Biopsychosocial nursing assessment practices by nurses for patients seeking curative care in Tamale Metropolitan

Biopsychosocial nursing assessment practices by nurses for patients seeking curative care in Tamale Metropolitan | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Biopsychosocial nursing assessment practices by nurses for patients seeking curative care in Tamale Metropolitan Paulina Kafari, Luke Laari, Josephine Mpomaa Kyei This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7646389/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background. Caring for the total man is prioritized in nursing, and this is possible when a holistic nursing assessment is performed. Nurse clinicians believe that patient assessment must be holistic to identify patients’ needs and deliver desired care. Nurse clinicians’ views on assessment practices dwelt much on obtaining biological, psychological, and social data in order to inform care choices. Aim. This study explored and described nurse clinicians’ views on their biopsychosocial assessment practices, using data collected from 16 professional nurse clinicians at the Tamale Regional Hospital. Method . Using an exploratory descriptive qualitative design, data were collected and analysed using qualitative thematic content analysis to describe the practices of the nurse clinicians. Results. The study's findings revealed that nurses, through physical assessment, history taking, and review of past medical information and laboratory investigations, can make informed decisions about patient care. Conclusion. The study recommended that biopsychosocial assessment be considered as a core practice of nursing assessment of patients. Biological Assessment Psychological Assessment Social Assessment Figures Figure 1 1.0 Introduction Providing nursing care commences with an identification of the patient’s biopsychosocial situation (Borowiak et al., 2021). Assessment is the collection of information about an individual’s health state (Jarvis, 2018), which involves sorting, analyzing, organizing, documenting and communicating the information gotten from the patient to the health team to inform care (Toney-Butler & Unison-Pace, 2018). Conducting a total health assessment is essential to developing confidence in clinical skills and improving nurses ability to respond effectively to patient’s healthcare needs (Jarvis, 2018). Health assessment allows nurses to make clinical judgement about the patient health status, response to actual and potential health problems (Jarvis, 2019). Health assessment is a key skill in nursing practice, but its value is poorly recognised, leading to partial and incorrect performance of patient assessment (Laari & Duma, 2023). The role of the nurse entails meeting the unmet health needs of patients, documenting patient psychological, social and biological status (Nilsson et al., 2018).The ability of the nurse to discharge these roles successfully help to prevent, protect, advocate, and promote the wellbeing of patients and this is based on the nurse capacity to identify patient health problems through assessment (Agyeman-Yeboah & Korsah, 2018). Accurate needs assessment to diagnose and plan care for a patient consist of 70% biopsychosocial history taken from the patient, 15% to 20% physical assessment and 10% to 15% diagnostic investigation (Toney-Butler & Unison-Pace, 2018). Patient needs assessment to achieve patient centred care is guided by the nursing process (Toney-Butler & Thayer, 2022), a scientifically validated strategy that directs care to achieve quality nursing care. The most crucial step in the nursing process to be completed at the start of every shift is an ongoing nursing assessment, which can be carried out using a variety of strategies. For professional nurses to be able to make informed decisions and continue to nurse patients with holistic nursing care, assessment need be done correctly (Osman et al., 2021). The decision-making process and tailored risk assessment necessary to build a care plan with specific actions to be undertaken for each patient are driven by the accurate gathering of assessment data (Solà‐Miravete et al., 2018). Several evidence suggests that health and disease are better understood as effects of biological, psychological, and social elements that interact continuously across time (Gatchel et al., 2021; Sharma et al., 2020; Wade & Halligan, 2017) . WHO (2017) defined health as a state of total physical, mental, and social well-being and not just the absence of disease or weakness. A holistic clinical assessment should identify all problems that obstruct obtaining health (Sharma et al., 2020). Complete health assessment should follow the biopsychosocial model which focuses on the complex interaction of biological factors, psychological factors, and social factors and their impact on diseases (Gatchel et al., 2020; Wade & Halligan, 2017). Ignoring any part of the biopsychosocial factors may result in a negative impact on not only the physical recovery but also the mental health of individuals (Maxwell et al., 2018). Nursing the healing profession must be able to treat an individual as a whole (Sulmasy, 2002). As such, the current study explored nurse clinician practices of biopsychosocial assessments of patients at the Tamale Regional Hospital. 2.0 Aim The aim of this study is to explore nurse clinician practices of biopsychosocial assessment of patients. 3.0 Methods 3.1 Study design This research is grounded in the constructivist/ interpretivist paradigm which seeks to understand experiences and perceptions within a specific environmental context. Engel’s biopsychosocial model depicted by The Pharos/Winter 2020 was used as the theoretical framework to guide the study. This study utilized an exploratory descriptive qualitative approach. The exploratory study design examines the dynamic, comprehensive, and personal facets of the human experience and seeks to document those characteristics in their whole, as experienced by the individuals involved (LoBiondo-Wood & Haber, 2021). This design has been necessary to answer the research questions to gain in-depth understanding of nurse clinician practices of biopsychosocial assessments. A qualitative approach, therefore, aided in exploring the participant’s perspective on biopsychosocial assessment practices. 3.2 Study setting The study was conducted at the Tamale Regional Hospital in the Tamale Metropolis. There is significant ethnic diversity of the Metropolis due to its cosmopolitan nature. The Metropolis is religious diverse with about 84% of the population practice Islam and 13.6% practicing Christianity (GSS, 2014). The Tamale Regional Hospital is currently the second largest hospital in the Metropolis, second to the Tamale Teaching Hospital and serves as a referral point for several health facilities in the region. Most patients visit the hospital because it is the first hospital built in the region and most of the indigenes are familiar with it. The facility was also selected because of researchers’ familiarity to the hospital. 3.3 Sampling and sample size This study intent is to explore nurse clinician practices of biopsychosocial assessment of patients. A sample of 16 nurses, 6 males and 10 female professional nurses were interviewed. Their level of education ranged from diploma in nursing to degree in nursing. This study adopted a purposive sampling technique . The use of this sampling technique is appropriate because researcher selected participants who have the experience of assessing patient presenting to the hospital at first contact and prior to admission. During the initial stages of data collection, we recruited professional nurses who met the inclusion criteria . The size of the sample was based on data saturation. Saturation was reached at the 16 th participant in which no fresh responses emerge from the participants since they all essentially start saying the same thing. 3.4 Data collection The study utilised a semi-structured interview guide, designed based on the objectives of the study. The following research questions facilitated this interview: (1) What are the biological assessment practices of nurses on patients at the Tamale Regional Hospital? (2) What are the psychological assessment practices of nurses on patients at the Tamale Regional Hospital? (3) What are the social assessment practices of nurses on patients at tamale the Tamale Regional Hospital? The interviews were conducted by the first author in English, the formal communication language in healthcare in Ghana. The interviews were audio- recorded. Each interview was conducted in a nurse’s office and lasted 30 to 60 minutes. The first author, a female registered general nurse with a master of philosophy degree in nursing conducted the data collection. The other two authors with their doctorate in nursing and an in depth understanding of the study area provided guidance through the write up of the entire manuscript. Research has no prior established relationship with participants before data collection. 3.5 Data analysis Analysis of data started as soon as interview starts. All the recorded interviews were transcribed verbatim by the researchers at the end of each interview. The accuracy of the transcribed transcripts was re-checked by reading repeatedly and listening to the audio-tape recordings at the same time. The acquired data was analysed using thematic content analysis. Through the establishment of themes and sub-themes, thematic content analysis provided a logical, coherent, and concise presentation of the material (Braun & Clarke, 2006). Analyses began with familiarizing with the data by reading the transcripts several times. Using Braun and Clarke (2006) method of extracting patterns and meanings from data, the researchers manually coded the patterns and group together comparable findings on a larger scale to establish themes. The resulting themes were subsequently defined and designated to correspond to the study's specific goals. The researchers provided the data in a clear, coherent, logical, and non-repetitive manner within the themes developed. Three main themes emerged, with 10 total subthemes. 3.6 Ethical considerations and rigour This study was approved by the Ghana Health Service ethics review committee in Ghana with approval number GHS-ERC 063/03/23, which oversees that the research complied with established national standards for health research. This research aligned with the principles in accordance with the declaration of Helsinki. However, permission letters were obtained from data collection site. Participation in the study was voluntary. Before the start of data collection, all participants received a comprehensive information on the purpose of the study, how participants safety, privacy and dignity will be protected, how the data will be managed to maintain confidentiality and the potential benefits to the community. Participants declared their consent by appending their signatures on the consent form before they were part of the study. To the establishment of trustworthiness of the research findings, the research instrument was pre-tested before data collection to ensure credibility, for confirmability the co-authors, are well incline in qualitative content analysis, evaluated and confirmed the codes derived from the raw data. A draft of the final study and an audit record of all the interviews and transcripts were subjected to an independent review to serve this purpose. The interviews were also conducted face-to-face to ensure that only the participants' thoughts were recorded. Accurate descriptions of the participant’s experiences were ensured by the use of recording and transcription of recorded data. Participants were given the chance to authenticate, verify, and reread the findings to make sure that their opinions were accurately captured. To ensure transferability, a full description of the study's research methodologies, settings are provided. This in-depth information allowed any reader to determine whether the findings would be applicable another specific environment. All participants in the research were interviewed using the same interview guide to ensure dependability. 