Humanistic Assessment In Mental Health

Introduction

Nurses execute their duties within a nursing process that begins with patient assessment, then diagnosis phase, planning phase, implementation phase and evaluation/assessment phase (Howatson et al, 2013). Here, we are interested in the assessment phase, where we will conduct an analysis of an assessment process involving a case study patient, Tom, who is 64 years old with mental health issues i.e. severe Generalised Anxiety disorder (GAD) with a score of 14 on the GAD scale, and moderately severe depression with a score of 19 in the PHQ-9 score. Tom has been referred for treatment. But, Ralph & Taylor (2005) strongly supports that the nursing process includes a holistic, individualised and humanistic approach. Therefore, in regards to conducting a holistic assessment to Tom, there will be a comprehensive assessment of his mental health condition, gathering all the necessary information regarding all the aspects underpinning his mental health condition including his psychological, cultural, physiological and developmental well-being (Taylor, 2005). Next, an individualised assessment will be characterised by the identification of information that assist in establishing the most appropriate treatment options for Tom, considering his occupation, preferences and what he is passionate about – because according to Mallik et al (2009), the individualised approach focuses on the patient’s needs, desires, goals and wants. Lastly, the humanistic approach focuses on empathy as well as good human behaviour i.e. conducting the assessment in a manner that will make Tom feel worthwhile, especially considering his perception of himself as a proud man who holds high regard for his working-class roots.

Apart from these approaches, the assessment process will be anchored on several themes such as collaborative care, and patient empowerment. Boyd (2005) defines collaborative care as the delivery of integrated care to mentally ill persons through a multifaceted approach that includes a collaboration of primary care and mental health care, with much focus on the treating the patient and their family as a whole. This is especially important in Tom’s case because his wife, Liz, is dependent on him and would be concerned with, or affected by any health issue that interferes with Tom’s well-being. On the other hand, the empowerment approach will entail helping Tom to develop control over various factors such as retirement, his recent issues with his knee, and the death of colleague; which affect his life. This is especially of great importance because Tom attests to being overwhelmed by these issues.

Role of the Nurse in the Assessment Process

During the entire process of assessing Tom, it is of great importance to consider all the aforementioned themes and concepts to ensure that Tom’s mental health issues are effectively addressed. This implies that the nurse has to implement a holistic and individualised assessment, be humanistic, collaborative; and empower Tom. The following sections describe each of the approaches and themes that are applicable to Tom’s assessment.

While assessing Tom, there is a need to take a holistic approach so as to identify different dimensions of the data that may be material to the development of an effective treatment plan for him. This approach will help in identifying various aspects such as Tom’s psychological, physiological, sociological, spiritual, cultural and developmental issues that might have influenced his health condition to what it is now (Alraro-lefevre, 2013). Conducting a physiological assessment will be of special importance to Tom because it will help identify to what extent his poor knee condition might have contributed to his current mental state. Likewise, according to O’carroll et al (2007), conducting a sociological assessment assists in identifying the patient’s family networks, thereby assisting to identify who might be ready to help the patient while at home. Therefore, it would be of great importance to sociologically assess Tom to identify his closeness with his wife, and whether the wife is at a condition to care for him while recovering from his mental ill-health condition. Next, psychological assessment is also important especially in cases of mental health because it helps identify any stressors that might have led to an exacerbation of the patient’s condition (Forester, 2001). Therefore, it would be necessary to conduct a psychological assessment of Tom to identify the extent to which the recent stressor events such as the death of his colleague or his retirement; might have contributed to his mental health issues (Fulton et al, 2009). Last but not least, it would be necessary to conduct a cultural assessment so as to identify whether issues to do with Tom’s traditional views pride and military background contributed to his mental health issues.

Norman & Ryrie (2013) argue that conducting an effective mental health assessment must involve an individualised approach where exhaustive examinations are conducted to measure various factors affecting the patient’s health and well-being. Ideally, it entails a detailed focus on the patient’s habits or behavioural aspects to collect various pieces of information that may help in conducting analysis and diagnosis of the patient’s health defect (Hawthorne, 2011).

An individualised approach to assessing Tom would be of particular importance considering his various personal aspects that might have contributed to his mental health condition. For instance, this would identify factors such as his currently poor state of physical health (i.e. his knee) that has made it difficult to practice his current job. In fact, this information would complement the physiological health assessment conducted in the earlier holistic assessment process.

