Assessment Tools Analysis The vulnerable population of single low-income mothers and their children are at risk for poor health: physically, socially, and psychologically. As a nurse, I know the importance of performing a complete nursing assessment to provide the best nursing care. It is helpful to use available assessment tools to evaluate and fully assess the patient. Nurses need to be knowledgeable in assessment tools to expand the assessment process and evaluate clients in various stages and states of health, illness, stress, and life.
In this paper, I will discuss and analyze three assessment tools: The Beck Depression Inventory, The Norbeck Social Support Questionnaire, and The Family Hardiness Index. Beck Depression Inventory According to the Center for Psychological Studies (2010), the BDI is used to measure the presence and degree of depression. This self-reporting questionnaire measures depression symptoms, such as headache, constipation, loss of appetite, backache or chronic fatigue (Viinamaki, Tanskanen, et al. , 2004). It is a straightforward, low-cost, easy to use, 21-item test presented in multiple-choice format.
The BDI is intended to be used in research and clinical settings to assess depression in adults and adolescents 13 and older. Administration of the BDI takes approximately five minutes. The test is either self-administered or verbally administered by trained personnel. Each item is a list of four statements about a particular symptom of depression, such as loss of appetite and sleep loss, and they are arranged in increasing severity. Validity and Reliability The BDI has been used for over 35 years to identify depressive symptoms and is reported to be highly reliable in being able to distinguish depressed from non-depressed patients.
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The new version showed improved clinical sensitivity, with the reliability of the BDI–II scoring higher than the BDI (Center for Psychological Studies, 2010). Recently, the BDI has been updated and the name changed to BDI-II. The BDI-II conforms more closely to the diagnostic criteria for depression and specifically assesses for depression by identifying the presence and severity of symptoms. This increased the validity. Nursing Even though mood disorders are common in the general population, many people suffering from depression remain undiagnosed (Viinamaki, Tanskanen, et al. , 2004).
Because many low-income single mothers lack self-esteem, self-confidence, and adequate coping skills, leading them to feel isolated and alone, this vulnerable population is especially at risk for depression. The nurse can use the Beck Depression Inventory (BDI) to assess each patient for signs and symptoms of depression. Using this tool within the nursing assessment will help the nurse to differentiate patients experiencing symptoms of depression. This will then allow the nurse an opportunity for teaching and information on therapy, counseling, or outpatient psychiatric follow-up can be provided to the patient.
Norbeck Social Support Questionnaire The Norbeck Social Support Questionnaire is self-administered, low-cost, and measures multiple dimensions of social support including affect, affirmation, and aide. Nine categories are used to determine sources of support, and size, stability, and accessibility of those sources are measured. “The Social Supports Questionnaire measures include: the kinds of help and support that the parent/caregiver and youth received from people in the past 6 months, and the kinds of people who helped the parent/caregiver and youth in the past 6 months” (Kernan & Morilus-Black, 2010, p. 258).
Adults and adolescents 13 or older are asked to list the first names or initials for each significant person in his or her life, such as spouse, relatives, friends, neighbors, etc. The patient then labels the kind of relationship he or she shares with each person listed Finally, the patient then rates and describes the amount of support available from each person on the list. The amount of social support can then be calculated. Validity and Reliability Reliability was assessed through analysis of consistency and test-retest measures taken a week apart. High levels of consistency and reliability were found.
According to a study published by UCSF School of Medicine (2005), the test-retest correlations were Affect, 0. 89; Affirmation, 0. 88; and Aid, 0. 86 and response bias, which ranged from 0. 01 to 0. 17, was not significant. Nursing The nurse must accurately assess the patient’s social support, especially in the vulnerable population of single low-income mothers. According to Campbell-Grossman, Hudson, Keating-Lefler, & Fleck (2005), “Inadequate social support is related to poor public health outcomes, particularly in conditions of stress such as poverty and single motherhood” (p. 242).
Nursing care of single mothers needs to focus on teaching, providing information on community resources, and providing support and encouragement. Family Hardiness Index Low- income single mothers experience many personal barriers to successful parenthood, usually because they suffer from the stress of new responsibilities with minimal resources to back them up. Major life changes can occur within the single parent household with family structure and function. Family and job demands, and family strengths, capabilities, and weaknesses all play a role in how families, including children, adapt to the current situation (Robinson, 2003).
The Family Hardiness Index (FHI) can be used with adults and children over the age of nine to assess family adaptation. “Hardiness is defined as the family members’ internal strengths and durability as characterized by an ability to work together to find solutions to difficulties, a view of change as beneficial and growth producing rather than threatening, and a sense of control over the outcomes of life events and hardships” (Leske& Jiricka, 1998, p. 383). The Family Hardiness Index is a 20-item questionnaire.