4.0. FINDINGS OF THE STUDY The study participants were professional registered nurses with the nursing and midwifery council of Ghana working at the Tamale Regional Hospital. Out of the sixteen participants number of participants, the youngest participant was 27 years of age and the oldest participant was 40 years old. With regards to religion, majority (11) of the participants, practised Islam and five (5) of them practised Christianity. In terms of highest level of education, majority (11) of them were having Bachelor of Science and the remaining five (5) of the participants having Diploma. Among the sixteen (16) nurses, their ranks included NO (10), SSN (4), SN (1) and SNO (1). The number of years that the participants had practised as nurses ranged from two (2) to thirteen (13) years. Data analysis revealed three themes consisting of biological assessment practices, psychological assessment practices and social assessment practices. This is summarized in Table 1. 4.1.0 Nurse Clinician’s Biological assessment practices Biological assessment practices sought to explore the types of assessment that were primarily biological, which nurses routinely conducted on patients. The findings discovered that observational skill is paramount in biological assessment. Nurses looked at the general appearance of the patient as a form of assessment and took records which aid them to offer appropriate direction toward the required treatment of ailments. The three (3) sub-themes which emerged under biological assessment practices are initial familiarization, anatomical state, and physiological state. 4.1.1 Initial Familiarization. Majority of the participants appraised the patients mentally right from how they entered the premises before even proceeding with any verbal communication. The initial familiarization entails welcoming and greeting the patient and relatives, checking the patient for the state of alertness, head-to-toe examination, physical appearance, grooming, gait, and mode of arrival. First of all, when the patient comes, we received the patient by greeting the patient first and introduce yourself as a nurse to the patient then you provide the seat for the patient you will ask and then maybe as he is walking in you first of all look at the person appearance the way the person walk towards . (N5) You can also look at the patient from head to toe again from the hair, the face, the eyes, the hands, the feet everything about the patient you are supposed to check to know, that one will also help you not what the patient tells you alone but per your own observation and examinations from head to toe (N5) Table 1 Themes and subthemes for biopsychosocial assessment of patients seeking curative care THEMES SUB-THEMES BIOLOGICAL ASSESSMENT PRACTICES Initial familiarization Anatomical state Physiological state PSYCHOLOGICAL ASSESSMENT PRACTICES Mental state Emotional state Patient's beliefs Patient expectation SOCIAL ASSESSMENT PRACTICES Social support Interpersonal relationships Financial state 4.1.2 Anatomical State The anatomical state of the patient was also assessed as part of the biological assessment that nurses conduct on patients. Key indicators of the anatomical state of the patient include skin integrity, tissue health, deformity and disability. You look out for maybe breakages in the skin, if there is fracture, if there is a deviation maybe on the face, if there is maybe a disability on the patient those kinds of things . (N2) You can also touch the patient skin to know whether the patient is dehydrated or not you can also check the conjunctiva to know whether the patient is pale or not. (N15) 4.1.3 Assessing the physiological state. Vital signs, checking breathing pattern, checking patency of airways and circulation formed an integral part of the physiological state in biological assessment as the findings of the study reveal. When you get there, you take your vitals and if you find out the person is having difficulty in breathing, you make sure you loosen tight clothing then the air ways, that will even determine the position to put the patient, consider all those factors. After your vitals and assessments, you document because at times the vitals alter so if there is the need to resuscitate you do that before you call the physician assistant. (N14) You take into consideration the breathing pattern, airways, circulation, you check the SPO2 to see the oxygen saturation then you observe, you will take the patient vitals is also very important then you monitor pulse respiration to see whether is within the normal range then if possible if the saturation level is down too then you can give oxygen you just do certain things before the prescriber comes you don’t wait till things are deteriorating before you call the prescriber . (N14) 4.2. 0 Nurse Clinician’s Psychological Assessment Practices The study discovered that nurses laid emphasis on the mental and emotional health of patients as it guided their interactions with them. The four (4) sub-themes which emerged under psychological assessment are mental state, emotional state, patient beliefs and patient expectations. 4.2.1 Mental State. Participants acknowledged the impact of the mental state of the patient in even responding to their enquiries. A coherent speech, ability to comprehend and attentiveness of the patient form part of the mental state that the patient exhibits. You don’t see someone neatly dress and you think all is well, all is not well until the person starts talking to you and then you realise that is a different person all together. (N15) Ok with the psychological looking at the way maybe sometimes some of the patient per their speech their way of answering questions to you, the way they are responding to your questions you will know either the patient’s mind is with you or somewhere. (N5) 4.2.2 Emotional state. The emotional state of a patient also influenced how they responded to the medical team. As a result, the participants revealed that they always performed an assessment to check the stability or otherwise of the patients’ emotions in order to determine which course of action to proceed with. A sound mind, stable emotions and the mood of the patient are important factors which aid the nurses in assessing the emotional state of a patient. So, in the first place you must be in the right frame of mind to cooperate with your treatment regime, others wise you will see treatment as something harmful. (N1) So, you observe whether the person is having a sound mind or the person had problems, psychological has to do with whether the person is at the normal state so that is what I think (N15) Yes, it is because everybody has how he /she feels at a particular time, this minute you are happy, this minute you are sad so sometimes you have to know the state of the person before attend to the person . (N16) 4.2.3 Patient beliefs Participants in the study admitted that patient beliefs played a major role in how the patients even co-operated with the medical staff hence it was important that it was considered as part of the psychological assessment conducted on patients. The participants identified that a patient’s beliefs concerning the health system are shaped by past medical experiences, religious affiliation, cultural background and perception. Because there was a patient who came, I was with my boss so we realize that whenever we talk about metronidazole, it was metronidazole they were to give to the patient so not knowing she lost her daughter after giving her large dose of metronidazole by the nurse, it was incorrect which was not supposed to be for the child so she is someone that no matter what you do if you give her metronidazole, she will not take It (N16) If the patient believe that this my sickness is from my ancestors, they are doing me, no matter how much medications you give the patient the patient will not recover or maybe I am from Muslim background that is the religion aspect, we don’t take injections so how then do you recover, those are the things, patient believes is something that can also affect or help the patient recovery. (N5) In my own understanding, assessing a patient on what he/she thinks of their health condition, how does the patient think about you the one who is going to render the service, how does the patient think about his/her religion, how does the patient think about accepting who he/she is, all this will affect his health outcome? (N14) 4.2.4 Patient expectations. Expectations of the patients were important to take note of in order to navigate medical treatment options for them. Yes, because if the patient is expecting that oh, I have to go to a juju man before I recover, and maybe you are also keeping the patient in the hospital, I don’t think it will work, patient expectations is just to get health somewhere not in the hospital and they want to move out of the hospital sometimes some come to the hospital they want to go somewhere else to get their treatment, they have their expectation somewhere not in the hospital. (N5) Ok, so um there are sometimes that um client comes in base on what they expect to receive from the health personnel and if they don’t get that it brings about disappointment, the express it in a diverse way, some can go to the extent of abuse, be it physical or verbal (N1) 4.3.0 Nurse Clinician’s Social Assessment Practices In exploring the social assessment practices nurses conduct on patients, the study identified elements of the social wellbeing of patients such as relationships and finances. These were very important as it served as a link to both the biological and psychological welfare of the patient. Even in terms of reporting at the health facility, social support and financial support were revealed to be important to enable the patient access healthcare. The three (3) sub-themes which emerged under social assessment practices nurses conduct on patients include social support, interpersonal relationships and financial state. 4.3.1 Social support . An important dimension of social assessment is the social support that is available to patients. Most often, sick people need people to accompany them to the hospital. In critical cases, patients are even brought to the hospital in unconscious states. It is therefore of essence that nurses take note of the persons who can be notified in instances of worsening conditions or persons who would generally offer assistance to the patients. In this regard, family support, support from friends and support after discharge from the hospital were revealed to constitute a part of the social support that a patient need. It’s important because that is where you can get much of the information from, especially unconscious patients, information is gotten from the family and friends, and the financial support, family and friends can buy drugs for the patient. (N7) Yes, you also see if there is family around to assist patient even though we are there to do that but they also need their family around so is also important to have their information so you can call them when the need be. (N6) Well it is important, because when you are dealing with a patient, when a patient is being brought to the hospital, the patient cannot do anything for himself because the patient is sick so it is good you involve the family because when they are going to buy drugs that is not covered by insurance you need the family, you need to let them know the disease state of the patient so that when they are spending money they wouldn’t think like maybe they are wasting their money (N15) 4.3.2 Interpersonal relationship . The study identified interpersonal relationships as part of the components of social assessment practices that nurses conduct on patients. In their view, the presence or absence of interpersonal relationships influenced the health of patients indirectly. Interpersonal relationship was identified as being key in maintaining a person’s mental health because when people isolate themselves from others, they easily fall prey to depression. Interpersonal relationships are evidenced by the presence of family and friend, having a next of kin as well as a close person to contact in emergency situations. Nowadays depression is rampant and so most people decide to isolate themselves which is not the best. Too much of isolation can bring suicidal thoughts into the person’s mind because of this, friends and family must be there for the person