Nonetheless, the individualised approach would also yield information regarding sleep behaviours and energy levels, nutrition and psychological behaviour, all which produce complementary information to the data collected through the holistic approach. For example, in tom’s case, the individualised approach would have provided much information regarding his high level anxiety and DEPRESSION. Hence, as confirmed by Elling & Elling (2003), the individualised approach to mental health assessment complements holistic assessment because either of the approaches produces similar patient information.

Details by Gehrig & William (2013) reveal that collaborative approaches to mental health assessment are deep and broad in scope. BUT based on the principles of person-centred care, interagency collaboration, respect & trust, informed decision making, and continuous learning (Howatson et al, 2013), there is much that a nurse can achieve from the patient when they decide to use a collaborative approach to mental health assessment.

First, according to Mallik et al (2009), the person-centred aspect of collaborative approaches would entail focusing on the patient and tailoring the assessment to their needs and the needs and the needs of their families. In Tom’s case, it would mean focusing on his needs and preferences which includes his knee issues and events surrounding his retirement and/or his beliefs. This would entail the use of heron’s intervention model, especially the facilitative intervention model, by being cathartic to help him overcome his emotions and thoughts about his dead colleague, and helping him understand that despite the sorrows he might have undergone for losing a colleague, life has to continue. It would also be important to focus on his wife by assessing whether there are factors about his wife that would be contributory to his current mental state. Tom also describes himself as a proud man; therefore person-centred collaborative mental assessment would also entail an evaluation of whether there are issues affecting his pride, thereby contributing to his state of depression and anxiety. This could be especially true based on the reports by Anwar (2014) that people with a feeling pride are prone to depression and anxiety based on the concept that humans tend to assess their place in the social cycle and respond accordingly to avoid conflict or promote cooperation. Against this background, a person-centred collaborative mental assessment could reveal how tom’s sense of pride could be associated with his anxiety and depression.

O’carroll et al (2007) assert that collaborative approaches also entails making informed decisions by involving the patient in decision making, as well as respecting the decisions made by them. Therefore, in Tom’s case, enhancing informed decision-making would involve providing him with the relevant information regarding the assessment process and enhancing his control and choice in the assessment process.

A collaborative approach to assessment, according to Boyd (2005), also entails the creation of mutual trust and respect between the practitioner and the client. Applying this to Tom’s case, it implies that a collegial environment must be created to support creativity, innovation and shared decision-making that enables an effective assessment. For example, while assessing tom, the practitioner would seek the opinion of other practitioners to incorporate a shared knowledge into the assessment process to ensure that the assessment is based on current and most appropriate principles of practice. Moreover, to achieve this, the practitioner must apply their skills and knowledge to the results of the psychological, physiological and cultural assessments as indicators any other necessary assessments referral to other healthcare services. This can especially be applicable in the case of tom’s pain a depression, where the use of antidepressants could be helpful. but again based of adequate nursing knowledge, it would be important to make a consideration of tom’s culture and how he culturally perceives the use of antidepressants. this is especially based on the findings of Bass et al (2015) and Ivbijaro et al (2005) that different cultural groups have different presentation of depression symptoms. In fact, Ivbijaro et al (2005) asserts that physicians must understand the religious, gender and cultural paradigm that is brought into the consultation by the patient so as to create an opportunity for establishing a therapeutic interaction that minimizes the personal distance between the patient and the physician.

These processes involve the use of participatory approaches to help the patient be involved in the nursing process so that they might develop control over various factors that affect their health (Howatson et al, 2013). In Tom’s case, empowerment can be applied in the context of a psychological model which holds that empowered individuals are able to influence their personal growth and development. This would be possible by giving Tom a chance to support the process of self-awareness, whereby the practitioner gives him the chance to be self-aware, develop self-confidence, and earn the necessary health literacy during the process (Howatson et al, 2013). However, Mallik et al (2009) contend empowered patients can also be seen as threats to the practitioner and therefore it is important to recognize that patient empowerment constitutes a change of power balance, and thus the practitioner needs to understand the patient as an expert of their own conditions through experience.

Applying this to Tom’s case, it is possible to argue that he has some form of self-awareness because he has a strong stand against suicide, has his own beliefs, and knows what he wants in terms of his dreams. Thus, empowering him by developing an interaction that enhances his self-awareness and self-confidence would be more effective in making him more open to revealing several other pieces of information that might be of importance during the assessment process.

as part of efforts to improve professional nursing skills of practice, the NMC code requires nurses and midwives to take time and reflect on reflect on their practice and use the reflections as tools for improving their standards of care (NMC, 2015). Fundamentally, the process of nursing reflection involves thinking about professional conduct and examining whether such conduct was good practice or whether there needed to be improvements. Hence, as part of my efforts to enhance my professional development and make it more meaningful, the following section is a reflection of tom’s assessment and how it would have developed my professional skills in mental health assessment. Here, i narrate some of my experiences and the key learning points from these experiences.

