PSYCHOSOCIAL CULTURAL FUNCTIONS

Mental Status Assessment

1. Components of mental status exam
   1. Appearance - appropriate dress, grooming, facial expression, stereotyped movements, mannerisms, rigidity.
   2. Behavior - anxiety level, congruence with situation, co-operativeness, openness, hostility, reaction to interview, consistency.
   3. Speech characteristics - relevance, coherence, meaning, repetitiveness, qualitative (what is said), quantitative (how much is said), abnormalities, inflections, affectations, congruence with level of education, impediments, tone quality.
   4. Mood - appropriateness, intensity, hostility turned inwards or toward others, duration, swings.
   5. Thought content - delusions, hallucinations, obsessive ideas, phobic ideas, themes, areas of concern, self-concept.
   6. Thought processes - organization and association of ideas, coherence, ability to abstract and understand symbols.
   7. Sensorium:
      1. Orientation to person, time and place, situation.
      2. Memory - immediate, rote, remote, and recent.
      3. Attention and concentration - susceptibility to distraction.
      4. Information and intelligence - account of general knowledge, history, and reasoning powers.
      5. Comprehension - concrete and abstract.
      6. Stage of consciousness - alert/awake, somnolent, lethargic, delirious, stuporous, comatose.
   8. Insight and judgment
      1. Extent to which client sees self as having problems, needing treatment.
      2. Client awareness of intrapsychic nature of own difficulties.
      3. Soundness of judgment.
      
      
2. Individual assessment - consider the following:
   1. Physical and intellectual factors.
   2. Socioeconomic factors.
   3. Personal values and goals.
   4. Adaptive functioning and response to present involvement.
   5. Developmental factors.
   
   
3. Cultural assessment:
   1. Knowledge of ethnic beliefs and cultural practices can assist the nurse in the planning and implementation of holistic care.
   2. Consider the following:
      1. Demographic data: is this an “ethnic neighborhood”?
      2. Socioeconomic status: occupation, education (formal and informal), income level; who is employed?
      3. Ethnic/racial orientation: ethnic identity, value orientation.
      4. Country of immigration: date of immigration; where were the family members born? Where has the family lived?
      5. Languages spoken: does family speak English? Language and dialect preferences.
      6. Family relationships: what are the formal roles? Who makes the decisions within the family? What is the family lifestyle and living arrangements?
      7. Degree of acculturation of family members: how are the family customs and beliefs similar to or different from the dominant culture?
      8. Communication patterns: social customs, nonverbal behaviors.
      9. Religious preferences: what role do beliefs, rituals, and taboos play in health and illness? Is there a significant religious person? Are there any dietary symbolisms or preferences or restrictions due to religious beliefs?
      10. Cultural practices related to health and illness: does the family use folk medicine practices or a folk healer? Are there specific dietary practices related to health and illness?
      11. Support systems: do extended family members provide support?
      12. Health beliefs: response to pain and hospitalization; disease predisposition and resistance.
      13. Other significant factors related to ethnic identity: what health care facilities does the family use?
      14. Communication barriers:
          1. Differences in language.
          2. Technical languages.
          3. Inappropriate place for discussion.
          4. Personality or gender of the nurse.
          5. Distrust of the nurse.
          6. Time-orientation differences.
          7. Differences in pain perception and expression.
          8. Variable attitudes toward death and dying.