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The scope of mental health nursing assessment

Increasing emphasis is placed on assessment of the ‘whole person’, by which different authors may mean different things. We have suggested that mental health nursing assessments are concerned with how people function in relation to health problems as well as in relation to the broader context of their lives. This focus on functioning provides one way of understanding the whole person and thereby the potential scope of assessment.

Barker (1997) draws out a number of different levels on which people function or live simultaneously including their physiological self, biological self, behavioural self, social self and spiritual self. Actions as well as thoughts and feelings are included in Barker’s ‘behavioural self’. By so doing we proposed that human experience is made up of a subjective and objective sense of self and a subjective and objective sense of community, and each of the models tapped into a different aspect of the human condition. Consideration of each of the quadrants is necessary to understand and assess the whole person. The upper left quadrant (subjective–self) reflects a person’s inner thoughts and feelings. It is concerned with the subjective meaning a person attributes to their life and/or their problems.

We would position Barker’s (1997) spiritual self and the thought and feeling components of his behavioural self in this quadrant. The upper right quadrant (objective–self) reflects a person’s quantifiable, observable, external attributes. We would include the action component of Barker’s (1997) behavioural self in this quadrant, along with the physiological and biological self. Similarly, we would place psychiatric diagnoses in this quadrant for their attempt to categorize people according to external, normative criteria. The lower left quadrant (subjective–community) captures a person’s collective sense of self. Their relations with family members and significant others are important here, as are their cultural roots and identity.

But there is another side to our sense of self in community and this is reflected by the lower right quadrant (objective–community). As well as the intersubjective experiences of culture and kinship there are interobjective social phenomenon in the form of health and social care systems (including the Care Programme Approach [CPA]), financial and other community resources that impact on our sense of self and thus on our sense of health or illness. We would place nursing diagnoses or problem statements that deal with a person’s thoughts, feelings or beliefs (written in the first person and using their words) in the upper left (subjective–self) quadrant.

Those that deal with external, observable behaviour or actions are upper right (objective–self). In reality, problem statements can straddle both quadrants (or all quadrants) dealing with thoughts and behaviours in relation to self and community. This is to be expected since human experience is made up of all four quadrants. To repeat our earlier example, ‘Arguments with my parents mean I don’t like to be at home, so I spend my time alone in public parks where I smoke cannabis to make the day more interesting.’ therefore represents our framework for assessment of the whole person upon which all assessment approaches and methods can be mapped. We will continue to refer to it throughout this chapter. However, we must also consider in general terms the focus of any assessment in each of the quadrants. Following our discussion of the models of mental disorder in Chapter 1, problems can arise in any one of the quadrants. Equally though, particular personal or community strengths can reside in any one of the quadrants.

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