always and the way the person relate with them will tell if they will be there” (N14) Aspect, like I said, socially if the patient doesn’t have people around her, it will affect the person treatment, because nobody is around to bring food or to buy medication for the person, I don’t think the patient will recover very quickly from the hospital, that is one, so the person’s relationship with others will bring these people in these times . (N5) 4.3.3 Financial state Incidents of illness and hospital visits demand considerable financial expenditure. Therefore, participants in this study revealed that they assessed the socioeconomic status of patients in order to have fair comprehension of the medical treatments that they might be able to afford if the need arose. In another light, the socioeconomic status of the person such as the nature of his or her job may have consequences on the health outcomes hence the need for nurses to perform holistic assessments in order to have a clue about the patient’s background. The occupation of patient, health insurance status and any financier of the patient are key in assessing a patient’s financial state. Maybe what the person does. The work the person does, is the person a farmer? Is the person a trader? A teacher? Does the person have money? Is the person unemployed? All those things, will the person be able to pay for his or her medical bills? (N5) Medications if you are health insured, we, the nurses, can go for it but if it involves money, we can’t do otherwise, we still need somebody to be there for the patient. That is what I know about it though some will come with insurance there is certain drugs that is not covered by insurance hey need to pay and some they don’t even have insurance so you need to find out (N5) “So, we do that to ask for support where maybe those who are to fund the person treatment and all those things”. (N16) Based on the findings in the study, a visual summary of the results is presented in figure 1. For assessment to be holistic, information gathering must include the biological, psychological and social component of a patient lifestyle. Nurse clinicians must be taken through capacity building to be able to accurately assess for patients’ pertinent health needs. The availability of a guide on what information to be taken during biopsychosocial assessment and a proper demarcation of columns for documentation will improve its practice 5.0 DISCUSSIONS This qualitative study explored nurse clinician biopsychosocial assessments practices of patients. Participants talked about a number of assessments practices which they categorise under biological, psychological and social assessment practices. Findings from this study revealed that patients are assessed by nurses immediately they are brought to the ward or unit as part of the rudiments of nursing practice. This enables the nurses to be oriented with the state of the patient prior to any verbal discourse. According to Hamilton and Manias (2007) and Wilson and Giddens (2020) nurses observe patients in a subtle manner through which they are able to gain important social and medical information on the patient without subjecting the patients to the discomfort of verbal probes. Additionally, initial familiarization by nurses was found to facilitate the early recognition of clinical deterioration of patients’ wellbeing in a study at a general public hospital in Singapore. This recognition enables nurses to promptly initiates measures to improve and restore optimum health to patients under their care (Chua et al., 2019). Moreover, the present study also revealed that nurses observe how patients get into the hospital as part of the components of biological assessment practices, with attention being paid to whether the person had a walking aid, was agile or totally immobile. These were all standard best practices in nursing which every professional nurse adhered to in administering healthcare services to patients. These findings are consistent with findings from Perry et al. (2021) which confirm that general observation and inspection of patients are major skills which are regularly utilized by nurses in the course of their work. Comparatively, findings from the United Kingdom reported that nurses relied on the Modified Early Warning Score (MEWS) system to assess, monitor and identify deteriorating conditions of patients rather than the nurse’s own clinical judgement and/or analysis of the situation. Nurses were found to easily notify physicians about necessary adjustments to patient’s care based on high MEWS score (Dalton et al., 2018). The reliance of nurses on observation and intuition for patient assessment found in this study requires in-depth knowledge based on empirical research and self-confidence in one’s clinical ability to ensure accurate interpretation of these physiological parameters. Physical appearance of a patient also informs part of nurses’ assessments, including a head-to-toe examination, with attention paid to the minutest details even to the fingernails as well as grooming. These findings are in accordance with findings from Chan et al. (2018) which revealed that although nurses may ask more detailed questions, they would examine the appearance and manner of the patient as these provide information about the background. According to Lopes-Júnior (2021) the ability of nurses to take patient history has become an essential skill owing to the broadening scope of nursing practice and the important role of nurses as frontliners. The present study also revealed that due to the fact that some health conditions are hereditary, nurses assess the family history of a patient to gain in-depth knowledge of the person’s condition. These findings are consistent with findings from Oladiran (2021) which note that certain medical conditions such as hypertension, diabetes and sickle cell have genetic undertones hence the need for a patient’s family medical history. In addition, Kaufman (2008) also indicate that health professionals must ask questions about the patient’s family in the case of conditions such as diabetes, allergies and mental health issues. The anatomical state of a patient is assessed as part of biological assessment as found out by this study and keen interest is taken in any form of breakage in skin or fracture in bone. According to Nixon (2013) and Bernatchez and Bichel (2023) skin integrity and tissue health may be compromised as a result of injuries hence the need for health professionals to assess the degree of damage by establishing the mechanism of injury. Also, this finding is similar to studies in the United States of American which highlighted the recognition and identification of unique nursing considerations and use of critical thinking skills to meet the needs of patients including classification of risk for positioning injury and how obesity affects hemodynamic parameters and airway management (Barth & Jenson, 2006; Bjorklund‐Lima et al., 2019) Findings from this study revealed that in examining the physiological state of a patient, vital signs and organ functioning are taken into consideration due to the role they play in determining the direction of medical care to be offered to the patient. These findings are in accordance with findings from Sapra et al. (2023) which note that vital signs such as pulse and temperature present an objective dimension of the physiological state of living beings. Moreover, this present study revealed that nurses take records of vital signs and monitor these closely in order to detect any changes. This is confirmed by Elliott (2021) who noted that vital signs are very important for proving good healthcare as they provide evidence of a patient’s response to medical intervention. Further, clinical judgements can be passed by nurses with the aid of vital signs (Reblora et al., 2020). These findings were further reiterated by Wolf et al. (2018) who indicated that vital signs went as far as enabling emergency nurses to prioritize patients based on the need for urgent care. Healthcare professionals are however cautioned to avoid sole reliance on vital signs at the expense of conducting thorough physical assessments to ensure the wellbeing of patients (Tan et al., 2021). The present study also revealed that the functioning of internal organs such as the brain and the respiratory system were observed by monitoring speech and breathing patterns. These findings are consistent with findings from Kaufman (2008) which reiterate the need to assess patients in relation to any respiratory issues, coughing episodes, ear and throat issues. Findings from this study revealed that nurses observe the attentiveness, comprehension ability and coherence of speech in patients to make medical opinions. The findings emphasize the need to delve deeper than the surface and outward appearance of patients due to the diverse issues that people battle with emotionally. These findings are in accordance with findings by Maj et al. (2020) which emphasize the need for examining the patient to determine any signs of anxiety, depression or sadness. These findings are very important as they highlight the essence of mental healthcare education among nurses and other health workers who work in the frontline to equip them with basic skills that can be applied in managing the mental health of patients. Various studies have also reported that nurses use clear processes in the assessment of the mental state of patients under their care. Mental state assessment help nurses gain important information about patient mental illnesses and develop strategies to help them solve daily problems (Chien et al., 2001; Coombs et al., 2013; Holmberg et al., 2020; Montgomery et al., 2009). The present study identified that nurses pay particular attention to a patient’s emotions and the pointers which help them in doing this include the patient’s mood, stability of emotions and having a sound mind. The importance of this kind assessment is to determine the level of co-operation the patient would even be capable of offering the medical team since the nurses acknowledged that mood swings affect the way patients respond to their probes. This is confirmed by Chan et al. (2019) which highlight that the credibility of information provided by patients may be influenced by their mood hence the need for nurses to pay attention in order to identify and record issues relating to the mood of the patient. Other studies reported varying patterns of nurses’ estimation of the emotional status of patients ranging from understating patients coping mechanisms and quality of life to overestimation of their emotional distress. Nurses caring for patients are aware of the risk of making miscalculations of their emotional status. This awareness ensures nurses intensify attention to patient’s internal resources to improve the ability to make accurate assessments and individualized care (Legg, 2011; Löfmark et al., 1999; Lovatt et al., 2015; Skilbeck & Payne, 2003). In psychological assessment nurses would consider the various beliefs systems which patients ascribe to because such beliefs reflect in their outlook of issues and influences their choices. These belief systems may be based on religion, culture, perception and past experiences. Moreover, findings from this study revealed that some patients may not even accept their health status. These findings are in accordance with findings by Hamilton and Manias (2007) who noted that in some cases such as mental health diagnosis, patients outrightly disagreed with the medical diagnosis and begrudged attempts at medical intervention. Additionally, various studies have revealed that the multicultural dynamics of modern communities pose substantial task to providing individualized comprehensive nursing care to patients. Thus, nurses are able to recognize and appreciate varying beliefs, cultural differences in health practices, values and norms. The training and skills acquired in school and experiences through practice helps to build the cultural competencies of nurses which helps to ensure patient satisfaction and optimum health outcomes (Lankau et al., 2017; Maier-Lorentz, 2008; Narayanasamy, 2004; van Dijk et al., 2017). Findings from the current study revealed that nurses also take the expectations of patients into account when