Discussion: Assessment Tools NRNP 6640
Assessment tools serve two primary functions: 1) measuring illness and diagnosing clients, and 2) measuring a client’s response to treatment. Multiple assessment tools are frequently designed to measure the same condition or response. However, not all tools are appropriate for use in all clinical situations. To choose the best assessment tool for your client, you must consider the strengths and weaknesses of each tool. Consider the use of the assessment tool assigned to you by the Course Instructor in psychotherapy as you examine it for this Discussion.
- Analyze psychometric properties of assessment tools
- Evaluate appropriate use of assessment tools in psychotherapy
- Compare assessment tools used in psychotherapy
Note: By Day 1 of this week, the Course Instructor will assign you to an assessment tool that is used in psychotherapy.
- Review this week’s Learning Resources and reflect on the insights they provide.
- Consider the assessment tool assigned to you by the Course Instructor.
- Review the Library Course Guide in your Learning Resources for assistance in locating information on the assessment tool you were assigned.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click Submit, you cannot delete or edit your own posts, and cannot post anonymously. Please check your post carefully before clicking Submit!
By Day 3
Post an explanation of the psychometric properties of the assessment tool you were assigned. Explain when it is appropriate to use this assessment tool with clients, including whether the tool can be used to evaluate the efficacy of psychopharmacologic medications. Support your approach with evidence-based literature.
Read a selection of your colleagues’ responses.
By Day 6
Respond to at least two of your colleagues by comparing your assessment tool to theirs.
Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing Company.
Chapter 3, “Assessment and Diagnosis” (pp. 95–168)
Chapter 4, “The Initial Contact and Maintaining the Frame” (pp. 169–224)
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
American Academy of Child and Adolescent Psychiatry. (1995). Practice parameters for the psychiatric assessment of children and adolescents. Washington, DC: Author. Retrieved from https://www.aacap.org/App_Themes/AACAP/docs/practice_parameters/psychiatric_assessment_practice_parameter.pdf
American Psychiatric Association. (2016). Practice guidelines for the psychiatric evaluation of adults (3rd ed.). Arlington, VA: Author. Retrieved from http://psychiatryonline.org/doi/pdf/10.1176/appi.books.9780890426760
Walden Library. (2017). NURS 6640 week 2 discussion guide. Retrieved from http://academicguides.waldenu.edu/nurs6640week2discussion
Walden University. (n.d.). Tests & measures: Home. Retrieved February 6, 2017, from http://academicguides.waldenu.edu/library/testsmeasures
Note: This database may be helpful in obtaining assessment tool information for this week’s Discussion.
Laureate Education (Producer). (2015a). Counseling competencies—The application of ethical guides and laws to record keeping [Video file]. Baltimore, MD: Author.
Provided courtesy of the Laureate International Network of Universities.
Note: The approximate length of this media piece is 23 minutes. Discussion: Assessment Tools NRNP 6640
Week 2: Assessment and Diagnosis in Psychotherapy
“A sensitively crafted intake assessment can be a powerful therapeutic tool. It can establish rapport between patient and therapist, further the therapeutic alliance, alleviate anxiety, provide reassurance, and facilitate the flow of information necessary for an accurate diagnosis and appropriate treatment plan.”
—Pamela Bjorklund, clinical psychologist
Whether you are treating patients for physical ailments or clients for mental health issues, the assessment process is an inextricable part of health care. To properly diagnose clients and develop treatment plans, you must have a strong foundation in assessment. This includes a working knowledge of assessments that are available to aid in diagnosis, how to use these assessments, and how to select the most appropriate assessment based on a client’s presentation.
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This week, as you explore assessment and diagnosis in psychotherapy, you examine assessment tools, including their psychometric properties and appropriate use.
