NSG/502 Week 5: Psychological, Spiritual and Sociocultural Assessment, sample paper

Through an Interpreter, Eight Months After Arrival: A Psychological, Spiritual and Sociocultural Assessment of a 24-Year-Old Refugee Mother Using Three Named Tools

[Student Name]

University of Phoenix

NSG/502: Pathophysiology, Assessment Variables and Pharmacology II

Week 5 Assignment

[Instructor Name]

[Date]

The patient, her family and all findings are a composite written for a model paper.

Identifying Data and Setting

Mrs. L. M., 24, a married mother of two children aged 4 and 1, who arrived in the United States as a refugee from Afghanistan eight months ago. Seen for a return appointment at the community health center that has served the family since resettlement. A professional Dari interpreter joined in person; her husband waited outside at her request.

Psychological Assessment

Subjective: Mrs. M. reports trouble sleeping, waking at 3 a.m. with her heart pounding and difficulty falling back asleep. She says she worries constantly about her parents and sister, who remain in Afghanistan, and that she "cannot stop thinking" about the day the family left. She has headaches most afternoons and less appetite than before. She cares for her children and cooks but no longer enjoys things she used to, and she cries when alone. She denies thoughts of harming herself or her children.

Refugee Health Screener-15: total score on the first 14 items of 19, with item 15, a distress thermometer, rated 7 of 10. Both exceed the tool's thresholds for a positive screen. The RHS-15 was developed for newly arrived refugees in public health settings and, in its validation study, showed good sensitivity and specificity for depression, anxiety and posttraumatic stress in two of the three ethnic groups studied (Hollifield et al., 2013).

PHQ-9: score of 14, in the moderate range, with item 9 about self-harm answered "not at all" (Kroenke et al., 2001).

Observations: she was appropriately dressed and cooperative, made intermittent eye contact, spoke softly and became tearful when describing her family. Thought process was logical. No evidence of psychosis.

Spiritual Assessment

The FICA framework was used (Puchalski & Romer, 2000).

Faith or meaning: she is Muslim and says her faith "is what holds me."

Importance: very important; prayer calms her, and she has found it hard to pray five times a day with the children and a small apartment.

Community: she has not found a mosque yet because the nearest is two bus rides away, and she has not met other women from her community.

Address in care: she would like female providers where possible, prefers to keep her headscarf on during examinations that do not require its removal and would welcome information about a mosque and a women's group.

Sociocultural Assessment

Family and roles: she lives with her husband and two children in a two-bedroom apartment. Her husband works nights at a warehouse. She manages the home and children and speaks for the family less than he does.

Language and literacy: she speaks Dari and some Pashto, reads Dari, and understands a few words of English. She has attended two English classes but stopped because of childcare.

Social determinants: rent is paid with resettlement assistance that will end in two months; she is worried about food running short at the end of the month. She does not drive, and the health center is a 30-minute bus ride. Her children's vaccinations are up to date.

Beliefs about health: she describes her symptoms mostly as physical, headaches, poor sleep and a heavy chest, and says that sadness is "something to bear," not an illness. She is unsure whether talking to someone about feelings would help but is willing to try "if it helps the headaches."

Interpretation

The three tools and the history together show moderate depressive symptoms with prominent anxiety and intrusive memories, in a young mother with severe ongoing stressors: family separation, recent displacement, isolation, financial insecurity and the end of resettlement support. Her positive screens are not a diagnosis; they indicate that she needs a full mental health evaluation, which should consider depression, generalized anxiety and posttraumatic stress disorder.

Cultural context shapes how these results should be read. Mrs. M. expresses distress largely through her body, and a clinician who treated only her headaches would miss the depression that the screens reveal. Her belief that sadness should be borne may make her reluctant to accept a psychiatric label, so framing referral around her own goals, better sleep, fewer headaches and energy for her children, is more likely to succeed. Her faith is a strength and a source of coping, and reconnecting her with a religious community could relieve isolation as much as any clinical service.

The tools have limits. The PHQ-9 was developed and validated largely in Western populations and may underestimate distress expressed physically; the RHS-15 was designed for refugees but performed differently across ethnic groups in its validation (Hollifield et al., 2013). Interpretation through an interpreter can also lose nuance. These limits argue for using the scores as a starting point for conversation rather than a final measure.

Conducting the Assessment With an Interpreter

The quality of this assessment depended on how the interpreter was used. The nurse met the interpreter briefly before the visit to explain the purpose of the screening tools and to ask about any words in Dari that might not carry the same meaning, such as words for depression or anxiety, which in many Afghan communities may be described as heaviness of the heart or thinking too much. During the visit, the nurse spoke directly to Mrs. M., not to the interpreter, in short sentences, and paused often. The screening tools were administered item by item through the interpreter, since no validated Dari version of the PHQ-9 was available at the clinic, and the nurse noted this in the record as a limit of the result. At the end, the nurse used teach-back through the interpreter to confirm that Mrs. M. understood the referral and why it was offered. Asking her husband to wait outside, at her request, allowed her to speak about her feelings and her worries about money, which she said she had not discussed with him.

Plan Based on Findings

Refer to the health center's behavioral health clinician, preferably a woman, with an interpreter, framed around sleep, headaches and stress. Provide information about the nearest mosque and an Afghan women's group run by the resettlement agency. Connect her with the health center's social worker for food assistance and housing planning before resettlement support ends. Offer on-site childcare during English classes if available. Arrange follow-up in two weeks, with the same interpreter where possible, and reassess safety at each visit.

Documentation Choices

How these findings are written matters for Mrs. M. The record states her screening scores and her own descriptions without labeling her with a diagnosis the full evaluation has not made. It records that she was assessed through a professional interpreter and that the tools were read aloud rather than validated in Dari, so future readers understand the limits of the scores. It notes her preferences for female providers and modest dress in plain terms, so they follow her to every visit. And it records the strengths observed, her faith and her attentive care of her children, alongside the needs.

Conclusion

Mrs. M.'s psychological, spiritual and sociocultural assessment shows moderate depressive and anxiety symptoms in the setting of displacement, separation from family, isolation and financial strain, along with strengths in her faith and her care for her children. Named tools made the findings measurable, and cultural understanding made them interpretable.

References

Hollifield, M., Verbillis-Kolp, S., Farmer, B., Toolson, E. C., Woldehaimanot, T., Yamazaki, J., Holland, A., St. Clair, J., & SooHoo, J. (2013). The Refugee Health Screener-15 (RHS-15): Development and validation of an instrument for anxiety, depression, and PTSD in refugees. General Hospital Psychiatry, 35(2), 202-209. https://doi.org/10.1016/j.genhosppsych.2012.12.002

Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606-613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x

Puchalski, C., & Romer, A. L. (2000). Taking a spiritual history allows clinicians to understand patients more fully. Journal of Palliative Medicine, 3(1), 129-137. https://doi.org/10.1089/jpm.2000.3.129