The document provides guidance on conducting a comprehensive psychosocial assessment in psychiatric nursing. It discusses key areas to assess including mental status, mood, thought process and content, cognition, risk of harm, relationships, and functioning. The nurse is advised to establish rapport, use open-ended and nonjudgmental questions, and assess for symptoms, stressors, strengths and risks to develop an accurate understanding of the client's situation.

1. Presented by: ERIC F. PAZZIUAGAN, RN, MAN

5.  Involves the collection, organization, and
analysis of information about the client’s
health.
 In psychiatric- mental health nursing, it is
referred to as psychosocial assessment, which
includes a mental status examination.
 Purpose: to construct a picture of the client’s
emotional state, mental capacity and
behavioural function.

6.  Serves as a basis for
developing a plan of care
to meet the client’s needs.
 A clinical baseline data
used to evaluate the
effectiveness of treatment
and interventions or a
measure of the client’s
progress. (ANA, 2007)

8.  If client is unavailable or unwilling to
participate, some areas of the
assessment will be incomplete or vague.
 The nurse may have several contacts
with some clients to complete the
assessment or gather information as the
client’s condition permits.

9.  If client is anxious, tired, or in pain, the nurse
may have difficulty eliciting the client’s full
participation.
 Information gathered may reflect the pain or
anxiety rather than an accurate assessment
of the client’s situation.
 The client may need to rest, receive
medications to alleviate pain, or be calmed
before the assessment continues.

10.  Client’s perception of his own circumstances
can elicit emotions that interfere with
obtaining an accurate psychosocial
assessment.
 If reluctant to seek treatment or has previous
unsatisfactory experiences with the health
care system, he may have difficulty
answering questions directly.

11.  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 perceptions to establish a trusting
working relationship before proceeding with
the assessment.

12.  The nurse must determine the client’s
ability to hear, read, and understand the
language being used in the assessment.
 It is important that the information in
the assessment reflects the client’s
health status; it should not be a result of
poor communication.

13.  If the client perceives the nurse’s questions to
be short and curt or feels rushed or pressured
to complete the assessment, he may provide
only superficial information or omit
discussing problems in some areas
altogether.
 The client may also refrain from providing
sensitive information if her perceives the
nurse as nonaccepting, defensive or
judgmental.

15.  Comfortable, private and
safe for both the client and
the nurse.
 Fairly quiet with few
distractions
 Do not choose an isolated
location for the interview,
particularly if the patient is
unknown or has a history of a
threatening behavior.

16.  Obtain client’s behavior and emotional
state.
 Family or friends may not feel comfortable
talking about the client in his presence and
may provide limited information.
 It is desirable to conduct at least part of
the assessment without others, especially
in cases of suspected abuse or
intimidation.

17.  Use open-ended questions to start the
assessment.
 Allows the client to begin as he feels comfortable
and also gives the nurse an idea about the client’s
perception of his situation.
 Examples of open-ended questions:
 What brings you here today?
 Tell me what has been happening to you.
 How can I help you?

18.  If client cannot organize thoughts, or
has difficulty answering open-ended
questions, the nurse may need to use
more direct questions to obtain
information.
 Questions should be clear, simple and
focused on one specific behavior or
symptom.

19.  “How are your eating and sleeping habits and
have you been taking any over-the-counter
medications that affect your eating and
sleeping?”
 The above question can be confusing to the
client. Questions should not cause the client to
remember several things at once.

20.  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 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?

21.  Use a nonjudgmental tone and language,
particularly when asking about sensitive
information such as drug or alcohol use, sexual
behavior, abuse or violence, and child-rearing
practices.
 Using nonjudgmental language and matter-of-
fact tone avoids giving the client verbal cues to
become defensive or not to tell the truth.

22.  “How often do you physically punish your
child?”
 “What types of discipline do you use?”
 First question: gives the impression that
physical discipline is wrong and it may cause
the client to respond dishonestly.
 Second question: more likely to elicit honest
and accurate information.

24.  History
 General appearance and behavior
 Mood and affect
 Thought process and content
 Sensorium and intellectual process
 Judgment and insight
 Self-concept
 Roles and relationships
 Physiologic and self-care concerns

26.  Previous history
 History of client and his family
 Age and Developmental stage
 Evaluate chronological age and developmental stage for
congruence with expected norms
 Cultural and spiritual beliefs
 To avoid making inaccurate assumptions about
psychosocial functioning
 Ask clients about the beliefs or health practices that are
important to them.
 Consider beliefs on health and illness

27.  Hygiene and grooming
 Unkempt or dishevelled?
 Appears to be his stated age?
 Appropriate dress
 For age and weather?
 PostureEye contact
 Unusual movements or mannerisms
 Unusual tics or tremors?

28.  Speech
 Quantity, quality and any abnormalities
 Nonstop?
 Perseverate? (seems to stuck on one topic
and unable to move to another idea)
 Minimal “yes” or “no” without elaboration?