Delirium Rating Scale Revised-98
Delirium is an acute psychiatric syndrome characterized by impairment of consciousness with a prominent disturbance of attention and deficits in other cognitive areas, perception, language, thought, motor behavior, sleep-wake cycle, and affective control, according to Lee, Ryu, Lee, Kim, Shin, Kim, and Trzepacz (2011). (para.1). Delirium is common among critically ill hospitalized patients, affecting approximately 25% of this population (Lee et al., 2011). Delirium has been linked to a significant increase in morbidity, mortality, and hospitalization length. Because delirium is frequently under- or misdiagnosed and associated with poor outcomes, a precise and reliable instrument for delirium diagnosis and repeated evaluation is required, leading to the development of the Delirium Rating Scale (DRS), which objectively measures symptom severity.
The Delirium Rating Scale -Revised-98 (DRS-R-98) is a 16-item, clinician-rated scale that includes anchored item-descriptions for both symptoms and temporal aspects of delirium. The Severity scale has 13 items, each rated from 0 to 3, with a total of 39 points, and higher scores indicating greater delirium severity (Sharma, Malhotra, Grover, & Jindal, 2017). Three additional items (rated 0 to 2 or 3) capture temporal course and attribution to an underlying etiology and, when added to the sum of the 13 symptom-items, yield the DRS-R-98 Total score, which ranges from 0 to 46. (Thurber et al., 2015).
The Delirium Rating Scale -Revised-98 (DRS-R-98) can be used in evaluating phenomenology in medically ill patients. It can also be used to evaluate the efficacy of psychopharmacologic medications by assessing the severity ratings range from 0 to 3 indicating no impairment to severe impairment and higher scores indicating the higher severity of delirium (Sharma, Malhotra, Grover, & Jindal, 2017).
Kato, M., Kishi, Y., Okuyama, T., Trzepacz, P. T., & Hosaka, T. (2010). Japanese Version of the Delirium Rating Scale Revised–98 (DRS-R98–J): Reliability and Validity. Psychosomatics, 51(5), 425–431. https://doi-org.ezp.waldenulibrary.org/10.1016/S0033-3182(10)70725-8
Lee, Y., Ryu, J., Lee, J., Kim, H. J., Shin, I. H., Kim, J. L., & Trzepacz, P. T. (2011). Korean version of the delirium rating scale-revised-98: reliability and validity. Psychiatry investigation, 8(1), 30–38. https://doi.org/10.4306/pi.2011.8.1.30
Sharma, A., Malhotra, S., Grover, S., & Jindal, S. K. (2017). Symptom profile as assessed on delirium rating scale-revised-98 of delirium in respiratory intensive care unit: A study from India. Lung India: official organ of Indian Chest Society, 34(5), 434–440. https://doi.org/10.4103/lungindia.lungindia_416_14
Thurber, S., Kishi, Y., Trzepacz, P. T., Franco, J. G., Meagher, D. J., Lee, Y., Kim, J.-L., Furlanetto, L. M., Negreiros, D., Huang, M.-C., Chen, C.-H., Kean, J., & Leonard, M. (2015). Confirmatory Factor Analysis of the Delirium Rating Scale Revised-98 (DRS-R98). JOURNAL OF NEUROPSYCHIATRY AND CLINICAL NEUROSCIENCES, 27(2), E122–E127. https://doi-org.ezp.waldenulibrary.org/10.1176/appi.neuropsych.13110345.
I agree with you that the DRS-R-98 is a revised version of the Delirium Rating Scale. According to Neefjes et al. (2019), the DRS-R-98 is the gold standard to evaluate the accuracy of the delirium observation screening scale because of its good psychometricqualitiesThe DRS-R-98 consists of 13 severity items that are scored from 0 (not present) to 3 points(severely present), and three diagnostic items are rated over the past 24 hours. The severity of the scores range from 0 to 39, and the overall scores range from 0 to 46. A skilled professional is the designated personnel that completes the DRS-R-98 questionnaire, and it takes about 10-15 minutes to complete (Neefjes et al., 2019). The severity scale of The DRS-R-98 has a significant benefit, and it can be used repeatedly to assess the response to delirium treatment. The DRS-R-98 has a well‑validated instrument with high interrater reliability, sensitivity, and specificity (Grover et al., 2019)
Grover, S., Ghosh, A., Sarkar, S., Desouza, A., Yaddanapudi, L., & Basu, D. (2018). Delirium in the Intensive Care Unit: Phenomenology, Subtypes, and Factor Structure of Symptoms. Indian Journal of Psychological Medicine, 40(2), 169.
