Input From Family and Friends
If family members, friends, or caregivers have accom-
panied the client, the nurse should obtain their per-
ceptions of the client’s behavior and emotional state
(McBride & Walden-McBride, 1995). How this is done
depends on the situation. Sometimes the client does
not give permission for the nurse to conduct separate
interviews with family members. The nurse should
then be aware that friends or family may not feel com-
fortable talking about the client in his or her presence
and may provide limited information. Or the client
may not feel comfortable participating in the assess-
ment without family or friends. This, too, may limit
the amount or type of information the nurse obtains.
It is desirable to conduct at least part of the assess-
ment without others especially in cases of suspected
abuse or intimidation. The nurse should make every
effort to assess the client in privacy in cases of sus-
pected abuse.
How to Phrase Questions
The nurse may use open-ended questions to start the
assessment (see Chap. 6). Doing so allows the client
to begin as he or she feels comfortable and also gives
the nurse an idea about the client’s perception of his
or her situation. Examples of open-ended questions
are as follows:
- What brings you here today?
- Tell me what has been happening to you.
- How can we help you?
If the client cannot organize his or her thoughts
or has difficulty answering open-ended questions, the
nurse may need to use more direct questions to ob-
tain information. Questions need to be clear, simple,
and focused on one specific behavior or symptom;
they should not cause the client to remember several
things at once. Questions regarding several different
behaviors or symptoms—“How are your eating and
sleeping habits, and have you been taking any over-
the-counter medications that affect your eating and
sleeping?”—can be confusing to the client.
The following are examples of focused or closed-
ended questions: - How many hours did you sleep last night?
- Have you been thinking about suicide?
- How much alcohol have you been drinking?
- How well have you been sleeping?
- How many meals a day do you eat?
- What over-the-counter medications are you
taking?
The nurse should use a nonjudgmental tone and
language particularly when asking about sensitive in-
formation such as drug or alcohol use, sexual behavior,
abuse or violence, and childrearing practices. Using
nonjudgmental language and a matter-of-fact tone
avoids giving the client verbal cues to become defen-
sive or to not tell the truth. For example, when ask-
ing a client about his or her parenting role, the nurse
should ask, “What types of discipline do you use?”
rather than, “How often do you physically punish your
child?” The first question is more likely to elicit honest
and accurate information; the second question gives
the impression that physical discipline is wrong, and
it may cause the client to respond dishonestly.CONTENT OF THE ASSESSMENT
The information gathered in a psychosocial assess-
ment can be organized in many different ways. Most
assessment tools or conceptual frameworks contain
similar categories with some variety in arrangement
or order. The nurse should use some kind of organiz-
ing framework so that he or she can assess the client
in a thorough and systematic way that lends itself to
analysis and serves as a basis for the client’s care. The
framework for psychosocial assessment discussed here
and used throughout this textbook contains the fol-
lowing components:- History
- General appearance and motor behavior
- Mood and affect
- Thought process and content
- Sensorium and intellectual processes
- Judgment and insight
- Self-concept
- Roles and relationships
- Physiologic and self-care concerns
Box 8-1 lists the factors that the nurse should
include in each of these areas of the psychosocial
assessment.
History
Background assessments include the client’s history,
age and developmental stage, cultural and spiritual
beliefs, and beliefs about health and illness. The his-
tory of the client, as well as his or her family, may pro-
vide some insight into the client’s current situation.
For example, has the client experienced similar diffi-
culties in the past? Has the client been admitted to the
hospital, and, if so, what was that experience like? A
family history that is positive for alcoholism, bipolar
disorder, or suicide is significant because it increases
the client’s risk for these problems.
The client’s chronologic age and developmental
stage are important factors in the psychosocial as-
sessment. The nurse evaluates the client’s age and de-
velopmental level for congruence with expected norms.
For example, a client may be struggling with personal
identity and attempting to achieve independence from8 ASSESSMENT 159