Mental health articles

In its broadest sense assessment permeates all aspects of nursing care. It is not just a discrete activity that initiates the ‘nursing process’ or ‘problemsolving cycle’, leading to a plan of care, which is implemented and evaluated. The preferences people have for different health care options (planning) necessitate assessment, as do their abilities to engage meaningfully with the intervention itself (implementation), and evaluation requires still further assessment activity. Even then, it would be incorrect to suggest that assessment occurs only at these key points in the nursing process.

It is an ongoing cycle of activity that all nurses perform in all nursing situations. Assessment may be implicit or explicit, informal or formal. It may involve simply noting a person’s appearance and behaviour during a home visit or observing someone who is deemed to be at risk over extended periods. It can involve structured instruments that specify the type or severity of problem that someone experiences, or it may take the form of a seemingly casual conversation. Common to all types of assessment is the collection of information. The information we collect as nurses must be meaningful and necessary. Assessment data traditionally describe a person’s appearance and behaviour, or their presentation and performance, or again, the form and function of their thoughts and feelings.

Barker (1997) emphasizes the importance of these two viewpoints and their use by nurses to better understand a person. However, Barker cautions also against simply collecting data on the form and function of a person’s thoughts and feelings, which can contribute to the formation of a medical diagnosis but will tell us little else about the person in the broader context of their life. Diagnosis is therefore one ‘bit’ of assessment, which focuses typically on problems, deficits and abnormalities. More broadly, assessment information encompasses a person’s overall sense of self and their position in life, including not only problems and diagnoses but also their assets and strengths (Barker 1997). The collection of information is only one part of the assessment process. Savage (1991) and Barker (1997) point to the inferences nurses draw from the available data, and the decisions they make regarding a person’s need for care. Assessment is therefore a two-stage process. It is not enough to simply gather information; we must be able to do something useful with it, and that use is nursing’s purpose.

Hence, assessment is central to all nursing activity. Barker has defined mental health nursing assessment as ‘the decisionmaking process, based upon the collection of relevant information, using a formal set of ethical criteria, which contributes to an overall evaluation of a person and his circumstances’. This definition is useful since it implies the ongoing nature of assessment by referring to ‘the decisionmaking process’, which we take to be continuous and ever present in the activities of a nurse. Barker highlights also the importance of a ‘… formal set of ethical criteria’, referring to such issues as confidentiality, note keeping, our style of interaction, how we ask questions, what we ask and why.

We would add to Barker’s definition by stating that evaluations can be made also of groups and communities. Group programmes may involve assessment of the group’s cohesion, the balance of its members or their aggregate characteristics. Community assessments are increasingly important in contemporary care. For example, knowledge of a locality’s geography, social structures, deprivation and resources is important for outreach teams that work with drug users or with those who experience severe symptoms of mental disorder.

Tags: assessment, Mental health, mental health nursing, nursing