Assessment Tool Analysis
Dorcas
NUR/440
March 26, 2012
Vicki Clithero

Assessment Tool Analysis
Assessment is an important aspect of nursing care; it is the first phase of the nursing process. Assessment involves gathering information or data about and related to the patient. Data collected include physiological, psychological, environmental, sociocultural, economical, spiritual, developmental history of the patient. Data may be objective or subjective. Objective data refer to the measurable and observable signs, e.g. the patient’s facial expression, gait, pulse rate, heart rate, blood pressure, color, warmth, etc. Subjective data are obtained from the patient; and they are the patient’s account of his or her feelings, needs, and strength. Data are obtained by physical examination and by interviewing the patient, family, friends, and other health care providers.
Assessment tools are used during the assessment phase of the nursing process to identify areas of actual or potential problems that need further exploring; they are developed to pinpoint areas of health issues with the aim of promoting, improving, and maintaining the health of the individual. The three assessment tools chosen for this paper are: Social Support Questionnaire, Beck Depression Inventory, and Perceived Stress Scale.
Social Support Questionnaire
Social Support Questionnaire (SSQ) is an assessment tool that measures individual evaluation of social support that may be available to them in case of any untoward occurrence. It was designed for adolescents and adults. The SSQ comprises of 27 items, and it can be administered in about fifteen minutes (Sarason et al., 1987). Each item of the SSQ has two parts. The first part measures the number of people in the individual’s social network, to whom he or she believes will be available to support him or her should the unexpected happen; it includes questions such as: “if you were to become seriously ill, whom do you think would be there for you? (Sarason et al., 1987). In the second part, the individual ascribes numerical values to the extent of satisfaction with the help he or she will receive in such a situation; the number ranges from 0-6, and the scale goes from “very dissatisfied” to “very satisfied” (Sarason et al., 1987). According to Sarason et al., the SSQ has a “good psychometric properties” and “good test-retest reliability” (1987).
The SSQ is an important tool in the assessment phase of the nursing process because it gives the nurse an insight into how loved and valued the patient is, how much help and support is available for him or her in the community. The SSQ prepares the nurse for the need for referring the individual with no sounding social support to social services. Availability of a good support system has a great impact in promoting an individual’s psychological health.
The people living with HIV/AIDS are at risk for anxiety and depression related to the disease process, and they tend to face stigmatization, marginalization, and discriminations; having a good support system and resource group is important to promote their physical and psychological health. The SSQ will help in identifying those who need referrals to social services.
Beck Depression Inventory
The Beck Depression Inventory (BDI) was developed in 1961 by Aaron T. Beck, a cognitive therapist. It is a twenty-one question survey completed by a patient to measure the strength, severity, and profundity of depression in individuals with psychiatric diagnoses (Polgar, 2003). It was designed to be used both in inpatient and outpatient setting to identify and monitor the progression of depression. It is not uncommon to see the individuals self-administering the BDI, though it was designed to be used by trained professionals, and it can be administered in five to ten minutes (Polgar, 2003). Each of the 21 questions has four possible responses; each answer is scored on a scale of 0 to 3, and this reflects the severity of the depression (Polgar, 2003). “Individual questions of the BDI assess mood, pessimism, sense of failure, self-dissatisfaction, guilt, punishment, self-dislike, self-accusation, suicidal ideas, crying, irritability, social withdrawal, body image, work difficulties, insomnia, fatigue, appetite, weight loss, bodily preoccupation, and loss of libido”, (Polgar, 2003). Questions 1-13 deal with psychological symptoms, while the remaining questions deal with physical symptoms. The total score of 21 in the general population indicates depression. A score of 0-9 indicates minimal depression, 10-16 indicate mild depression, 17-29 indicate moderate depression, and 30-63 indicate severe in people that were already diagnosed with depression (Polgar, 2003).
According to Polgar, the BDI has been tested for validity, reliability as well as consistency, and it has been deemed successful by over 25 studies (2003). “The BDI has sound psychometric properties in a primary care setting among adolescents while being used by paediatricians”, (Baskar et al., 2007, Conclusion).
Using the Beck Depression Inventory in the assessment phase of the nursing process will aid in early detection and treatment of depression, therefore keeping it under control and preventing it from progressing into major depression, and also preventing the complications.
Depression is a common thing among the People living with HIV/AIDS. Depression is the cumulative effect of the enormous amount of stress that comes with being HIV positive. The Using the BDI is essential to identify and treat depression in this population. The nurse should let the patients know that depression is treatable, and help the patients with referral to the health care provider, encourage them to attend group therapy, and to take their medications as prescribed.
Perceived Stress Scale
When the demand placed upon an individual is perceived to be greater than he or she has the reserve to cope with, there is an imbalance in the ability to cope which gives rise to negative emotional response, such as labeling oneself as being stressed. The Perceived Stress Scale is a 10-item self- administering questionnaire used to determine people’s perception of stressful situations they have encountered in the past month; it explores the individual’s feeling over a month period (Cohen, 1994). The PSS measures the degree to which one identifies certain situations as stressful to one’s life. The questionnaire may be self-administered by anyone with at least a junior high school education (Cohen, 1994). The items 1-10 are general question, and they have five responses each ranging from “never” to “very often”. To score the PSS, reverse the score for the responses to items numbers: 4, 5, 7, and 8 (the positively scored items), and all the scores across the 10 items are summed up. The scores range from 0-40; the higher the score is, the greater the stress. According to Cohen, Kamarck, and Mermelstein, the PSS “has been proven to possess substantial reliability and validity; thus it provides a potential tool for examining issues about the role of appraised stress levels in the etiology of disease and behavioral disorders” (1983, p. 394).
By using the PSS is the assessment phase of the nursing process, the nurse can possibly identify the patient’s risk for stress, explore how the patient copes in a stressful situation, and design a way to work with the patient in a way that can improve the quality of care the patient receives.
Living with HIV/AIDS can be stressful. They people living with HIV/AIDS have to cope with the antiviral therapy, the side effects and complications of the medications, making lifestyle changes, disclosure issue, social isolation, financial difficulties, knowledge deficit about HIV related issues, and of course, the fatality of the case. A high PSS score among this population is detrimental, as high stress level can weaken the already compromised immune system, making the patient more vulnerable to infections and illnesses. The nurse’s role is to encourage the patient to look for stress-reducing techniques that work best for them, such as adequate rest and exercise, meditation, deep breathing, meditation, visualization, adequate nutrition, music, keeping a journal, etc.

References
Baskar, M., Moses, P., Russell, S., Russel, P. (2007). The psychometric properties of Beck Depression Inventory for adolescent depression in a primary-care paediatric setting in India. Child and Adolescent Psychiatry and Mental Health 2007, 1:8 doi:10.1186/1753-2000-1-8
Cohen, S. (1994). Perceived Stress Scale. Retrieved from http://www.mindgarden.com/docs/PerceivedStressScale.pdf
Cohen, S., Kamarck, C., and Mermelstein, R. (1983). A Global measure of Perceived Stress. Journal of Health and Social Behavior, vol. 24, No. 4, 385-396
Polgar, M. (2003). Beck Depression Inventory. Retrieved from http://www.ask.com/health/galecontent/beck-depression-inventory/3?oo=16775
Sarason, I. G., Sarason, B. R., Shearing, E. N., Pierce, G. R. (1987). A Brief Measure of Social Support: Practical and Theoretical Implications. Retrieved from
http://www.web.psych.washington.edu/research/sarason/files/SocialSupportQuestionnaireShort.pdf