Against that backdrop, the most interesting thing I have learned is that the main goal for nursing care is to enhance the well-being of patients both physically, mentally and spiritually. The idea of targeting the interrelationship between patients and their environment while enhancing health and wellness has been the focus of nursing since the 19th Century during the time of Florence Nightingale – one of the most prominent health practitioners considered to be the founder of holistic care.

This new understanding may be of important relevance for three main reasons. First, it implies that when a holistic approach is applied to health assessment, it creates an opportunity to view the patient as interconnected with their family as well as their community thereby helping in conducting effective health assessment for purposes of developing an effective care plan (Alraro-lefevre, 2013). Secondly, it implies that holistic care gives an opportunity for patients to be more involved in the assessment process, which later encourages them to understand the role of self-care in enhancing their health conditions. Thirdly, it implies that implementing a holistic approach to health assessment helps in a quicker identification of the underlying cause of illness, or whether there are other factors that could contribute to a slower recovery.

This new understanding is important for it will change the way I approach patient assessment, especially having understood that holistic assessment approaches entail being responsible and committed to integrating the assessment process with the patient’s personal life, thereby increasing the connection between the patient and their environment – to remove any barriers that may hinder effective healing after a successful assessment (Howatson et al, 2013).

This new insight is connected to Mallik et al’s (2009) theorization that when nurses include holistic approaches the assessment process, they are likely to develop treatment plans that combine both mainstream and complementary treatments that facilitate quicker healing. These may include deep breathing, music, yoga or natural products. O’carroll et al (2007) also assert that holistic approaches to patient assessment can enhance sustainable, practical and patient-centred approach to health and well-being that can be applied to patients of any age.

This realization is important in my current course, and in my future career as a healthcare practitioner and in my life. In this course, I intend to put more emphasis on the concept of holistic healthcare, not only in the context of health assessment but also in the context of other nursing processes such as diagnosis, development of treatment plans, and implementation of treatment. In my future career as a health practitioner, this new insight will be helpful as it provides background knowledge, on the psychological, cultural, physiological, spiritual and developmental assessment on the important aspect of holistic approaches to the entire nursing process (Howatson et al, 2013).

Another thing I understand now is that the theme of individualised health assessment is quite an important aspect partly because it complements holistic care and partly because it gives a personalised focus to the patient’s health issues (Taylor, 2005). For instance, the individualised approach to health assessment provides an opportunity for the practitioner to assess the patient’s psychological behaviour that might be a contributory factor to their current poor health condition. But I am also keen to note the difference between an individualised assessment and holistic assessment, where the latter covers psychological assessment while the former does not.

A possible meaning of this new idea is that there is great importance in taking an overview of the patient’s health with a wider consideration to all relevant aspects that may be contributing to their health defects. Besides, this new idea implies that the test results achieved by conducting an individualistically approached health assessment can be used to analyse and diagnose the patient’s health defects based on their medical history and genetic profiles (Hawthorne, 2011).

This new idea might also be of important relevance because having a good understanding of the various aspects affecting the patient’s well-being allows them to influence their own health conditions both at the present and in future. This realization is connected to Boyd’s (2005) remarks that individualised health assessment focuses on the patient’s behavioural aspects that may cause their current health defects, and help in a quicker identification of the behaviours that patients can change to improve their health and well-being.

Having realised that, I wonder whether the currently practicing nurses have developed the necessary interpersonal skills to interact with the patient and study their behaviours during assessment, so that they are able to identify how these behaviours are contributing to patient’s health defects. Nonetheless, this realization will change the way I approach the nursing process, having realised that individualised approaches are not only applicable to the assessment process but also to the entire nursing process.

A significant issue I have not addressed in my previous writing is the aspects of best practices in collaborative processes as applied in healthcare assessment. I have realised that for a collaborative approach to be taken during patient assessment practice, the practitioner must evaluate whether there are cultural, cognitive and communication needs of the patient or their family members that should be identified and documented for future reference during the implementation stage of the nursing process.

This new understanding is likely to mean three things. First, it could be possible that the patient’s cognitive or communication needs are the main cause of their mental health defects. Secondly, there is a possibility that there could be important person-centred information (i.e. information that relates to the patient’s qualities, interests, aspirations, and issues) that might of great contribution to the patient’s poor mental health. Thirdly, there is a need to evaluate whether the patient would like to be involved in the assessment, whether they can be involved in a meaningful manner, and whether this information is well documented for future reference.

