Nursing assessments are the initial subjective and objective statements and observations that help determine a patient’s nursing diagnosis, goal and treatment within the nursing process.
Nurses in hospital settings plan their care based on the nursing process. Forensic Nurses plan their investigations based on their assessments of the individual involved. When dealing with patients who are in some way involved in the criminal justice system, Forensic Nurses need to be well developed in their assessment skills. When assessing patients with mood disorders such as depression or a bipolar disorder, a Forensic nursing assessment needs to include a history of the patient’s mood disorder, their basic mental status, interpersonal relationships, mood and affect, clarity of thought and thoughts of death. These assessment areas are used as well by nurses in the hospital setting in order to determine the pharmacological need for appropriate medication for a patient’s specific mood disorder.
The Forensic Nurse needs to obtain a history of the individual’s mood disorder by determining the length of time the person has had the disorder as well as if the disorder is of a depressive nature or are there both manic and depressive phases in their illness. What factors (physiological or environmental) contribute to the mood of the patient? How long does the mood persist? Has the patient been treated previously with medications for this disorder? Have they experienced any adverse effects from these medications? Is alcohol or drug abuse an issue? Is the patient on any medications at present? What is the length of time that they have been on these medications? Are they adhering to their medication protocol?
Assessment of basic mental status includes noting the general appearance and posture (erect, stooped, or slumped) of the patient as well as if the patient is alert and oriented to person, place and time.
The Forensic Nurse will also need to assess the patient’s relationship with family, friends and coworkers. Is there a support system in place? Is there a past history of abuse from a family member? Have there been any conflicts among friends and coworkers?
The patient’s mood and affect during assessment can suddenly change. The Forensic Nurse needs to ensure a quiet environment conducive to patient assessment. The nurse needs to remain calm; to ask concise, simple questions and to use active listening. The patient may be in a manic phase of their disorder during the nurse’s assessment and may become quite talkative or argumentative. A direct, firm but kind manner of conversation needs to be used. Assess the patient’s behavior for irritability, joy, sadness, anger or tearful expressions. Are the verbal and nonverbal actions consistent with the circumstances the patient is discussing?
Is there clarity in the patient’s thought processes? Is the nurse able to identify any delusional or hallucinating thoughts? Is there any flight of ideas or paranoia exhibited by the patient?
Is the patient verbalizing any thoughts of death towards themselves or others? Does the patient have any plans formulated for suicide? Assess for any direct or indirect statements regarding death.
Nursing assessment, regardless of the different roles nurses play in their profession is the primary aspect of the nursing process. Subjective and objective assessments give Forensic Nurses the data relevant to their investigations as well as possible causes of the criminal activity of the patient.
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Forensic Nursing Chronicles 
November 12, 2011 at 3:04 pm
My 17 year old son has just been recently diagnosed w/major depression. It explains headaches, stomache aches, isolation, and not taking part in things he used to enjoy. Until now, I didn’t know that it can also cause irritability and aggression. He is bigger and stronger than me and he scared me earlier today. I was in tears after he stormed upstairs and started punching and throwing things. All because I asked him to get off of a computer game. My husband had to come home from work early because I didn’t feel safe. I guess it’s time to taper up to 100 mg. of Zoloft. If it doesn’t work I don’t know what else to do……….
September 27, 2011 at 6:49 am
clinical depression…
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