examining their psychological state. This is important as it provides a clue of whether the patient may end up satisfied or disappointed with the healthcare that is provided and also enables the nurses to brace themselves for any frustrations by disgruntled patients. These findings are in agreement with Kaufman (2008) who indicated that it is essential for the expectations of patients to be considered in order for the healthcare provider and the patient to maintain a mutual understanding aimed at a better health outcome. More so, nursing assessment of patient expectations help provide awareness to what they consider significant throughout healthcare continuum hence building a solid foundation for measuring patients experience based on their expectations. Nurses awareness of the expectations of patients under their care may have an added advantage of positively influencing patients’ satisfaction through nursing care (Reck, 2013; Redman & Lynn, 2005). However, it was found in other studies that nurses constantly underestimated the scale at which patients valued nursing care rendered to them. Patients' opinions regarding their expectations of nursing care can be an important consideration and/or opportunity for nurses to modify care plan and institute relevant approaches to improve the quality of nursing care which positive influences patient expectations (Abdel Maqsood et al., 2012; Karaca & Durna, 2019; Weaver et al., 2023) Nurses acknowledge the importance of social support and interactions on the health and wellbeing of patients. As a result, questions are asked by nurses in order to have an overview of the patient’s social background and support system. Findings from the current study indicate that a person’s social support is crucial especially in times of ill-health. This is because sickness may render a person incapable of adequately caring for himself or herself. Nurses are therefore interested in establishing the identities and contacts of persons who would assist the patient during hospital rounds. According to Baker and Clark (2020), social support is important and must be considered when dealing with patients because negative thoughts and feelings usually arose from isolation. Medical diagnosis and treatment may bring significant changes to personal life patterns, activities of daily living, work, relationships, family roles which invariably heighten psychosocial stress. Social support provided to patients by nurses may contribute substantially to improving and reinforcing coping mechanisms and overall wellbeing of hospitalized and chronically ill patients (Khatatbeh et al., 2021; Tarkka & Paunonen, 1996; Usta, 2012). Interpersonal relationships are also important for patients and humans in general as social beings. A person’s state of health, particularly the mental health, may be influenced by the kind of interpersonal relationships that the individual keeps. Nurses therefore try to obtain information about a patient’s interpersonal relationships in order to have a more complete picture during assessment. These findings are consistent with findings by Nixon (2013) who reiterate the importance of a patient’s social history in revealing the possible cause of a medical condition. The author stressed that lifestyle issues bordering on family or job may influence the onset of a condition such as chest pain and also emphasized on the need to identify the people the patient lives with (Nixon, 2013). Findings from this present study highlighted the effect of a person’s job on the individual’s health status. As a result, nurses would usually ask questions on the nature of a patient’s occupation. These findings are consistent with findings by Kaufman (2008) which also indicate that a person’s occupation may reflect in the medical diagnosis hence health practitioners needed to obtain such information. 6.0 Conclusion Biopsychosocial assessments have proven to be a necessary practice for quality and effective health care delivery. Unlike in western countries, in the northern part of Ghana nurse clinicians seem to focus more on biological assessment. Participants outlined what they would be assessing for in biopsychosocial assessments but also testified that the psychological and social component of this assessments were neglected. Reasons were that there were no columns created in patient documents for these assessments to be written which means when they assessed, it would be a waste of their time. They also said due to the workload pressure on them the psychological and social components were not assessed. However, if these barriers are addressed biopsychosocial assessment will encompass the three components in totality. Limitation and further research Data was collected from nurses working in the same facility hence the results may not be a true reflection in another context. Secondly, the qualitative approach adopted by the study resulted in the involvement of a limited number of participants to elicit in-depth information about their experiences. These limitations however do not invalidate the findings of this study because the importance of rigour and trustworthiness in qualitative research was considered. Further research should be conducted to explore the health outcomes of patients on whom biopsychosocial assessments has been done. Declarations Authors contribution All authors conceptualised the idea, wrote the proposal, and designed the instrument for data collection. Data collection was done by PK whiles LL and JK reviewed and made corrections. All authors read and approved the manuscript. All authors contributed to this paper. Declaration of conflicting interest The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Funding The authors received no financial support for the research, authorship, and/or publication of this article Ethical approval and consent to participate The study received ethical clearance from the Ghana Health Service ethics review committee in Ghana with approval number GHS-ERC 063/03/23. All participants voluntarily signed a written informed consent form. Consent for Publication Not applicable Clinical trial number Not applicable Consent statement All participants in the study were above 18 years old and provided voluntary agreement to participate Data Availability Statement The data that supports the findings of this study are available but restrictions apply to the availability of these data so are not publicly available. 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P., ling Siew, A., Levett-Jones, T., Chua, W. L., & Liaw, S. Y. (2021). Why are physical assessment skills not practiced? A systematic review with implications for nursing education. Nurse Education Today , 99 , 104759. Tarkka, M. T., & Paunonen, M. (1996). Social support provided by nurses to recent mothers on a maternity ward. Journal of advanced nursing , 23 (6), 1202-1206. Toney-Butler, T. J., & Thayer, J. M. (2022). Nursing process. In StatPearls [Internet] . StatPearls Publishing. Toney-Butler, T. J., & Unison-Pace, W. J. (2018). Nursing admission assessment and examination. Usta, Y. Y. (2012). Importance of social support in cancer patients. Asian Pacific Journal of Cancer Prevention , 13 (8), 3569-3572. van Dijk, J. F., Schuurmans, M. J., Alblas, E. E., Kalkman, C. J., & van Wijck, A. J. (2017). Postoperative pain: knowledge and beliefs of patients and nurses. Journal of Clinical Nursing , 26 (21-22), 3500-3510. Wade, & Halligan. (2017). 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Assessment is the collection of information about an individual\u0026rsquo;s health state (Jarvis, 2018), which involves sorting, analyzing, organizing, documenting and communicating the information gotten from the patient to the health team to inform care (Toney-Butler \u0026amp; Unison-Pace, 2018). \u0026nbsp;Conducting a total health assessment is essential to developing confidence in clinical skills and improving nurses ability to respond effectively to patient\u0026rsquo;s healthcare needs (Jarvis, 2018). Health assessment allows nurses \u0026nbsp;to make clinical \u0026nbsp;judgement about the patient health status, \u0026nbsp;response to actual and potential health problems (Jarvis, 2019). Health assessment is a key skill in nursing practice, but its value is poorly recognised, leading to partial and incorrect performance of patient assessment (Laari \u0026amp; Duma, 2023).\u003c/p\u003e\n\u003cp\u003eThe role of the nurse entails meeting the unmet health needs of patients, documenting patient psychological, social and biological status (Nilsson et al., 2018).The ability of the nurse to discharge these roles successfully help to prevent, protect, advocate, and \u0026nbsp;promote the wellbeing of patients and this is based on the nurse capacity to identify patient health problems through assessment (Agyeman-Yeboah \u0026amp; Korsah, 2018). \u0026nbsp;Accurate needs assessment to diagnose and plan care for a patient consist of 70% biopsychosocial history taken from the patient, 15% to 20% physical assessment and 10% to 15% diagnostic investigation (Toney-Butler \u0026amp; Unison-Pace, 2018). Patient needs assessment to achieve patient centred care is guided by the nursing process (Toney-Butler \u0026amp; Thayer, 2022), a scientifically validated strategy that directs care to achieve quality nursing care. The most crucial step in the nursing process to be completed at the start of every shift is an ongoing nursing assessment, which can be carried out using a variety of strategies. For professional nurses to be able to make informed decisions and continue to nurse patients with holistic nursing care, assessment need be done correctly (Osman et al., 2021). The decision-making process and tailored risk assessment necessary to build a care plan with specific actions to be undertaken for each patient are driven by the accurate gathering of assessment data (Sol\u0026agrave;‐Miravete et al., 2018). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSeveral evidence suggests that health and disease are better understood as effects of biological, psychological, and social elements that interact continuously across time (Gatchel et al., 2021; Sharma et al., 2020; Wade \u0026amp; Halligan, 2017) . WHO (2017) defined health as a state of total physical, mental, and social well-being and not just the absence of disease or weakness. A holistic clinical assessment should identify all problems that obstruct obtaining health (Sharma et al., 2020). Complete health assessment should follow the biopsychosocial model which focuses on the complex interaction of biological factors, psychological factors, and social factors and their impact on diseases (Gatchel et al., 2020; Wade \u0026amp; Halligan, 2017). Ignoring any part of the biopsychosocial factors may result in a negative impact on not only the physical recovery but also the mental health of individuals (Maxwell et al., 2018). Nursing the healing profession \u0026nbsp;must be able to treat an individual as a whole (Sulmasy, 2002). As such, the current study explored nurse clinician practices of biopsychosocial assessments of patients at the Tamale Regional Hospital.\u0026nbsp;\u003c/p\u003e"},{"header":"2.0 Aim","content":"\u003cp\u003eThe aim of this study is to explore nurse clinician practices of biopsychosocial assessment of patients.\u003c/p\u003e"},{"header":"3.0 Methods ","content":"\u003cp\u003e\u003cem\u003e3.1 Study design\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis research is grounded in the constructivist/ interpretivist paradigm which seeks to understand experiences and perceptions within a specific environmental context. Engel\u0026rsquo;s biopsychosocial model depicted by The Pharos/Winter 2020 was used as the theoretical framework to guide the study. This study utilized an exploratory descriptive qualitative approach. The exploratory study design examines the dynamic, comprehensive, and personal facets of the human experience and seeks to document those characteristics in their whole, as experienced by the individuals involved (LoBiondo-Wood \u0026amp; Haber, 2021). This design has been necessary to answer the research questions to gain in-depth understanding of nurse clinician practices of biopsychosocial assessments. A qualitative approach, therefore, aided in exploring the participant\u0026rsquo;s perspective on biopsychosocial assessment practices.