Being Prepared Can Lead to Better Care

Kevin Kawamoto
Special to The Hawai‘i Herald

You’ve probably heard this before: A person is more than a diagnosis or a disease, even though the disease may be the focus of the visit to the doctor. In these days of increasingly specialized medicine, sometimes the idea of the patient as a “whole person” can get lost in the effort to treat a specific health problem. Lab tests can detect the presence of high cholesterol, high blood glucose and abnormal liver function, among many other conditions, but they don’t provide the full picture of the person.

That’s why a psychosocial assessment is often used to capture much more of whom the person really is — certainly not a full life story, but a broader understanding of the patient or client. It is an important narrative that is usually completed by someone in the helping professions — like a social worker, a nurse or a therapist — through a sit-down interview with the patient. It’s an opportunity for the helping professional to get to know the person needing care — his or her past, present and future.

Sometimes the person being interviewed cannot answer some, or any, of the questions due to memory problems or severe illness. That’s when caregivers can be helpful in filling in the gaps. The psychosocial assessment attempts to learn about the essential aspects of a person’s life history and current status. Anyone who works with the patient can glean important information and insights from this assessment, which can help in many different ways to plan for future care and assistance. For example, if an individual does not have any family members or friends who can help him or her after being discharged from the hospital, that information will affect the patient’s “discharge plan,” the recommended care plan after being discharged from the hospital.

There isn’t any one standard way of doing a psychosocial assessment. If you look at different examples of psychosocial assessments, they are not always the same length, nor do they necessarily address the exact same issues. The questions asked may be dictated by the organization collecting the information, such as a hospital, doctor’s office or a social service agency. Additionally, interviewers such as a social worker or a nurse may have their own particular style of interviewing. Some may conduct the assessment in a quick and somewhat formal manner. Others may take more time, gathering lots of details, asking follow-up questions, and having more of a conversation or a “talk story” than a formal interview. One approach is not necessarily better than the other. A lot of the differences between assessments can be explained by the interviewer’s personal style and training, as well as the institutional practices of the organization that employs the interviewer.

People with a history of medical problems, especially when they involve stays in the hospital, may already be familiar with the psychosocial assessment. In fact, they may have been interviewed multiple times. For others, the process may be new and might even seem invasive. Personal questions are often asked. This article will reveal some typical questions asked during an assessment. The more information a patient can provide to the interviewer during a psychosocial assessment, the more effective the overall health care plan will be. So, having the answers prepared ahead of time can make the interview go more smoothly and the information collected more accurate.

If a patient or client cannot provide the answers needed for the assessment, the primary caregiver is often asked to assist, which is helpful for patients who have dementia or other conditions that impair memory and communication.

As noted earlier, the assessment is often done during a hospital stay, although it might also be done in a long-term care facility or even during a home visit for social services. The assessment aids everyone on the patient’s care team in learning about the patient’s life and how to plan for future care.

A note on terminology: Many social workers and other helping professionals prefer to use the word “client” when working with someone outside of a hospital setting. The word “patient” is more commonly used in a hospital setting or a doctor’s office. In a nursing home or long-term care facility, the word “resident” is typically used. In this article, “patient” will be used for brevity’s sake.

Typical Parts of a Psychosocial

Let’s use a hypothetical hospital patient by the name of “Mrs. Sato.” (Her first name would also be listed in the assessment, but it is intentionally not included here to avoid giving the impression that Mrs. Sato is an actual person.)

The interviewer — let’s say a hospital social worker — would want to mention in the assessment why Mrs. Sato is in the hospital. This is referred to as a “presenting problem.” Mrs. Sato may have other ailments and conditions, but the intent is to find out the current problems that brought Mrs. Sato into the hospital, along with some basic identifying information, such as, “Mrs. (first name) Sato is an 85-year-old Japanese American woman who was admitted to this hospital on (date) after falling at home and complaining of severe pain in her left hip. After a physical exam and diagnostic imaging, ER physician concluded that Mrs. Sato had sustained a fracture in her left hip and was recommended for hospital admission and referral to orthopedic care.”

As mentioned earlier, there are different ways the interviewer might write up the assessment, but, in general, you want to capture something about Mrs. Sato beyond medical information, which is already in a patient’s medical chart. As such, the psychosocial assessment typically does not need to get into considerable detail about a person’s physical problems.

However, if the physical problems result in psychological and social issues, they should be mentioned. For example, if Mrs. Sato is diabetic and also has dementia, that combination of diseases will require family support, if she lives at home, to ensure that her nutritional and self-care needs are met. Also, health problems often result in severe stress and even depression, not only for the person suffering from the health problems but for family members and friends, as well. The emotional impact of a person’s physical disease or injury can be included in a psychosocial assessment, as well as the emotional and physical burden experienced by caregivers.

The assessment will involve finding out about personal status (single, married, divorced, widowed, etc.), living arrangement (who the patient lives with, if not alone), other significant relationships and whether there is a social support system in place. There may be questions that come across as being personally invasive, such as drug history and current use, substance abuse and treatment history, tobacco use, legal history (e.g., criminal background) and sexual abuse. Honest answers to these questions can help the care team put together a more effective treatment plan. The psychosocial assessment is not meant to be like a prison interrogation, however. If a person feels uncomfortable answering a personal question, she or he can say, “I don’t want to answer that question right now.” Other questions may relate to education, employment, roles and responsibilities, social and recreational activities, as well as religious and spiritual involvement.

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