29.  Rate of speech fast or slow?
 Content relevant to the question?
 Audible or loud?
 Neologisms? (invented words that have
meaning only for client)
 Any speech difficulties or lisping?

31.  Specific terms in general appearance and motor
behavior:
 Automatisms: repeated purposeless behaviors often
indicative of anxiety, such as drumming of fingers,
twisting locks of hair, or tapping of foot.
 Psychomotor retardation: overall slowed
movements
 Waxy flexibility: maintenance of posture or position
over time even when it is awkward or uncomfortable

32.  Mood: refers to the client’s pervasive and
enduring emotional state.
 Affect: outward expression of the client’s
emotional state.
 Assess for:
 Expressed emotions
 Facial expressions
 Inconsistencies

33.  Mood:
 Happy
 Sad
 Depressed
 Euphoric
 Anxious
 Angry
 Labile (rapidly changing)
 May let client estimate intensity of mood using a
scale of 1 to 10.

34.  Common terms for assessing effect:
 Blunted affect: showing little or slow-to-respond
facial expression.
 Broad affect: displaying a full range of emotional
expressions.
 Flat affect: showing no facial expression.
 Inappropriate effect: displaying a facial expression
that is incongruent with mood or situation; often
silly or giddy regardless of circumstances.
 Restricted affect: displaying one type of expression,
usually serious or somber.

35.  Thought process: refers to how the
client thinks.
 Thought content: what the client
usually says.
 Verbalizations makes sense?
 Preoccupied?
 Marked difficulties ?

36.  Circumstantial thinking: a client eventually
answers a question but only after giving
excessive unnecessary detail.
 Delusion: a fixed false belief not based in
reality.
 Flight of ideas: excessive amount and rate of
speech composed of fragmented or unrelated
ideas.

38.  Ideas of reference: client’s inaccurate
interpretation that general events are personally
directed to him or her, such as hearing a speech
on the news and believing the message had
personal meaning.
 Loose associations: disorganized thinking that
jumps from one idea to another with little or no
evident relation between the thoughts.
 Tangential thinking: wandering off the topic and
never providing the information requested.

39.  Thought blocking: stopping abruptly in the
middle of a sentence or a train of thought;
sometimes unable to continue the idea.
 Thought broadcasting: a delusional belief that
others can hear or know what the client is
thinking.
 Thought insertion: a delusional belief that
others are putting ideas or thoughts into the
clients head- that is, the ideas are not those of
a client.

40.  Thought withdrawal: a delusional belief that
others are taking the client’s thoughts away
and the client is powerless to stop it.
 Word salad: flow of unconnected thoughts
that conveys no meaning to the listener.

41.  Determine whether the
depressed or hopeless
client has suicidal ideation
or lethal plan.
 Ask directly “Do you have
thoughts of suicide?” or
“What thoughts of suicide
have you had?”

42.  Suicide assessment questions:
 Ideation: Are you thinking of killing yourself?
 Plan: Do you have a plan to kill yourself?
 Method: How do you plan to kill yourself?
 Access: How would you carry out this plan? Do you
have access to the means to carry out the plan?
 Where: Where would you kill yourself?
 When: When do you plan to kill yourself?
 Timing: What day or time of day to you plan to kill
yourself?

44.  If client is angry, hostile, or making threatening
remarks about a family member, spouse, or
anyone else, the nurse must ask if the client
has thoughts or plans about hurting that
person.
 Questions:
 What thoughts have you had about hurting
(person’s name)?
 What is your plan?
 What do you want to do to (person’s name)?

45.  When a client makes specific threats or has a
plan to harm another person, health care
providers are legally obligated to warn the
person who is the target of the threats or plan
(duty to warn).
 This one situation in which the nurse must
breach the client’s confidentiality to protect
the threatened person.

46.  Orientation
 Recognition of person, place and time
 Knowing who he and where he is and the correct day,
date, and year.
 Order of person, place, and time is significant.
 When a person is disoriented, he first loses track of
time, then place, and finally person.
 Absence of correct information about person, place,
and time is referred to as disorientation, or “oriented x
1” (person only) or “oriented x 2” (person and place).

47. Orientation is not synonymous with
confusion.
A confused person cannot make sense of
his surroundings or figure things out
even though he may be fully oriented.

48.  Memory
 Recent and remote
 Ask questions with verifiable answers
 Are these questions correct?
▪ Do you have any memory problems?
▪ What did you do yesterday?

49.  NO, because the nurse cannot
verify the accuracy of the answers.

50.  Questions to assess memory generally
include the following:
 What is the name of the current president?
 Who was the president before that?
 In what country do you live?
 What is the capital of this state?
 What is your social security number?

