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 cur-
rent emotional state, mental capacity, and behavioral
function. This assessment serves as the basis for de-
veloping 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 re-
quires active client participation. If the client is unable
or unwilling to participate, some areas of the assess-
ment will be incomplete or vague. For example, the
client who is extremely depressed may not have the
energy to answer questions or complete the assess-
ment. Clients exhibiting psychotic thought processes
or impaired cognition may have an insufficient atten-
tion span or may be unable to comprehend the ques-
tions 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 psycho-
social 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 continu-
ing the full assessment. The client may need to rest,
receive medications to alleviate pain, or be calmed be-
fore 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 accu-
rate 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 percep-
tions to establish a trusting, working relationship be-
fore 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 dif-
fers from that of the nurse, the client may misunder-
stand or misinterpret what the nurse is asking, which
results in inaccurate information. A client with im-
paired 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 dis-
cussing problems in some areas altogether. The client
also may refrain from providing sensitive information
if he or she perceives the nurse as nonaccepting, de-
fensive, or judgmental. For example, a client may be
reluctant to relate instances of child abuse or domes-
tic 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 as-
sessment matter-of-factly.HOW TO CONDUCT THE INTERVIEW
Environment
The nurse should conduct the psychosocial assess-
ment in an environment that is comfortable, private,
and safe for both the client and the nurse. An envi-
ronment that is fairly quiet with few distractions al-
lows the client to give his or her full attention to the
interview. Conducting the interview in a place such
as a conference room assures the client that no one
will overhear what is being discussed. The nurse
should not choose an isolated location for the inter-
view, however, particularly if the client is unknown
to the nurse or has a history of any threatening be-
havior. The nurse must ensure the safety of self and
client even if that means another person is present
during the assessment.158 Unit 2 BUILDING THENURSE–CLIENTRELATIONSHIP