‘Tell me what the problem is’
Thirteen of the 18 respondents talked of problem identification as a component of a comprehensive mental health nursing assessment. What is the problem that brings the mental health patient here? In which part of their life is there a problem? For example, a male arrives at the accident and emergency department, seeking admission to the acute psychiatric unit:
How did you get here? I want to know everything about why they are here now, who brought them and who has got the problem (Kelly, Manager, 24 years experience). The following example highlights the use of the problem from the patient’s perspective as the basis for the assessment process. It is not simply identifying a problem; it is placing the problem within the context of the patient’s whole life. I usually start with, ‘tell me what the problem is’ . . . get them to elaborate and then to go back and put that into some sort of context for that Patient (Edward, Clinician, 24 years experience).
Nursing in general has been seen as problem orientated rather than solution focused (McAllister 2003). The process of determining the mental status of the patient involves the elicitation of symptoms that are often deficits or problems (Jacob 2003), so it is not surprising that problem identification is part of the practice of mental health nursing assessment. However, the need for mental health to be delivered in a way that is strengths based, recovery orientated and in a collaborative manner is being called for by patients (Piat et al. 2009) and clinicians alike (Castle & Gilbert 2006; Lester et al. 2006). While there have been efforts in psychiatry to adopt a collaborative, recovery orientated, strengths-based approach to assessment (Chopra et al. 2009), which patients find more satisfying (Björkman et al. 2002), this has been proven challenging in mental health (Deane et al.2006).