Assessment Tool Analysis

Assessment Tool Analysis

The application of nursing assessment is essential to solve problems and make decision during patient care. Nursing process includes application of knowledge of nurse and patient to determine the factors on which the nurses should focus developing a treatment plan. Assessment creates a database regarding client's psychosocial, physical, and emotional health. Health care staffs use varieties of assessment tools to evaluate patient's physical, mental, and emotional well-being, and to help the vulnerable individuals to improve the family dynamics, and to make positive changes in their lifestyle.

This paper will review three of these tools and will discuss data about each tool such as the cost, length, ease of using the tool, validity of information gained, population it may be useful for, and how each tool could enhance the assessment phase of the nursing process. According to Alligood, 2010, the major elements of Jean Watson's theory are factors of caring, transpersonal caring relationship, and caring moments. The theory has a holistically view of the person wherein mind, body, and soul; it defined health as a balance (harmony) between the mind, body, and soul in which the individual acquires a high level of physical, mental, and social functioning.

Beck Depression Inventory (BDI)

The first tool is Beck Depression Inventory (BDI); the instrument measures the severity of depression in adolescents and adults. "The BDI was originally created by patients' descriptions of their symptoms - mood, pessimism, sense of failure, self-dissatisfaction, guilt, suicidal ideas, crying, irritability, social withdrawal, insomnia, fatigue, appetite, weight loss, and self-accusation. In the first portion of the test, psychological symptoms are assessed whereas the second portion assesses physical symptoms. The BDI test includes a 21 item self-report using a four-point scale ranging which ranges from 0 (symptom not present) to 3 (symptom very intense). The test takes approximately 5 to 10 minutes to complete. There is a shortened version of the test consisting of seven items intended to use by primary care providers" (Beck, 2012, para. 2).

Beck conducted a test validity of this test for content, concurrent, and construct. "The BDI-II positively correlated with the Hamilton Depression Rating Scale, r = 0.71, had a one-week test-retest reliability of r = 0.93 and an internal consistency α=0.91. The BDI has also showed high construct validity with the medical symptoms measured. Beck's study reported a coefficient alpha rating of 0.92 for outpatients and 0.93 for college student samples" (Beck, 2012, para. 4).

The complete Beck Depression Inventory kit price is $53 and consists of the manual and 25 record forms. The manual cost is $22.50, record forms (quantity of 25) are $27.50, or (quantity of 100) are $104.50. Spanish record forms are also available for the same price (Association for Assessment in Counseling and Education, 2011).

In addition, BDI is useful to discover depressive symptoms in a primary care environment. BDI is easy to use and typically takes between five and 10 minutes to perform together with a psychological or medical assessment. This tool could enhance the assessment phase of the nursing process by helping to determine the depression and capability of the patient to carry out instructions. It would be especially useful in the elderly; for example, the Ocampo couple who seem to get depressed more as age progresses and by the emergence of chronic disease. Appling this assessment tool to the vulnerable population selected in the neighborhood would have helped to measure the depth of Danilo and Lydia Ocampo's depression would assist the primary care team in the implementation of a treatment plan to cover their needs, and would decrease their stress resulting for the aggravating events.

Mini-Mental Status Examination (MMSE)

The second tool reviewed was the Mini-Mental Status Examination (MMSE) also called neurocognitive testing, or Folstein test. The Mini-Mental Status Examination consists of 30-point questions. This tool is useful in outpatient and inpatient settings to screen for cognitive impairment in the elderly and patients assessed for dementia, or delirium (A.D.A.M., 2013). Researchers have validated the scale used in clinical practice and research to assess cognitive function, orientation, registration, attention, calculation, recall, and language; a score of ≤ 23 indicates cognitive impairment (Hsieh, Chu, Cheng, Shen, & Lin, 2012).

Normal scores for this test are 27 or above (out of 30); nevertheless, lower scores are not enough to diagnoses a person with dementia. Low scores indicate impaired patients' mental abilities, or that patients are suffering a physical condition such as hearing loss. Furthermore, the person's level of education affects the MMSE scores as demonstrated by previous studies. For highly educated people with mild dementia, the questions may be easy whereas for poorly educated people with no problems in cognition can be difficult and may score in the dementia range. The person's cultural background influences the scores; for people from certain cultures some of the questions may be easier to answer; for example, questions that require knowledge relevant to English history (Alzheimer's Society, 2013).

According to A.D.A.M, 2013, the health care providers use this tool to test the patients' thinking ability, and to determine if patients' problems are improving or worsening. With MMSE, the providers check physical appearance, orientation, attention span, recent and past memory, language function, and judgment. The MMSE test scores from zero to 30 and consist of sections, each with its own smaller score. The test's results help to determine what part of patients' thinking and memory may be affected.

It is important to mention that the MMSE is not beneficial to assess patients with attention and concentration disabilities. An easy MMSE may take as little as five minutes to evaluate a healthy individual; the patient's condition determines the length of time required for this test. Individuals with speech issues, mental problems, dementia, natural or organic brain dysfunctions might need 15 or 20 minutes because this will be a harder examination. In a study conducted, researchers found that the "test-retest reliability ranged between 45% and 50% over a one year interval and was 38% over a 2-year period" (Mitrushina & Satz, 1991, p. 537), which shows the high reliability of the test.

This test is freely available in the Internet. Even though the validity r =0.78 and reliability tested using t-retest= 0.89 are remarkable

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