV)
• How can this impact recovery?

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Educational Level

• The higher the level of education, the greater
  the knowledge base.
• The higher the level of education, the more
  likely one is to engage in health promotion
  activities.
• How can you tell?

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Educational Level

• Vocabulary
• People do not necessarily read at their
  educational level
• The mean literacy level in the US is 10th grade
• Clients with less education are less likely to
  comprehend the technical language you may use

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Adaptation

• What you do to counter stress and reduce its
  effects.
• We are in a constant state of adaptation
• Two ways to cope Face it or deny it
• There are times when denial is okayfor the short
  term
• Helps the patient maintain some control

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Adaptation

• Denial can also be destructive
• The client can distort or disregard all you are
  trying to teach them
• Direct confrontation may work to arouse anger but
  anger can be energizing.
• How well the client adapts to an illness will
  depend largely on what their self-concept was
  before they became ill. ---intrinsic worth

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Intrinsic worth

• High self esteem---face the challenge and
  overcome it
• Low self esteemgive up

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Severity of the illness

• Severity of the illness and its impact on the
  clients lifestyle also impact adaptation
• Sore throatsinger.sore throatconstruction
  worker
• Loss of a finger to a piano player
• Loss of a leg to a runner

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The role of the family

• The necessity of a solid support system cannot be
  underestimated.
• Families also have to adapt to the illness of a
  family member
• You need to be sensitive to the family dynamics

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Communication Difficulties

• Hearing Impairments
• Vision Impairments
• Language Impairments
• How you can contribute to communication
  difficulties

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The Teaching/Learning Environment

• You are a critical subsystem in the
  teaching/learning system
• Your relationship with your client will impact
  the success of your teaching
• Warmth, caring, mutual respect

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The Physical Environment

• Often overlooked
• Space, temperature, stimuli, equipment,
  resources, furniture arrangement

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Time

• Do not try and cram too much into one learning
  session
• Remember 5-7 new thoughts in the short term
  memory

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Task---select one

• Share one example in which the clients
  perception of his/her health status was different
  from yours.
• Describe a situation in which it was hard to
  relate to a client. Why do you think this
  occurred? What factors in you and the client made
  it hard for you to understand each others
  perceptions?

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Communication

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