Historically, and even in present times, the social assessment of a patient (that is, a thorough assessment of all aspects of the patient’s culture, ethnicity, socioeconomic background, education level,family life, lifestyle and values) has not always formed as important a part in the plan of care as would be ideal. As nursing develops a more holistic approach to patient care — one that encompasses all aspects of a patient: mental, physical, psychosocial and spiritual – the social assessment is becoming more central to the formation of the patient’s plan of care. This paper reviews the multimedia presentation of the “Social Assessment/Analysis Framework” and the article “Characterizing Social Support: Global and Specific Social Support Experiences for HIV-Infected Youth”, then discusses the general importance of social assessments for AIDS patients.
The ability to conduct an assessment is one of the most valuable skills a nurse can acquire in the course of his/her career. It is “first and most critical step in the nursing process” (Cape Fear Community College, 2012, p. 2) and from it, nursing diagnoses will be formed and corresponding nursing interventions, goals, and ongoing evaluation will occur. There is ample proof of its importance: a recent study in the British Medical Journal found that, for instance, there was a strong correlation between accurate nursing assessments and positive patient outcomes and assessments were declared to be “sensitive indicators of patient condition” (Rotham, 2012, p 14). The article and multimedia presentation and article under review delve into the importance of the social assessment in particular.
The multimedia presentation “Social Assessment./Analysis Framework” emphasizes one particular facet of this part of the nursing process, going into great detail about all the aspects of a nurse’s social assessment. Specifically, the aspects which the module presents include the five factors which must be part of this assessment: the stakeholders (the patients themselves), social diversity (factors such as the patient’s age, race, social class, religion), participation (the ability of the patient to be an active part of the plan of care), institutional rules/behaviors (an analysis of the parameters of the patient’s community and how those parameters affect the patient), and social risk (an analysis of the patient’s vulnerability and of how they are affected by the communities in which they live). (Crouch & Meurier, 2005, p. 1-2). The module showed the immense complexity of issues through which the nurse must navigate to complete the social assessment of her patient and come up with a plan of care which is realistic, takes the patient background into consideration, and can in fact be followed by the patient to improve outcomes.
Social assessment is also an integral part of the article “Characterizing Social Support: Global and Specific Social Support Experiences of HIV-Infected Youth.”: The article outlines a study done to understand more about the relationship between between depression and the quality and availability of social support for a group of young adults, all of whom are HIV infected. The study was based on extensive questionnaires and depression was assessed using the Beck scale. It concluded that “youth satisfied with the social support they receive report significantly lower levels of depression” (Abramowitz, Koenig, Chandwani, Orban, Stein, Lagrange, & Barnes, 2009, p328). The study was interesting from a nursing point of view because it shows the important role psychosocial factors play in the mental health of HIV-infected youth which in turn, of course, can affect the course of their physical health.
In the nursing of AIDS patients, social assessment can be an important factor, as is shown by the Abramowitz article. AIDS is a disease caused by the human immunodeficiency virus which causes progressive damage to the body’s immune system and its ability to ward off disease; it is spread through unprotected sex, contact with infected blood, and can be passed from mother to baby. To prevent transmission, the Mayo Clinic recommends using a condom during sex, telling the partner about one’s HIV status and using a clean needle if injecting drugs (Mayo Clinic, 2013, p. 1, 7). AIDS has thus been shown to be a condition heavily impacted by social behaviors and an early article on the AIDS phenomenon states specifically that AIDS patients overwhelmingly “fall into well-identified groups: homosexuals, bisexuals….and IV drug users” (Kirby, 1986, p. 188).
Because certain behaviors are classified as high risk , a thorough social assessment is a crucial part of forming a plan of care that will be based on accurate knowledge of the patient’s background and lifestyle. Equally important is the development of a relationship between the nurse and patient that is positive enough to make the patient feel comfortable disclosing behaviors that have historically been stigmatized. This is backed up by a recent study from the Journal of Sexual Behavior in which Abramson states bluntly that “research on the transmission dynamics of AIDS necessitates an extraordinarily rigorous sexual science” (Abramson, 1988, p323) and notes that when dealing with this subject, certain parameters emerge which are central to understanding AIDS epidemiology: “three consistent parameters emerge: sexual orientation, anal intercourse, and selection of sexual partners” (p324). These are intimate subjects, and before any of these topics can be broached, it has been my experience that the trust must be built up between the nurse and patient to a very high degree, or the patient will not feel comfortable giving this information.
Another aspect of nursing care for AIDS patients that can be overlooked without a thorough social assessment is that AIDS is a disease which does not just affect the patient but all those who are involved in the patient’s life. Understanding of this dynamic simply cannot occur without understanding, through a thorough social assessment, who is important in the patient’s life and who forms their support network. The Abramowitz article shows one aspect of this: that the social support shown to HIV-infected youth has a dramatic impact on their overall sense of emotional well-being, and the article mentions similar studies which found a correlation between social support and other aspects of the AIDS disease, including “morbidity, adherence, safe sex practices, mental health, mood, and disclosure of HIV status” (Abramowitz, et. al., 2009, p. 323). It has been noted that “only slowly did society come to recognize the implications of the disease for the many persons who were emotionally involved with the person with AIDS, such as lovers, partners, spouses, parents, siblings, children, friends, and caregivers” (Mackelin, 1988, p. 144). A holistic view of nursing — one that encompasses all aspects of a patient’s life -is necessary to understand the effects that AIDS has on those who surround the patient. This cannot be done without first assessing the patient’s social background.
Thus, it is shown in both the article and the multimedia presentation that social assessment is an important part of nursing in general and becomes particularly important in dealing with patients who are at high risk for contracting AIDS or who have already contracted it. When trust is built up between the nurse and patient, and when the nurse takes the time to do a thorough assessment of the patient’s social background, a clearer picture of the patient’s life and lifestyle emerges, and much important knowledge can be gained that will lead to a relevant plan of care and, hopefully, an improved outcome for the patient.
Abramowitz, Susan. et. al. (2009). Characterizing Social Support: Global and Specific Social Support Experiences of HIV-Infected Youth. AIDS Patient Care & STD’s. 23:(5) 323- 330
Abramson, Paul R. (1988). Sexual Assessment and the Epidemiology of AIDS. The Journal of Sexual Research. 25:(3) 323-346
Cape Fear Community College Nursing Program. (2012). Nursing Process Module. Retrieved from: www.cfcc.edu/pn/documents/Module5.pdf
Crouch, A. & Meurier, C. (2005). Health Assessment. Malden, MA: Blackwell
Kirby, M.D. (1986). AIDS Legislation – Turning Up the Heat? Medical Ethics. 12:(2) 187-194
Mayo Clinic. (2013). AIDS/HIV. Retrieved from: www.mayoclinic.com/DiseasesIndex/AIDSHIV.html
Rotham, Micheal J. (2012). Clinical Implications and Validity of Nursing Assessment: A Longitudinal Measure of Patient Condition from Analysis of Electronic Health Records.British Medical Journal. 2:(4). 56-61
Sodah, A.E. et. al. (2010). Attitudes of Health-care Workers towards HIV-Infected Patients. African Journal of Reproductive Health. 10: (2) 40-44
Mackelin, Eleanor. (1988). AIDS: Implications for Families. Journal of Family Medicine. 37: (2) 141-149