FACTORS INFLUENCING ASSESSMENT
A thorough and complete psychosocial assessment requires active client participation. If the client is unable or unwilling to participate, some areas of the assessment will be incom-plete or vague. For example, the client who is extremely depressed may not have the energy to answer questions or complete the assessment. Clients exhibiting psychotic thought processes or impaired cognition may have an insuf-ficient attention span or may be unable to comprehend the questions 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.
The client’s health status also can affect the psychosocial assessment. If the client is anxious, tired, or in pain, the nurse may have difficulty eliciting the client’s full partici-pation in the assessment. The information that the nurse obtains may reflect the client’s pain or anxiety rather than an accurate assessment of the client’s situation. The nurse needs to recognize these situations and deal with them before continuing the full assessment. The client may need to rest, receive medications to alleviate pain, or be calmed before the assessment can continue.
The client’s perception of his or her circumstances can elicit emotions that interfere with obtaining an accurate 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 cli-ent’s feelings and perceptions to establish a trusting work-ing relationship before proceeding with the assessment.
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 differs from that of the nurse, the client may misunderstand or misin-terpret what the nurse is asking, which results in inaccu-rate information. A client with impaired hearing also may fail to understand what the nurse is asking. It is impor-tant that the information in the assessment reflects the client’s health status; it should not be a result of poor communication.
The nurse’s attitude and approach can influence the psy-chosocial 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 discussing problems in some areas altogether. The client also may refrain from providing sensitive information if he or she perceives the nurse as nonaccepting, defensive, or judgmental. For example, a client may be reluctant to relate instances of child abuse or domestic violence if the nurse seems uncom-fortable or nonaccepting. The nurse must be aware of his or her own feelings and responses and approach the assess-ment matter-of-factly.