Assessment Tools Analysis - Essay Example

 Assessment Tools Analysis Assessment tools are indispensable nursing instruments which influence decisions or courses of actions to be taken to provide the appropriate health care for every patient problem. These decisions, together with the presenting needs and concerns of a patient, are crucial in that they guide and scaffold health care interventions which are adopted (Linton, Lach, Matteson, & McConnell, 2007; Walsh & Crumbie, 2007). This paper discusses on three of such assessment tools: the Beck Depression Inventory II; the second edition of Mini-Mental State Examination; and Health Promoting Lifestyle profile II. Included in the exposition are pertinent information about each tool and how this tool can enhance the assessment phase of the nursing process, particularly its impact of the quality of nursing service delivery. An attempt will also be made to apply each of the three selected tool to the vulnerable population assignment from Week 2, when applicable. Beck Depression Inventory The Beck Depression Inventory II (BDI II) is a 21-question multiple-choice self-report inventory designed to evaluate the gravity of the depressive symptoms that a subject is experiencing at the time of the assessment (Cusin, Yang, Yeung & Fava, 2010). BDI II was developed in 1996 by Aaron T. Beck, Robert A. Steer and Gregory K. Brown (Groth-Marnat, 2009). A complete kit of the latest BDI II tool, which includes a manual and 25 record forms costs $110.00. The tool may be administered in as short as 5 minutes, either as a self-report or by a trained administrator. (PsychCorp, 2010). BDI II is applicable for ages 13 through 80 years old among a diverse group of subjects including adolescents, geriatrics, ethnic and cross-cultural groups, particularly African Americans and Hispanics (PsychCorp, 2010, Groth-Marnat, 2009). Beck, Steer, Ball, and Ranieri (1996) calculated one-week test-retest reliability at 0.93 and an internal consistency of 0.91. Improved clinical sensitivity was observed in more recent calculations (Cronbach alpha=0.92) reported by PsychCorp (2010). Grounded on the aforementioned features of the BDI II, the assessment tool can help enhance the assessment phase of the nursing process by its ability to distinguish between primarily anxiety and primarily depressive disorders (Groth-Marnat, 2009). Hence, the nurse stands in a better vantage point to offer the best quality health care service available. Moreover, since the instrument has also been translated into Spanish, Chinese and Persian, wider usage among a number of cultures is permitted (Meites, 2009). In a position statement issued during the National Down Syndrome Congress (2006), individuals afflicted with Down syndrome are said to be as susceptible to depression as are the general population. Since BDI II is a self report, the instrument may be used on Gary from the Week 2 assignment, by a nurse administering the tool. It is much harder to observe the symptoms of depression in patients like Gary, but observable changes in mood and behavior are believed to be observable. However, to the untrained observer, the signs of depression in Gary may either be missed or incorrectly interpreted as dementia or even Alzheimer’s disease. In this regard, the nurses’ role is very important for earlier detection of dementia on Gary. Mini-Mental State Examination The Mini-Mental State Examination, 2nd Edition (MMSE-2) was developed by Marshal F. Folstein and Susan E. Folstein (Psychological Assessment Resources [PAR], 2010). MMSE-2 is consists of a 30-item assessment on a wide range of cognitive abilities (Baity, 2010). The standard version kit costs $149. The examination may be administered in 10-15 minutes by anyone trained to assess individuals with cognitive impairment (PAR, 2010). MMSE-2 is applicable for ages 18 to 100 years old, particularly to psychological, neurological and demented patients (PAR, 2010; Ardilla, Rosselli & Puente, 1994). Based on clinical samples, internal consistency of this tool ranges from 0.66 to 0.79, whereas test-retest stability using G coefficients is  0.96 and inter-rater capability ranges from 0.94 to 0.99 (PAR, 2010). Compared with routine medical assessment, MMSE-2 has been proven to be more sensitive to dementia (Camicioli &Wild, 2006). Combined with the ease of administration and minimal training required on the part of nurses, this instrument boosts the diagnostic accuracy of assessment phase in the nursing process. To date, ten translations of the MMSE-2, including French, Russian, and Hindi, are available from PAR (2010), implying the utility of the instrument among a variety of cultures to facilitate handling of dementia cases on a global scale. Meanwhile, Stanton