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e3.2 Study setting\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted at the Tamale Regional Hospital in the Tamale Metropolis. There is significant ethnic diversity of the Metropolis due to its cosmopolitan nature. The Metropolis is religious diverse with about 84% of the population practice Islam and 13.6% practicing Christianity (GSS, 2014). The Tamale Regional Hospital\u003cstrong\u003e\u003c/strong\u003eis currently the second largest hospital in the Metropolis, second to the Tamale Teaching Hospital and serves as a referral point for several health facilities in the region. Most patients visit the hospital because it is the first hospital built in the region and most of the indigenes are familiar with it. The facility was also selected because of researchers\u0026rsquo; familiarity to the hospital.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e3.3 Sampling and sample size\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis study intent is to explore nurse clinician practices of biopsychosocial assessment of patients.\u003cstrong\u003e\u003c/strong\u003eA sample of 16 nurses, 6 males and 10 female professional nurses were interviewed. Their level of education ranged from diploma in nursing to degree in nursing.\u003c/p\u003e\n\u003cp\u003eThis study adopted a purposive sampling technique\u003cstrong\u003e.\u003c/strong\u003eThe use of this sampling technique is appropriate because researcher selected participants who have the experience of assessing patient presenting to the hospital at first contact and prior to admission.\u003cstrong\u003e\u003c/strong\u003eDuring the initial stages of data collection, we recruited professional nurses who met the inclusion criteria\u003cstrong\u003e.\u003c/strong\u003e\u003cstrong\u003e\u003c/strong\u003eThe size of the sample was based on data saturation. Saturation was reached at the 16\u003csup\u003eth\u003c/sup\u003e participant in which no fresh responses emerge from the participants since they all essentially start saying the same thing.\u003cstrong\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e3.4 Data collection\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe study utilised a semi-structured interview guide, designed based on the objectives of the study. The following research questions facilitated this interview: (1) What are the biological assessment practices of nurses on patients at the Tamale Regional Hospital? (2) What are the psychological assessment practices of nurses on patients at the Tamale Regional Hospital? (3) What are the social assessment practices of nurses on patients at tamale the Tamale Regional Hospital? The interviews were conducted by the first author in English, the formal communication language in healthcare in Ghana. The interviews were audio- recorded. Each interview was conducted in a nurse\u0026rsquo;s office and lasted 30 to 60 minutes.\u003c/p\u003e\n\u003cp\u003eThe first author, a female registered general nurse with a master of philosophy degree in nursing conducted the data collection. The other two authors with their doctorate in nursing and an in depth understanding of the study area provided guidance through the write up of the entire manuscript. Research has no prior established relationship with participants before data collection.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e3.5 Data analysis\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAnalysis of data started as soon as interview starts. All the recorded interviews were transcribed verbatim by the researchers at the end of each interview. The accuracy of the transcribed transcripts was re-checked by reading repeatedly and listening to the audio-tape recordings at the same time.\u003cstrong\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe acquired data was analysed using thematic content analysis. Through the establishment of themes and sub-themes, thematic content analysis provided a logical, coherent, and concise presentation of the material (Braun \u0026amp; Clarke, 2006). \u003c/p\u003e\n\u003cp\u003eAnalyses began with familiarizing with the data by reading the transcripts several times. Using Braun and Clarke (2006) method of extracting patterns and meanings from data, the researchers manually coded the patterns and group together comparable findings on a larger scale to establish themes. The resulting themes were subsequently defined and designated to correspond to the study\u0026apos;s specific goals. The researchers provided the data in a clear, coherent, logical, and non-repetitive manner within the themes developed. Three main themes emerged, with 10 total subthemes.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e3.6 Ethical considerations and rigour\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ghana Health Service ethics review committee in Ghana with approval number GHS-ERC 063/03/23, which oversees that the research complied with established national standards for health research. This research aligned with the principles in accordance with the declaration of Helsinki. However, permission letters were obtained from data collection site. Participation in the study was voluntary. Before the start of data collection, all participants received a comprehensive information on the purpose of the study, how participants safety, privacy and dignity will be protected, how the data will be managed to maintain confidentiality and the potential benefits to the community. Participants declared their consent by appending their signatures on the consent form before they were part of the study.\u003c/p\u003e\n\u003cp\u003eTo the establishment of trustworthiness of the research findings, the research instrument was pre-tested before data collection to ensure credibility, for confirmability the co-authors, are well incline in qualitative content analysis, evaluated and confirmed the codes derived from the raw data. A draft of the final study and an audit record of all the interviews and transcripts were subjected to an independent review to serve this purpose. The interviews were also conducted face-to-face to ensure that only the participants\u0026apos; thoughts were recorded. Accurate descriptions of the participant\u0026rsquo;s experiences were ensured by the use of recording and transcription of recorded data. Participants were given the chance to authenticate, verify, and reread the findings to make sure that their opinions were accurately captured. To ensure transferability, a full description of the study\u0026apos;s research methodologies, settings are provided. This in-depth information allowed any reader to determine whether the findings would be applicable another specific environment. All participants in the research were interviewed using the same interview guide to ensure dependability.\u003c/p\u003e"},{"header":"4.0. FINDINGS OF THE STUDY","content":"\u003cp\u003eThe study participants were professional registered nurses with the nursing and midwifery council of Ghana working at the Tamale Regional Hospital.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOut of the sixteen participants number of participants, the youngest participant was 27 years of age and the oldest participant was 40 years old. With regards to religion, majority (11) of the participants, practised Islam and five (5) of them practised Christianity. In terms of highest level of education, majority (11) of them were having Bachelor of Science and the remaining five (5) of the participants having Diploma. Among the sixteen (16) nurses, their ranks included NO (10), SSN (4), SN (1) and SNO (1). The number of years that the participants had practised as nurses ranged from two (2) to thirteen (13) years.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eData analysis revealed three themes consisting of biological assessment practices, psychological assessment practices and social assessment practices. This is summarized in Table 1.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e4.1.0\u003c/em\u003e\u003cem\u003e\u0026nbsp;Nurse Clinician\u0026rsquo;s Biological assessment practices\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Biological assessment practices sought to explore the types of assessment that were primarily biological, which nurses routinely conducted on patients. The findings discovered that observational skill is paramount in biological assessment. Nurses looked at the general appearance of the patient as a form of assessment and took records which aid them to offer appropriate direction toward the required treatment of ailments. The three (3) sub-themes which emerged under biological assessment practices are initial familiarization, anatomical state, and physiological state.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e4.1.1 Initial Familiarization.\u003c/em\u003e Majority of the participants appraised the patients mentally right from how they entered the premises before even proceeding with any verbal communication. The initial familiarization entails welcoming and greeting the patient and relatives, checking the patient for the state of alertness, head-to-toe examination, physical appearance, grooming, gait, and mode of arrival. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFirst of all, when the patient comes, we received the patient by greeting the patient first and introduce yourself as a nurse to the patient then you provide the seat for the patient you will ask and then maybe as he is walking in you first of all look at the person appearance the way the person walk towards\u003c/em\u003e\u003cem\u003e.\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e(N5)\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eYou can\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cem\u003ealso look at the patient from head to toe again from the hair, the face, the eyes, the hands, the feet everything about the patient you are supposed to check to know, that one will also help you not what the patient tells you alone but per your own observation and examinations from head to toe\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e(N5)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 1 Themes and subthemes for biopsychosocial assessment of patients seeking curative care\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"342\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTHEMES\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 195px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSUB-THEMES\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u0026nbsp;BIOLOGICAL ASSESSMENT PRACTICES\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 195px;\"\u003e\n \u003cp\u003eInitial familiarization\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 195px;\"\u003e\n \u003cp\u003eAnatomical state\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 195px;\"\u003e\n \u003cp\u003ePhysiological state\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003ePSYCHOLOGICAL ASSESSMENT PRACTICES\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 195px;\"\u003e\n \u003cp\u003eMental state\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 195px;\"\u003e\n \u003cp\u003eEmotional state\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 195px;\"\u003e\n \u003cp\u003ePatient\u0026apos;s beliefs\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 195px;\"\u003e\n \u003cp\u003ePatient expectation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003eSOCIAL ASSESSMENT\u003c/p\u003e\n \u003cp\u003ePRACTICES\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 195px;\"\u003e\n \u003cp\u003eSocial support\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 195px;\"\u003e\n \u003cp\u003eInterpersonal relationships\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 195px;\"\u003e\n \u003cp\u003eFinancial state\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003e4.1.2 Anatomical State\u003c/em\u003e The anatomical state of the patient was also assessed as part of the biological assessment that nurses conduct on patients. Key indicators of the anatomical state of the patient include skin integrity, tissue health, deformity and disability.