8 ASSESSMENT 169
(Schultz & Videbeck, 2002). Although the DSM-IV-
TR is not a substitute for a thorough psychosocial
nursing assessment, the descriptions of disorders and
related behaviors can be a valuable resource for the
nurse to use as a guide. The DSM-IV-TR uses a multi-
axial system to provide the format for a complete psy-
chiatric diagnosis:
- Axis I:clinical disorders, other conditions
that may be a focus of clinical attention - Axis II: personality disorders, mental
retardation - Axis III: general medical conditions
- Axis IV: psychosocial and environmental
problems - Axis V: global assessment of functioning
(GAF)
The psychosocial and environmental problems
categorized on Axis IV include educational, occupa-
tional, housing, financial, and legal problems as well
as difficulties with the social environment, relation-
ships, and access to health care.
The GAF is used to make a judgment about the
client’s overall level of functioning (Box 8-4). The
GAF score given to the client may describe his or her
current level of functioning as well as the highest
level of functioning in the past year or 6 months. This
information is useful in setting appropriate goals for
the client’s care.
SELF-AWARENESS ISSUES
Self-awareness is crucial when a nurse
is trying to obtain accurate and complete information
from the client during the assessment process. The
nurse must be aware of any feelings, biases, and
values that could interfere with the psychosocial as-
sessment of a client with different beliefs, values, and
behaviors. The nurse cannot let personal feelings and
beliefs influence the client’s treatment. Self-awareness
does not mean the nurse’s beliefs are wrong or must
change, but it does help the nurse to be open and ac-
cepting of others’ beliefs and behaviors even when the
nurse does not agree with them.
Two areas that may be uncomfortable or difficult
for the nurse to assess are sexuality and self-harm be-
haviors. The beginning nurse may feel uncomfortable,
as if prying into personal matters, when asking ques-
tions about a client’s intimate relationships and be-
havior and any self-harm behaviors or suicide. Asking
such questions, however, is essential to obtaining a
thorough and complete assessment. The nurse needs
to remember that it may be uncomfortable for the
client to discuss these topics as well.
The nurse may hold beliefs that differ from the
client’s, but he or she must not make judgments about
the client’s practices. For example, the nurse may be-
lieve abortion is a sin, but the client might have had
several elective abortions. Or the nurse may believe
that adultery is wrong, but during the course of an as-
sessment he or she may discover that a client has had
several extramarital affairs.
Being able to listen to the client nonjudgmentally
and to support the discussion of personal topics takes
practice and usually gets easier with experience. Talk-
ing to more experienced colleagues about such dis-
comfort and methods to alleviate it often helps. It may
also help for the nurse to preface uncomfortable ques-
tions by saying to the client, “I need to ask you some
personal questions. Remember, this is information
that will help the staff provide better care for you.”
The nurse must assess the client for suicidal
thoughts. Some beginning nurses feel uncomfortable
discussing suicide or feel that asking about suicide
might suggest it to a client who had not previously
thought about it. This is not the case. It has been
shown that the safest way to assess a client with sus-
pected mental disorders is to ask him or her clearly
and directly about suicidal ideas. It is the nurse’s pro-
fessional responsibility to keep the client’s safety needs
first and foremost, and this includes overcoming any
personal discomfort in talking about suicide (Schultz
& Videbeck, 2002).Points to Consider When Doing
a Psychosocial Assessment- The nurse is trying to gain all the informa-
tion needed to help the client. Judgments are
not part of the assessment process. - Being open, clear, and direct when asking
about personal or uncomfortable topics will
help to alleviate the client’s anxiety or hesi-
tancy about discussing the topic. - Examining one’s own beliefs and gaining
self-awareness is a growth-producing
experience for the nurse. - If the nurse’s beliefs differ strongly from
those of the client, the nurse should express
his or her feelings to colleagues or discuss
the differences with them. The nurse must
not allow personal beliefs to interfere with
the nurse–client relationship and the assess-
ment process.
➤ KEY POINTS
- 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 baseline clinical
picture serves as the basis for developing a
plan of care to meet the client’s needs.