This realization is connected to Norman & Ryrie’s (2013) theorization that collaborative assessment involves paying attention to the patient’s individual needs that present themselves beyond the issue that is currently being addressed and therefore it is important to identify these issues and document them for future reference. Besides, Boyd (2005) argues that the assessment stage of the nursing process is the best opportunity to identify and record all the ‘hidden’ information regarding the patient that could be useful in identifying the best treatment plan for them.

Having realised that, I wonder whether most practitioners take their time to learn the skills necessary to interact with the patient to an extent that they are able to identify, interpret and discern any person-centred information that the patient might be hesitant to share, or that, might not be readily available from the patient’s own account. This is why I insist on developing various interpersonal skills that will help me have a collaborative interaction between me and my patients – during my future career as a health practitioner.

Last but not least, one new insight I have gained is that from a patient’s point of view, the available care systems may not offer satisfactory care services to meet the needs of the patients (Hawthorne, 2011). It is therefore important to deliver a holistic care process and overcome the systematic challenge of fragmented care where patients have to fight against the health system to acquire effective care (Boyd, 2005). Hence, in order to effectively tackle mental health issues, there is a need to make a complete paradigm shift of focus from the mental issues themselves to a patient-centred approach, where the patients receive well-coordinated care services combined with community self-management approaches with timely professional support (Taylor, 2005).

A possible meaning of this new idea is that empowering patients from the start of the nursing process (i.e. the assessment stage) all the way to the treatment plan implementation stage ensures that the patients are actively involved in decision-making and designing of their treatment plans (Taylor, 2005). Besides, this new idea implies that there is still much that the health governance sector can do to enhance and advocate for patient empowerment, together with its key principles of health literacy and shared & informed decision-making.

Having realised this, I wonder whether there is are concerted efforts by various health organizations and policy-makers to strongly advocate for patient empowerment owing to the central role it plays in enhancing the patient experience and influencing positive patient outcomes during the nursing process. However, to this end, in future, I plan to develop a positive attitude towards patient empowerment, and incorporate the idea of patient empowerment in my daily practice by supplying patients will all the information they might need during the assessment process as well as during the entire nursing process.

References

• ALFARO-LEFEVRE, R. (2013). Applying nursing process: the foundation for clinical reasoning. Philadelphia, Wolters Kluwer Health.
• BOYD, M. (2005). Psychiatric nursing: contemporary practice. Philadelphia, Lippincott Williams & Wilkins.
• BASS JK, BOLTON PA, MURRAY LK. (2007) Do not forget culture when studying mental health. Lancet.
• ELLING, B., & ELLING, K. M. (2003). Principles of patient assessment in EMS. Australia, Thomson/Delmar Learning.
• FORSTER, S. (2001). The role of the mental health nurse. Cheltenham, Stanley Thornes.
• FULTON, J. S., FULTON, J. S., LYON, B. L., & GOUDREAU, K. A. (2009). Foundations of clinical nurse specialist practice. New York, Springer Publishing Company.
• GEHRIG, J. S., & WILLMANN, D. E. (2013). Patient assessment tutorials: a step-by-step procedures guide for the dental hygienist. Philadelphia, Wolters Kluwer Health/Lippincott Williams & Wilkins.
• HAWTHORNE, L. (2011). Patient assessment practice scenarios. Sudbury, Jones and Bartlett Publishers.
• HOWATSON-JONES, L., STANDING, M., & ROBERTS, S. (2015). Patient assessment and care planning in nursing.
• IVBIJARO GO, KOLKIEWICZ LA, PALAZIDOU E, PARMENTIER H. (2005) Look, listen and test: mental health assessment - the WONCA Culturally Sensitive Depression Guideline. Primary care mental health;3:145–147.
• MALLIK, M., HALL, C., & HOWARD, D. (2009). Nursing Knowledge and Practice E-Book. NORMAN, I. J., & RYRIE, I. (2013). The art and science of mental health nursing: principles and practice.
• O'CARROLL, M., PARK, A., & NICOL, M. (2007). Essential Mental Health Nursing Skills E-Book. RALPH, S. S., & TAYLOR, C. M. (2005). Nursing diagnosis reference manual. Philadelphia, Lippincott Williams & Wilkins. TAYLOR, H. (2005). Assessing the nursing and care needs of older adults: a patient-centred approach. Oxford, Radcliffe Pub.

Looking for further insights on Hospitality Management? Click here.