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eYou look out for maybe breakages in the skin, if there is fracture, if there is a deviation maybe on the face, if there is maybe a disability on the patient those kinds of things\u003c/em\u003e\u003cem\u003e.\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e(N2)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eYou can also touch the patient skin to know whether the patient is dehydrated or not you can also check the conjunctiva to know whether the patient is pale or not.\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e(N15)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e4.1.3 Assessing the physiological state.\u0026nbsp;\u003c/em\u003eVital signs, checking\u003cem\u003e\u0026nbsp;\u003c/em\u003ebreathing pattern, checking patency of airways and circulation formed an integral part of the physiological state in biological assessment as the findings of the study reveal.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;When you get there, you take your vitals and if you find out the person is having difficulty in breathing, you make sure you loosen tight clothing then the air ways, that will even determine the position to put the patient, consider all those factors. After your vitals and assessments, you document because at times the vitals alter so if there is the need to resuscitate you do that before you call the physician assistant.\u003c/em\u003e \u003cstrong\u003e(N14)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cem\u003eYou take into consideration the breathing pattern, airways, circulation,\u003c/em\u003e\u003cem\u003e\u0026nbsp;you check the SPO2 to see the oxygen saturation then you observe, you will take the patient vitals is also very important then you monitor pulse respiration to see whether is within the normal range then if possible if the saturation level is down too then you can give oxygen you just do certain things before the prescriber comes you don\u0026rsquo;t wait till things are deteriorating before you call the prescriber\u003c/em\u003e. \u003cstrong\u003e(N14)\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp id=\"_Toc153385592\"\u003e\u003cem\u003e4.2. 0 Nurse Clinician\u0026rsquo;s Psychological Assessment Practices\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The study discovered that nurses laid emphasis on the mental and emotional health of patients as it guided their interactions with them. The four (4) sub-themes which emerged under psychological assessment are mental state, emotional state, patient beliefs and patient expectations.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e4.2.1 Mental State.\u003c/em\u003e Participants acknowledged the impact of the mental state of the patient in even responding to their enquiries. A coherent speech, ability to comprehend and attentiveness of the patient form part of the mental state that the patient exhibits.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;You don\u0026rsquo;t see someone neatly dress and you think all is well, all is not well until the person starts talking to you and then you realise that is a different person all together.\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e(N15)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;Ok with the psychological looking at the way maybe sometimes some of the patient per their speech their way of answering questions to you, the way they are responding to your questions you will know either the patient\u0026rsquo;s mind is with you or somewhere.\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e(N5)\u003c/strong\u003e \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e4.2.2 Emotional state.\u003c/em\u003e The emotional state of a patient also influenced how they responded to the medical team. As a result, the participants revealed that they always performed an assessment to check the stability or otherwise of the patients\u0026rsquo; emotions in order to determine which course of action to proceed with. A sound mind, stable emotions and the mood of the patient are important factors which aid the nurses in assessing the emotional state of a patient.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;So, in the first place you must be in the right frame of mind to cooperate with your treatment regime, others wise you will see treatment as something harmful.\u003c/em\u003e \u003cstrong\u003e(N1)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSo, you observe whether the person is having a sound mind or the person had problems, psychological has to do with whether the person is at the normal state so that is what I think\u003c/em\u003e \u003cstrong\u003e(N15)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;Yes, it is because everybody has how he /she feels at a particular time, this minute\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp; you are happy, this minute you are sad so sometimes you have to know the state of the\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;person before attend to the person\u003c/em\u003e. \u003cstrong\u003e(N16)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e4.2.3 Patient beliefs Participants in the study admitted that patient beliefs played a major role in how the patients even co-operated with the medical staff hence it was important that it was considered as part of the psychological assessment conducted on patients. The participants identified that a patient\u0026rsquo;s beliefs concerning the health system are shaped by past medical experiences, religious affiliation, cultural background and perception.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;Because there was a patient who came, I was with my boss so we realize that whenever we talk about metronidazole, it was metronidazole they were to give to the patient so not knowing she lost her daughter after giving her large dose of metronidazole by the nurse, it was incorrect which was not supposed to be for the child so she is someone that no matter what you do if you give her metronidazole, she will not take It\u003c/em\u003e \u003cstrong\u003e(N16)\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;If the patient believe that this my sickness is from my ancestors, they are doing me, no matter how much medications you give the patient the patient will not recover or maybe I am from Muslim background that is the religion aspect, we don\u0026rsquo;t take injections so how then do you recover, those are the things, patient believes is something that can also affect or help the patient recovery.\u003c/em\u003e \u003cstrong\u003e(N5)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;In my own understanding, assessing a patient on what he/she thinks of their health condition, how does the patient think about you the one who is going to render the service, how does the patient think about his/her religion, how does the patient think about accepting who he/she is, all this will affect his health outcome?\u003c/em\u003e \u003cstrong\u003e(N14)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;4.2.4 Patient expectations.\u0026nbsp;\u003c/em\u003eExpectations of the patients were important to take note of in order to navigate medical treatment options for them.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;Yes, because if the patient is expecting that oh, I have to go to a juju man before I recover, and maybe you are also keeping the patient in the hospital, I don\u0026rsquo;t think it will work, patient expectations is just to get health somewhere not in the hospital and they want to move out of the hospital sometimes some come to the hospital they want to go somewhere else to get their treatment, they have their expectation somewhere not in the hospital.\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e(N5)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eOk, so um there are sometimes that um client comes in base on what they expect \u0026nbsp; \u0026nbsp;to receive from the health personnel and if they don\u0026rsquo;t get that it brings about disappointment, the express it in a diverse way, some can go to the extent of abuse, be it physical or verbal\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e(N1)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e4.3.0 Nurse Clinician\u0026rsquo;s Social Assessment Practices\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eIn exploring the social assessment practices nurses conduct on patients, the study identified elements of the social wellbeing of patients such as relationships and finances. These were very important as it served as a link to both the biological and psychological welfare of the patient. Even in terms of reporting at the health facility, social support and financial support were revealed to be important to enable the patient access healthcare. The three (3) sub-themes which emerged under social assessment practices nurses conduct on patients include social support, interpersonal relationships and financial state.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;4.3.1 Social support\u003c/em\u003e\u003cem\u003e.\u0026nbsp;\u003c/em\u003eAn important dimension of social assessment is the social support that is available to patients. Most often, sick people need people to accompany them to the hospital. In critical cases, patients are even brought to the hospital in unconscious states. It is therefore of essence that nurses take note of the persons who can be notified in instances of worsening conditions or persons who would generally offer assistance to the patients. In this regard, family support, support from friends and support after discharge from the hospital were revealed to constitute a part of the social support that a patient need. \u003cem\u003eIt\u0026rsquo;s important because that is where you can get much of the information from, especially unconscious patients, information is gotten from the family and friends, and the financial support, family and friends can buy drugs for the patient.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e(N7)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;Yes, you also see if there is family around to assist patient even though we are there to do that but they also need their family around so is also important to have their information so you can call them when the need be.\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e(N6)\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp id=\"_Toc153385599\"\u003e\u003cem\u003eWell it is important, because when you are dealing with a patient, when a patient is being brought to the hospital, the patient cannot do anything for himself because the patient is sick so it is good you involve the family because when they are going to buy drugs that is not covered by insurance you need the family, you need to let them know the disease state of the patient so that when they are spending money they wouldn\u0026rsquo;t think like maybe they are wasting their money\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e(N15)\u003c/strong\u003e \u003cem\u003e\u0026nbsp;4.3.2 Interpersonal relationship\u003c/em\u003e\u003cem\u003e.\u0026nbsp;\u003c/em\u003eThe study identified interpersonal relationships as part of the components of social assessment practices that nurses conduct on patients. In their view, the presence or absence of interpersonal relationships influenced the health of patients indirectly. Interpersonal relationship was identified as being key in maintaining a person\u0026rsquo;s mental health because when people isolate themselves from others, they easily fall prey to depression. \u0026nbsp;Interpersonal relationships are evidenced by the presence of family and friend, having a next of kin as well as a close person to contact in emergency situations.