and Coetzee (2004) maintained that there is yet “no consensus on the diagnosis of dementia in people with learning disability” (p. 50). In the case of Gary who suffers from a learning disability in the form of Down syndrome, there are a host of symptoms which may be observed: cognitive symptoms like geographical disorientation and confusion; affective symptoms such as low mood and insomnia; behavioral symptoms like social isolation and increased dependence; and neurological symptoms such as seizures and myclonus. Stanton and Coetzee (2004) listed 25 symptoms, but all these are not necessarily present in Gary. MMSE-2 may be administered on Gary as an interview procedure, as long as consideration is given on Gary who may have short attention span and responses which are not actually applicable to the question. Stanton and Coetzee (2004) suggested open questioning with frequent recapping. Use of pictures may also help. Like in depression, there is a possibility dementia symptoms may be misdiagnosed as a natural presentation from Down syndrome or Alzheimer’s disease. Appropriate knowledge of the attending nurse during the assessment phase and careful analysis of Gary’s clinical will make a lot of difference in making the correct diagnosis and the suitable nursing interventions. Health-Promoting Lifestyle Profile II The Health Promoting Lifestyle Profile II (HPLP II) is a 52-item, Likert-styled instrument consisting of four points and six subscales, namely health responsibility, physical activity, nutrition, interpersonal relations, spiritual growth and stress management. HPLP II appraises health promoting lifestyles of patients which will be useful for their nurses in providing quality patient support and education (Sakraida, 2006). The instrument has a high internal consistency (alpha coefficient=0.943), while three-week test retest stability registered a Pearson r of 0.892. The instrument is copyrighted and may be available to interested parties for a fee. The model used in formulating the HPLP II boasts of a potential to influence the interaction between the nurse and the patient (Sakraida, 2006). Since it is generally accepted that social support contributes to physical health, it is believed that relationships forged from the administration HPLP II as an integral part of the assessment phase of the nursing process defines the crucial role of nurses in helping promote positive behaviors among their patients. A patient who adheres to a healthy lifestyle as a consequence of a nursing procedure will surely experience the impact of quality healthcare delivery. Interestingly, like the general population, patients with Down syndrome also “benefit from a healthy lifestyle” (Selikowitz, 1997, p. 63). Gary can, therefore benefit from interventions designed based on the outcomes of an HPLP II assessment administered as an interview and heeding the advice of Stanton and Coetzee (2004). Conclusion Patients in general require nursing service because they are either sick or too old. Knowledge of assessment tools helps nurses in supporting and education these patients to cope with their infirmities. It is exhilarating to find that many of such tools have translation in various languages. As long as the translated versions are appropriately administered, the language barrier is deemed hurdled en route to better health care strategies for the vulnerable population of patients. In a rallying call to the nursing community, Sakraida (2006) stressed the importance of the role played by nurses in healthcare: “The movement to a greater responsibility and accountability for successful health practices requires the support of the nursing profession through evidence-based practice” (p. 462). For all it is worth, the behavior change resulting from a successful nurse-patient interaction should help minimize morbidity and mortality and even reduced functionality as a consequence of chronic conditions. It should, therefore, be an inherent objective in every health care strategy to strive towards the improvement of the well-being of people. References Ardilla, A., Rosselli, M. & Puente, A. E. (1994). Neuropsychological evaluation of the Spanish speaker. New York: Plenum Press. Baity, M. R. (2010). Brief rating scales for assessment of cognitive and neuropsychological status. In L. Baer & M. A. Blais (Eds.), Handbook of clinical rating scales and assessment in psychiatry and mental health (pp. 239-256). New York: Humana Press. Beck, A. T. Steer, R. A., Ball, R. & Ranieri, W. (1996). Comparison of Beck Depression Inventories –IA and II in psychiatric outpatients. Journal of Personality Assessment, 67(3), pp. 588-97. Berger, A. M. & Walker, S. N. (2004). 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