51.  Ability to concentrate
 Spell the word world backwards.
 Begin with the number 100, subtract 7,
subtract 7 again and so on. This is called
“serial sevens.”
 Repeat the days of the week backwards.
 Perform a three-part task, such as “Take a
piece of paper in your right hand, fold it in
half, and put it on the floor.”

52.  Abstract Thinking and Intellectual Abilities
 Consider the client’s formal education.
 Abstract thinking: to make use associations or
interpretations about a situation or comment.
 Let client interpret a common proverb
 If the client can explain the proverb correctly, his
thinking abilities are intact.
 When client continually gives literal interpretations,
this is evidence of concrete thinking.

53.  A stitch in time saves nine.
 People who live in glass stones
shouldn’t throw stones.

54.  A stitch in time saves nine.
 Abstract: If you take the time to fix
something now, you’ll avoid bigger
problems in the future.
 Literal: Don’t forget to sew up holes
in your clothes.

55.  People who live in glass houses
should not throw stones.
 Abstract: Don’t criticize others for
things you also may be guilty of doing.
 Literal: If you throw a stone at a glass
house, the glass will break.

56.  May also assess intellectual functioning
by asking him similarities between pairs
of objects:
 What is similar between an orange and an
apple?
 What do the newspaper and the TV have in
common?

57.  Hallucinations: false sensory perceptions
or perceptual experiences that do not
really exist.
 Can involve the five senses
 Auditory hallucinations: most common
 Visual hallucinations: second most
common

59.  Judgment: refers to the ability to interpret one’s
environment and situations accordingly.
 May be evidenced as the client describes recent
behavior and activities that reflect a lack of care
for self or others.
 Risky behaviors (picking up strangers in bars,
unprotected sexual encounters) may indicate
poor judgment.
 May ask: “If you found a stamped address
envelope on the ground, what would you do?”

60.  Insight: ability to understand the true nature of
one’s situation and accept some personal
responsibility for the situation.
 The nurse can frequently can infer insight from
the client’s ability to describe realistically the
strengths and weaknesses of his behavior.
 Examples of poor insight:
 Not accepting responsibility on for drinking and
fighting
 Expecting all problems to be solved with little or no
personal effort.

62.  Self-concept: the way one views oneself in
terms of personal worth and dignity.
 Ask the client to describe himself and what
characteristics he likes and what he would
change.
 Let client describe self in terms of physical
characteristics
 Include:
 Emotions frequently experiences
 Whether comfortable with those emotions

63.  Assess coping strategies:
 What do you do when you have a problem?
 How do you solve it?
 What usually works to deal with anger or
disappointment?

64.  Assess the roles the client occupies, client
satisfaction with those roles, and whether the
client believes he or she is fulfilling the roles
adequately.
 Number and types of roles vary but may
include:
 Family, occupation, and hobbies or activities.

65.  Relationships with other people are
important to one’s social and emotional
health.
 Relationships vary in terms of significance,
level of intimacy or closeness, and intensity.
 Inability to sustain satisfying relationships
can result from mental health problems or
can contribute to the worsening of some
problems.

66.  Common questions:
 Do you feel close to your family?
 Do you have or want a relationship with a
significant other?
 Are your relationships meeting your needs for
companionship or intimacy?
 Can you meet your sexual needs satisfactorily?
 Have you been involved in any abusive relationship?

68.  Although a full physical health assessment
may not be indicated, emotional problems
often affect some areas of physiologic
function.
 Ask if there is any major or chronic health
problems and how he takes prescribed
medications as ordered and follows dietary
recommendations.
 Explore use of alcohol and OTC or illicit drugs.

69.  Noncompliance with prescribed medications:
important area.
 Help the client feel comfortable enough to
reveal the information.
 Explore barriers to compliance.
 Undesirable effects?
 Failure to produce desired results?
 Difficult to obtain?
 Too expensive?

71.  Full name
 Gender
 Age
 DOB
 Address
 Marital status
 Family members’
 Partners’ significant others’ names and
ages

72.  Date and time of admission and type of
admission (voluntary or committed)

73.  Current problem as perceived by the
patient
 Stressors
 Difficulty with coping
 Developmental issues
 Emergency issues (suicidal or homicidal
ideas and attempts, aggression,
destructive behaviors, risk of escape)
 Family history

74.  Dates
 Inpatient or outpatient
 Reasons for and types of treatment and
their effectiveness
 Current medications
 Compliance

75.  Allergies
 Result of laboratory tests
 X-rays
 Examinations

76.  Amount
 Frequency
 Duration of past and present use legal
and illegal substances
 Date and time of last use
 Potential for withdrawal symptoms

77.  Sleep
 Intake
 Elimination
 Sexual activity
 Work
 Leisure
 Self-care
 hygiene

78.  Ethnicity
 Beliefs
 Practices
 Religious preference

79.  Amount of contact
 Nature and quality of relationships
 Availability of support