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;Nowadays depression is rampant and so most people decide to isolate themselves which \u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp; is not the best. Too much of isolation can bring suicidal thoughts into the person\u0026rsquo;s mind\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;because of this, friends and family must be there for the person always and the way the\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;person relate with them will tell if they will be there\u0026rdquo;\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;(N14)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cem\u003eAspect, like I said, socially if the patient doesn\u0026rsquo;t have people around her, it will affect \u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;the person treatment, because nobody is around to bring food or to buy medication for\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;the person, I don\u0026rsquo;t think the patient will recover very quickly from the hospital, that is\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eone, so the person\u0026rsquo;s relationship with others will bring these people in these times\u003c/em\u003e. \u003cstrong\u003e(N5)\u003c/strong\u003e\u003c/p\u003e\n\u003cp id=\"_Toc153385600\"\u003e\u003cem\u003e4.3.3 Financial state\u003c/em\u003e\u003cem\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eIncidents of illness and hospital visits demand considerable financial expenditure. Therefore, participants in this study revealed that they assessed the socioeconomic status of patients in order to have fair comprehension of the medical treatments that they might be able to afford if the need arose. In another light, the socioeconomic status of the person such as the nature of his or her job may have consequences on the health outcomes hence the need for nurses to perform holistic assessments in order to have a clue about the patient\u0026rsquo;s background. The occupation of patient, health insurance status and any financier of the patient are key in assessing a patient\u0026rsquo;s financial state.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eMaybe what the person does. The work the person does, is the person a farmer? Is the person a trader? A teacher? Does the person have money? Is the person unemployed? All those things, will the person be able to pay for his or her medical bills?\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;(N5)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eMedications if you are health insured, we, the nurses, can go for it but if it involves money, we can\u0026rsquo;t do otherwise, we still need somebody to be there for the patient. That is what I know about it though some will come with insurance there is certain drugs that is not covered by insurance hey need to pay and some they don\u0026rsquo;t even have insurance so you need to find out\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;(N5)\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;So, we do that to ask for support where maybe those who are to fund the person treatment and all those things\u0026rdquo;.\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e(N16)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBased on the findings in the study, a visual summary of the results is presented in figure 1. For assessment to be holistic, information gathering must include the biological, psychological and social component of a patient lifestyle. Nurse clinicians must be taken through capacity building to be able to accurately assess for patients\u0026rsquo; pertinent health needs. The availability of a guide on what information to be taken during biopsychosocial assessment and a proper demarcation of columns for documentation will improve its practice\u003c/p\u003e"},{"header":"5.0 DISCUSSIONS","content":"\u003cp\u003eThis qualitative study explored nurse clinician biopsychosocial assessments practices of patients. Participants talked about a number of assessments practices which they categorise under biological, psychological and social assessment practices.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFindings from this study revealed that patients are assessed by nurses immediately they are brought to the ward or unit as part of the rudiments of nursing practice. This enables the nurses to be oriented with the state of the patient prior to any verbal discourse. According to Hamilton and Manias (2007) and\u0026nbsp;Wilson and Giddens (2020)\u0026nbsp;nurses observe patients in a subtle manner through which they are able to gain important social and medical information on the patient without subjecting the patients to the discomfort of verbal probes. Additionally, initial familiarization by nurses was found to facilitate the early recognition of clinical deterioration of patients\u0026rsquo; wellbeing in a study at a general public hospital in Singapore. This recognition enables nurses to promptly initiates measures to improve and restore optimum health to patients under their care (Chua et al., 2019).\u0026nbsp;Moreover, the present study also revealed that nurses observe how patients get into the hospital as part of the components of biological assessment practices, with attention being paid to\u0026nbsp;whether the person had a walking aid, was agile or totally immobile.\u0026nbsp;These were all standard best practices in nursing which every professional nurse adhered to in administering healthcare services to patients. These findings are consistent with findings from\u0026nbsp;\u0026nbsp;Perry et al. (2021)\u0026nbsp;which confirm that general observation and inspection of patients are major skills which are regularly utilized by nurses in the course of their work.\u003c/p\u003e\n\u003cp\u003eComparatively, findings from the United Kingdom reported that nurses relied on the Modified Early Warning Score (MEWS) system to assess, monitor and identify deteriorating conditions of patients rather than the nurse\u0026rsquo;s own clinical judgement and/or analysis of the situation. Nurses were found to easily notify physicians about necessary adjustments to patient\u0026rsquo;s care based on high MEWS score (Dalton et al., 2018). The reliance of nurses on observation and intuition for patient assessment found in this study requires in-depth knowledge based on empirical research and self-confidence in one\u0026rsquo;s clinical ability to ensure accurate interpretation of these physiological parameters.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Physical appearance of a patient also informs part of nurses\u0026rsquo; assessments, including a head-to-toe examination, with attention paid to the minutest details even to the fingernails as well as grooming. These findings are in accordance with findings from\u0026nbsp;Chan et al. (2018) which revealed that although nurses may ask more detailed questions, they would examine the appearance and manner of the patient as these provide information about the background.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; According to\u0026nbsp;Lopes-J\u0026uacute;nior (2021) the ability of nurses to take patient history has become an essential skill owing to the broadening scope of nursing practice and the important role of nurses as frontliners. The present study also revealed that due to the fact that some health conditions are hereditary, nurses assess the family history of a patient to gain in-depth knowledge of the person\u0026rsquo;s condition. These findings are consistent with findings from\u0026nbsp;Oladiran (2021) which note that certain medical conditions such as hypertension, diabetes and sickle cell have genetic undertones hence the need for a patient\u0026rsquo;s family medical history. In addition, Kaufman (2008)\u0026nbsp;also indicate that health professionals must ask questions about the patient\u0026rsquo;s family in the case of conditions such as diabetes, allergies and mental health issues.\u003c/p\u003e\n\u003cp\u003eThe anatomical state of a patient is assessed as part of biological assessment as found out by this study and keen interest is taken in any form of breakage in skin or fracture in bone. According to Nixon (2013) and\u0026nbsp;Bernatchez and Bichel (2023)\u0026nbsp; skin integrity and tissue health may be compromised as a result of injuries hence the need for health professionals to assess the degree of damage by establishing the mechanism of injury. Also, this finding is similar to studies in the United States of American which highlighted the recognition and identification of unique nursing considerations and use of critical thinking skills to meet the needs of patients including classification of risk for positioning injury and how obesity affects hemodynamic parameters and airway management\u0026nbsp;(Barth \u0026amp; Jenson, 2006; Bjorklund‐Lima et al., 2019)\u003c/p\u003e\n\u003cp\u003eFindings from this study revealed that in examining the physiological state of a patient, vital signs and organ functioning are taken into consideration due to the role they play in determining the direction of medical care to be offered to the patient. These findings are in accordance with findings from Sapra et al. (2023) which note that vital signs such as pulse and temperature present an objective dimension of the physiological state of living beings. Moreover, this present study revealed that nurses take records of vital signs and monitor these closely in order to detect any changes. This is confirmed by Elliott (2021) who noted that vital signs are very important for proving good healthcare as they provide evidence of a patient\u0026rsquo;s response to medical intervention. Further, clinical judgements can be passed by nurses with the aid of vital signs (Reblora et al., 2020). These findings were further reiterated by Wolf et al. (2018) who indicated that vital signs went as far as enabling emergency nurses to prioritize patients based on the need for urgent care. Healthcare professionals are however cautioned to avoid sole reliance on vital signs at the expense of conducting thorough physical assessments to ensure the wellbeing of patients (Tan et al., 2021). The present study also revealed that the functioning of internal organs such as the brain and the respiratory system were observed by monitoring speech and breathing patterns. These findings are consistent with findings from Kaufman (2008) which reiterate the need to assess patients in relation to any respiratory issues, coughing episodes, ear and throat issues.\u0026nbsp;\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFindings from this study revealed that nurses observe the attentiveness, comprehension ability and coherence of speech in patients to make medical opinions. The findings emphasize the need to delve deeper than the surface and outward appearance of patients due to the diverse issues that people battle with emotionally. These findings are in accordance with findings by\u0026nbsp;Maj et al. (2020) which emphasize the need for examining the patient to determine any signs of anxiety, depression or sadness. These findings are very important as they highlight the essence of mental healthcare education among nurses and other health workers who work in the frontline to equip them with basic skills that can be applied in managing the mental health of patients. Various studies have also reported that nurses use clear processes in the assessment of the mental state of patients under their care. Mental state assessment help nurses gain important information about patient mental illnesses and develop strategies to help them solve daily problems (Chien et al., 2001; Coombs et al., 2013; Holmberg et al., 2020; Montgomery et al., 2009).\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe present study identified that nurses pay particular attention to a patient\u0026rsquo;s emotions and the pointers which help them in doing this include the patient\u0026rsquo;s mood, stability of emotions and having a sound mind. The importance of this kind assessment is to determine the level of co-operation the patient would even be capable of offering the medical team since the nurses acknowledged that mood swings affect the way patients respond to their probes. This is confirmed by\u0026nbsp;Chan et al. (2019)\u0026nbsp; which highlight that the credibility of information provided by patients may be influenced by their mood hence the need for nurses to pay attention in order to identify and record issues relating to the mood of the patient.\u003c/p\u003e\n\u003cp\u003eOther studies reported varying patterns of nurses\u0026rsquo; estimation of the emotional status of patients ranging from understating patients coping mechanisms and quality of life to overestimation of their emotional distress. Nurses caring for patients are aware of the risk of making miscalculations of their emotional status. This awareness ensures nurses intensify attention to patient\u0026rsquo;s internal resources to improve the ability to make accurate assessments and individualized care (Legg, 2011; L\u0026ouml;fmark et al., 1999; Lovatt et al., 2015; Skilbeck \u0026amp; Payne, 2003).