Chapter 13-Psychosocial Assessment

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Psychosocial Assessment

Complex process that involves the use of good communication skills, appropriate interview questions and purposeful observation and relevant assessment tools.

Visual and Hearing Impairments

Can affect the older adults ability to perceive nonverbal messages.

Type of Communication Barrier

Communication Barriers

Too much info being requested at one time
Too many people trying to communicate at one time
Environmental noise
Physical Discomfort (have to urinate etc)

Phrases like "Why cry over spilled milk?" Grandma, Everything's going to be ok etc. may?

Interfere with the ability to develop a sense of trust that is necessary for discussing psychosocial issues.

Good Communication Skills

Exhibited by introducing yourself, explaining your role and then asking the person his or her preferred name and use the wristband to confirm information.

Touch

Widely recognized as an important communication tool.

Attentive Listening

Important communication skill and it can be particularly effective as a psychosocial assessment tool and to communicate respect and caring.

"Mrs. P, you mentioned that your daughter doesnt want you living with her"

Gives feedback about what the nurse heard and leads into further questions about underlying feelings
AKA- FEEDBACK

Face to Face Positioning

Facilitates verbal as well as nonverbal communication and is particularly important when visual or hearing impairments interfere with communication
*Ppl feel more comfy when at same level

Comfort Zone

Physical space that makes person at ease when communicating with others.

Displaying Privacy

Closing the door and pulling the bed curtain.

Asking permission

Shows respect for person's territory and may be particularly important when talking with people who become anxious when they are in closed spaces (RE: Closing the door)

MINI COG

Consists of three word recall and simple clock drawing test.

Physical Appearance

Clothing, grooming, cosmetics and hygiene provide CLUES, but questions need to be asked.
Self Image

Motor function

Posture
Movement
Body Language
Can Provide Clues to Broader aspects of psychosocial function.

Social Skills

Friendly and cooperative with good conversational skills
OR
Hostility, Social Isolation, Poor Social Skills and Lack of Ambition.

Response to the Interview

Older adult may initially be very receptive to questions but may become defensive or sarcastic when uncomfortable with the line of questioning

Alertness

Measured along a continuum including stupor, drowsiness, somnolence etc.
Clue: Excessive daytime drowsiness can mean other physiologic issues

Attention

Ability to focus on task and filter out distractions.

Memory

Persons recal of recent past events.
Assess especially in relation to activites what are important in daily life like remembering to pay bills.

Speech and Language Characteristics

Assessing Pace, tone, volume, articulation, ability to organize and communicate thoughts.

Asses through observations about how older adults meet their needs in a particular situation.

Problem Solving Abilities

Insight

Ability to understand the significance of the present situation
*Establishes a basis for planning care

Affect

Refers to mood, emotions and expressions of emotions.

Mood

Closely associated with emotions but differs from them in that it is more pervasive, less intense and longer lasting.

Anxiety

Feeling of distress subjectively experinced as fear or worry

"Youre wasting your time on me you have more important things to do"

Low Self esteem

Rigidity, Procrastination, Uncessary Apologies, Lack of Confidence

Low Self Esteem

Assessing Depression

"How are you feeling right now?" This Week??

Delusions

Fixed false beliefs that have little or no basis in reality and cannot be corrected by appealing to reason. People use this to preserve their egos, maintain control over threatening situations, organize info that is hard to process.
*Paranoia is the most common type

Hallucinations

Sensory perceptions that have no basis in an external stimulus.
Visual/Auditory are most common.

Illusions

Misperceptions of an external stimulus. Differ from hallucinations in that they have some basis in reality.

Assessment of Social Network

Addresses the social supports that are important for day to day functioning as well as those that affect the person's quality of life
Example: Who do you rely on for help?

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