Neefjes, E. C. W., van der Vorst, M. J. D. L., Boddaert, M. S. A., Verdegaal, B. A. T. T., Beeker, A., Teunissen, S. C. C., Beekman, A. T. F., Zuurmond, W. W. A., Berkhof, J., & Verheul, H. M. W. (2019). Accuracy of the Delirium Observational Screening Scale (DOS) as a screening tool for delirium in patients with advanced cancer. BMC Cancer, 19(1), 160. https://doi-org.ezp.waldenulibrary.org/10.1186/s12885-019-5351-8
Geriatric Depression Scale
The Geriatric Depression Scale is a self-report measure of depression in older adults. Users respond in a “Yes/No” format. The GDS was originally developed as a 30-item instrument. Since this version proved both time-consuming and difficult for some patients to complete, a 15-item version was developed. The shortened form is comprised of 15 items chosen from the Geriatric Depression Scale-Long Form. These 15 items were chosen because of their high correlation with depressive symptoms in previous validation studies. Of the 15 items, 10 indicate the presence of depression when answered positively while the other 5 are indicative of depression when answered negatively. This form can be completed in approximately 5 to 7 minutes, making it ideal for people who are easily fatigued or are limited in their ability to concentrate for longer periods of time (APA, 2020).
The Geriatric Depression Scale has been tested and used extensively with the elderly population. The GDS was found to have a 92% sensitivity and a 89% specificity when evaluated against diagnostic criteria. The validity and reliability of the tool have been supported through both clinical practice and research. In a validation study comparing the Long and Short Forms of the GDS for self-rating of symptoms of depression, both were successful in differentiating depressed from non-depressed adults with a high correlation. It is a useful screening tool in the clinical setting to facilitate assessment of depression in older adults especially when baseline measurements are compared to subsequent scores. The GDS may be used to monitor depression over time in all clinical settings. Any positive score above 5 on the GDS Short Form should prompt an in-depth psychological assessment and evaluation for suicidality (Greenberg, 2012).
The Geriatric Depression Scale is used in both the clinical setting and research setting to measure treatment response of geriatric patients with depression. A study by Papakostas (2015) used the Geriatric Depression Scale to obtain a baseline score and treatment follow-up for adults older than 65 starting antidepressants. The study concluded Geriatric Depression Scale scores showed duloxetine to be significantly more efficacious than placebo for improving depression. A study conducted by Luck-Sikorski et al., (2017), also used the GDS to determine depressive symptoms in adults greater than 75. The study concluded medication, psychotherapy, talking to friends and family, and exercise were the preferred treatment options for this population. Having a GDS score ≥ 6 significantly lowered the endorsement of some treatment options. Depressive symptoms influenced the preference for certain treatment options and also increase indecision in patients (Luck-Sikorski et al., 2017).
American Psychiatric Association. (2020). Geriatric Depression Scale (GDS). Retrieved from https://www.apa.org/pi/about/publications/caregivers/practice-settings/assessment/tools/geriatric-depression
Greenberg, S. A. (2012). The geriatric depression scale (GDS). Best Practices in Nursing
Care to Older Adults, 4(1), 1-2.
Luck-Sikorski, C., Stein, J., Heilmann, K., Maier, W., Kaduszkiewicz, H., Scherer, M., …
& Bock, J. O. (2017). Treatment preferences for depression in the elderly. International
psychogeriatrics, 29(3), 389-398.
Papakostas, G. I. (2015). Antidepressants and their effect on cognition in major
depressive disorder. J Clin Psychiatry, 76(8), e1046. Discussion: Assessment Tools NRNP 6640