\u003c/p\u003e\n\u003cp\u003eIn psychological assessment nurses would consider the various beliefs systems which patients ascribe to because such beliefs reflect in their outlook of issues and influences their choices. These belief systems may be based on religion, culture, perception and past experiences. Moreover, findings from this study revealed that some patients may not even accept their health status. These findings are in accordance with findings by Hamilton and Manias (2007) who noted that in some cases such as mental health diagnosis, patients outrightly disagreed with the medical diagnosis and begrudged attempts at medical intervention.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Additionally, various studies have revealed that the multicultural dynamics of modern communities pose substantial task to providing individualized comprehensive nursing care to patients. Thus, nurses are able to recognize and appreciate varying beliefs, cultural differences in health practices, values and norms. The training and skills acquired in school and experiences through practice helps to build the cultural competencies of nurses which helps to ensure patient satisfaction and optimum health outcomes (Lankau et al., 2017; Maier-Lorentz, 2008; Narayanasamy, 2004; van Dijk et al., 2017).\u003c/p\u003e\n\u003cp\u003eFindings from the current study revealed that nurses also take the expectations of patients into account when examining their psychological state. This is important as it provides a clue of whether the patient may end up satisfied or disappointed with the healthcare that is provided and also enables the nurses to brace themselves for any frustrations by disgruntled patients. These findings are in agreement with Kaufman (2008) who indicated that it is essential for the expectations of patients to be considered in order for the healthcare provider and the patient to maintain a mutual understanding aimed at a better health outcome. More so, nursing assessment of patient expectations help provide awareness to what they consider significant throughout healthcare continuum hence building a solid foundation for measuring patients experience based on their expectations.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNurses awareness of the expectations of patients under their care may have an added advantage of positively influencing patients\u0026rsquo; satisfaction through nursing care (Reck, 2013; Redman \u0026amp; Lynn, 2005). However, it was found in other studies that nurses constantly underestimated the scale at which patients valued nursing care rendered to them. Patients\u0026apos; opinions regarding their expectations of nursing care can be an important consideration and/or opportunity for nurses to modify care plan and institute relevant approaches to improve the quality of nursing care which positive influences patient expectations (Abdel Maqsood et al., 2012; Karaca \u0026amp; Durna, 2019; Weaver et al., 2023)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; Nurses acknowledge the importance of social support and interactions on the health and wellbeing of patients. As a result, questions are asked by nurses in order to have an overview of the patient\u0026rsquo;s social background and support system. Findings from the current study indicate that a person\u0026rsquo;s social support is crucial especially in times of ill-health. This is because sickness may render a person incapable of adequately caring for himself or herself. Nurses are therefore interested in establishing the identities and contacts of persons who would assist the patient during hospital rounds. According to Baker and Clark (2020), social support is important and must be considered when dealing with patients because negative thoughts and feelings usually arose from isolation. Medical diagnosis and treatment may bring significant changes to personal life patterns, activities of daily living, work, relationships, family roles which invariably heighten psychosocial stress. Social support provided to patients by nurses may contribute substantially to improving and reinforcing coping mechanisms and overall wellbeing of hospitalized and chronically ill patients (Khatatbeh et al., 2021; Tarkka \u0026amp; Paunonen, 1996; Usta, 2012).\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInterpersonal relationships are also important for patients and humans in general as social beings. A person\u0026rsquo;s state of health, particularly the mental health, may be influenced by the kind of interpersonal relationships that the individual keeps. Nurses therefore try to obtain information about a patient\u0026rsquo;s interpersonal relationships in order to have a more complete picture during assessment. These findings are consistent with findings by Nixon (2013) who reiterate the importance of a patient\u0026rsquo;s social history in revealing the possible cause of a medical condition. The author stressed that lifestyle issues bordering on family or job may influence the onset of a condition such as chest pain and also emphasized on the need to identify the people the patient lives with (Nixon, 2013). Findings from this present study highlighted the effect of a person\u0026rsquo;s job on the individual\u0026rsquo;s health status. As a result, nurses would usually ask questions on the nature of a patient\u0026rsquo;s occupation. These findings are consistent with findings by Kaufman (2008) which also indicate that a person\u0026rsquo;s occupation may reflect in the medical diagnosis hence health practitioners needed to obtain such information.\u003c/p\u003e"},{"header":"6.0 Conclusion","content":"\u003cp\u003eBiopsychosocial assessments have proven to be a necessary practice for quality and effective health care delivery. \u0026nbsp;Unlike in western countries, in the northern part of Ghana nurse clinicians seem to focus more on biological assessment. Participants outlined what they would be assessing for in biopsychosocial assessments but also testified that the psychological and social component of this assessments were neglected. Reasons were that there were no columns created in patient documents for these assessments to be written which means when they assessed, it would be a waste of their time. \u0026nbsp;They also said due to the workload pressure on them the psychological and social components were not assessed. However, if these barriers are addressed biopsychosocial assessment will encompass the three components in totality. \u0026nbsp;\u003c/p\u003e"},{"header":"Limitation and further research","content":"\u003cp\u003e\u0026nbsp;Data was collected from nurses working in the same facility hence the results may not be a true reflection in another context.\u0026nbsp;Secondly, the qualitative approach adopted by the study resulted in the involvement of a limited number of participants to elicit in-depth information about their experiences. These limitations however do not invalidate the findings of this study because the importance of rigour and trustworthiness in qualitative research was considered.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eFurther research should be conducted to explore the health outcomes of patients on whom biopsychosocial assessments has been done.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthors contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors conceptualised the idea, wrote the proposal, and designed the instrument for data collection. Data collection was done by PK whiles LL and JK reviewed and made corrections. All authors read and approved the manuscript. All authors contributed to this paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of conflicting interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors received no financial support for the research, authorship, and/or publication of this article\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study received ethical clearance from the Ghana Health Service ethics review committee in Ghana with approval number GHS-ERC 063/03/23. All participants voluntarily signed a written informed consent form.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants in the study were above 18 years old and provided voluntary agreement to participate\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that supports the findings of this study are available but restrictions apply to the availability of these data so are not publicly available. The data are, however, available from the authors upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAbdel Maqsood, A. S., Oweis, A. I., \u0026amp; Hasna, F. S. (2012). Differences between patients\u0026apos; expectations and satisfaction with nursing care in a private hospital in Jordan. \u003cem\u003eInternational Journal of Nursing Practice\u003c/em\u003e,\u003cem\u003e 18\u003c/em\u003e(2), 140-146. \u003c/li\u003e\n\u003cli\u003eAgyeman-Yeboah, J., \u0026amp; Korsah, K. A. (2018). Non-application of the nursing process at a hospital in Accra, Ghana: lessons from descriptive research. \u003cem\u003eBMC nursing\u003c/em\u003e,\u003cem\u003e 17\u003c/em\u003e(1), 1-7. \u003c/li\u003e\n\u003cli\u003eBaker, E., \u0026amp; Clark, L. L. (2020). 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Elsevier Health Sciences. \u003c/li\u003e\n\u003cli\u003eWolf, L. A., Delao, A. M., Perhats, C., Moon, M. D., \u0026amp; Zavotsky, K. E. (2018). Triaging the emergency department, not the patient: United States emergency nurses\u0026rsquo; experience of the triage process. \u003cem\u003eJournal of emergency nursing\u003c/em\u003e,\u003cem\u003e 44\u003c/em\u003e(3), 258-266. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Biological Assessment, Psychological Assessment, Social Assessment","lastPublishedDoi":"10.21203/rs.3.rs-7646389/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7646389/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cem\u003eBackground.\u003c/em\u003e Caring for the total man is prioritized in nursing, and this is possible when a holistic nursing assessment is performed. Nurse clinicians believe that patient assessment must be holistic to identify patients’ needs and deliver desired care. Nurse clinicians’ views on assessment practices dwelt much on obtaining biological, psychological, and social data in order to inform care choices.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAim.\u003c/em\u003e This study explored and described nurse clinicians’ views on their biopsychosocial assessment practices, using data collected from 16 professional nurse clinicians at the Tamale Regional Hospital. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eMethod\u003c/em\u003e. Using an exploratory descriptive qualitative design, data were collected and analysed using qualitative thematic content analysis to describe the practices of the nurse clinicians.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eResults.\u003c/em\u003eThe study's findings revealed that nurses, through physical assessment, history taking, and review of past medical information and laboratory investigations, can make informed decisions about patient care.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConclusion.\u003c/em\u003e The study recommended that biopsychosocial assessment be considered as a core practice of nursing assessment of patients.\u003c/p\u003e","manuscriptTitle":"Biopsychosocial nursing assessment practices by nurses for patients seeking curative care in Tamale Metropolitan","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-08 07:21:55","doi":"10.21203/rs.3.rs-7646389/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c9ec1d1d-6bba-400e-b5e4-3d4519bf7b9c","owner":[],"postedDate":"October 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-12T09:38:20+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-08 07:21:55","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7646389","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7646389","identity":"rs-7646389","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}