It measures four components families use to respond to stressful life events: confidence, challenge, commitment, and control (Leske& Jiricka, 1998). Patients indicate on a three-point scale how well the questions or statements apply to their life and their family situation, and the scores are calculated by adding the values of the responses. Validity and Reliability According to a study described by Leske & Jiricka (1998), reported internal consistency and reliability of the FHI is 0. 82, and validity is strong. This study was on a combined sample of 51 family members going through major life changes and challenges.
Alpha reliability was 0. 98 for the total resource scores of their study (Leske & Jiricka, 1998). Increases in scores were related to adequate resources, coping, problem-solving communication, and family adaption. Response bias is possible due to the self-report nature of the questionnaire (Leske & Jiricka, 1998). Nursing The nurse needs to assess the whole person; sometimes this includes the family as one unit because children are a part of the vulnerable population too. Studies of parenting have shown that low-income families with maternal hardships impede the children’s cognitive and societal abilities (Mechanic & Tanner, 2007). Family deprivations also increase the probability of abuse and neglect of children, who then seek to escape the household early, associate with inappropriate peers, form tenuous sexual partnerships, have early pregnancies, and often replicate the pattern of inadequate parenting they experienced as children” (Mechanic & Tanner, 2007, p. 1223). The nurse can use this low-cost questionnaire to assess family functioning and family hardiness. Integrating Watson’s Theory of Human Caring Watson believes nursing should focus on health promotion and treating the whole person: body, mind, and spirit.
The transpersonal caring relationship builds when the nurse shows concern about the whole person and fully commits to protect and enhance the person’s human dignity. The nurse’s caring consciousness essentially allows a deeper connection between the person and the nurse, in which each person involved can understand the others perspective (Watson Caring Science Institute, 2009). The discussed assessment tools enhance the assessment phase of the nursing process, allowing the patient and nurse an opening opportunity for conversation, leading to a caring moment, and improving the quality of health care delivered by the nurse on a personal level.
Conclusion The Beck Depression Inventory, The Norbeck Social Support Questionnaire, and The Family Hardiness Index are three tools available to assist the nurse in completing a fully assessment of the patient and families. These tools can be used with many different age groups, are low-cost, straightforward, and easy to use. Researching the tools for this paper has helped me to understand the importance of fully evaluating clients in various stages and states of health, illness, stress and life. These tools improve the quality of health care delivered by the nurse by enhancing the assessment phase of the nursing process.
References Campbell-Grossman, C. , Hudson, D. , Keating-Lefler, R. , & Fleck, M. (2005). Community Leaders' Perceptions of Single, Low-Income Mothers' Needs and Concerns for Social Support. Journal of Community Health Nursing, 22(4), 241-257. (doi:10. 1207/s15327655jchn2204_6). Center for Psychological Studies. (2010). Beck depression inventory. Retrieved from http://www. cps. nova. edu/~cpphelp/BDI. html Kernan, J. , & Morilus-Black, M.. (2010). Social supports for youth and families. Community Mental Health Journal, 46(3), 258-64. Retrieved August 20, 2010, from ABI/INFORM Complete. (Document ID: 2026204261). Leske, J. S. & Jiricka, M. K. (1998). Family well-being and adaption after critical injury. American Journal of Critical Care, 7(5), 383-392. Retrieved from MEDLINE with Full Text database, University of Phoenix Research Library. Mechanic, D. , & Tanner, J. (2007). Vulnerable people, groups, and populations: societal view. Health Affairs (Project Hope), 26(5), 1220-1230. Retrieved from MEDLINE with Full Text database. Robinson, M. B. (2003). Family hardiness index- Methodology for use with children. Ph. D. dissertation, Saint Louis University, United States-Missouri. Retrieved from ProQuest Nursing & Allied Heath Source, Publication No.
AAT 3130049. UCSF School of Medicine. (2005). Summary of psychometric testing of the Norbeck Social Support Questionnaire. Retrieved from http://nurseweb. ucsf. edu/www/NSSQ-Psychometric. pdf Viinamaki, H. , Tanskanen, A. , Honkalampi, K. , Koivumaa-Honkanen, H. , Haatainen, K. , Kaustio, O. , et al. (2004). Is the Beck Depression Inventory suitable for screening major depression in different phases of the disease? Nordic Journal of Psychiatry, 58(1), 49-53. Retrieved from Academic Search Complete database. Watson Caring Science Institute. (2009). Transpersonal caring and the caring moment defined. Retrieved from
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