The following essay will highlight the significance of assessment in the field of adult nursing. It will bring out issues on when and to what degree it is carried out working on examples and structures as part of caring for patients. Through complete assessment, good communication, and the ongoing collection of objective and subjective data, nurses can provide improved person-centred care to patients. Also, it will explore the importance of physical, emotional, social, spiritual and cultural aspects of holistic assessment and how these can be included into the nursing process. Proper communication should be a key element and patients’ consent needed for assessment to take place. The Nursing and Midwifery Council (NMC 2018) advised that communication made by nurses should be easy to perceive, understood or interpreted. They should keep accurate records and reflect to improve on their practice. In the end, it will discuss the leadership role of nurses in attaining holistic care of patients, patient’s safety and positive results.
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Patient assessment is an important nursing skill that deals with the bringing together of a person’s health data, recognises, describes issues and explanations for planning and implementations in line with their choices (Roper et al 2000). Accordingly, having an easily understood knowledge about health is relevant because it decides which assessment data should be collected. The definition of health means that the nursing approach to health care is general and for that, assessments should consider the person and their way of life e.g. physical, emotional, social, spiritual and cultural needs (Howatson- Jones, Standing and Roberts 2015). Assessment is the complete and uninterrupted collection, structuring, supporting and recording of facts (Berman et al2010 cited in Dougherty and Lister 2015). This task starts from admission of the patient until they are sent home (Aldridge, Eshun and Meurier 2005:52).
One type of explanation for assessment requires a combination of knowledge and understanding in clinical practice. The aim is to collect information of the patient in a proper and practical way. Secondly, it provides baseline information on which to plan the interventions and results of care to be achieved. Thirdly it is an interactive process in which the patient actively participates. Assessment involves gathering of information about a patient’s condition through interviewing, inspecting and observing the body with the patient’s consent. The information obtained is used to work out a nursing plan which is a document that is used and changed constantly. The care plan is developed with the patient instead for the patient with the rules that guide confidentiality, consent and recording are used. A nurse continuously does a health assessment on a patient to see if the care plan is having a desired effect. If not, makes changes to address the patient’s health care needs. The nurse may also understand normal and abnormal guidelines and explanation skills. Also, the nurse should have significant decision-making skills, communication skills and working together with the multidisciplinary team (Dougherty et al 2015). For example, nurses and patients can agree on an applicable care and support when collecting objective and subjective data. Objective data consider temperature, pulse rate, weight, blood pressure etc, whilst personalised information encourage patients to talk about their own experience and explain how they are feeling about their illness. This also allows them to talk about their carers, family and loved ones. This act provides information for the clinicians to make the right decisions (Sibson2010). Objective and subjective data help nurses have a whole picture from which diagnosis is made (Cox 2004; Dougherty, Lister and West-Oram 2015). Potter and Berry argue that if wrong information of a patient is recorded, then there is a potential for the patient to be diagnosed wrongly and their overall care may be affected or be at risk along with their treatment. The NMC (2018) encourage nurses to work in a professional manner and abide by the policies of the trust they work in. It advises that recording accurate information is important and any change could lead to conceivable results if standards are not met.
There is continuing concern to bring into line the quality of care across the UK and to make sure that nursing staff have similar level of knowledge and competency. However, there have been continuing reports of shortcoming in systems designed to guarantee patient safety notably the Francis report into the Mid Staffordshire NHS Trust (Francis 2013). The report led to the improvement of policy structures on fundamental values of nursing the 6Cs which are care, compassion, competence, communication, courage and commitment. These skills are required by all nurses to provide patient right care meaning treating patients as individuals and their identified needs should dictate the care provided. Putting the patient at the centre of care requires adjustable service provision (Advisory Group on the safety of patients in England, 2013).
Townsend (2015) argues that the nursing process is the systematic approach for the handing over of care. The act of nursing is a repetitive model starting with assessment problem identification, diagnosis, planning, implementation and evaluation. Assessment is checked constantly and continually to reflect the changing needs of the patient (Ballantyne 2016). For instance, if a patient is not responsive, the nurse will undertake a quick assessment using the ABCDE principles (use the airway, breathing, circulation, disability and exposure) to identify any life-threatening condition for quick intervention (Resuscitation Council UK 2019). The aim is to keep the patient alive and reach some clinical improvement. The result of this assessment may call for a new care plan to adjust to the changes in the patient’s condition.
The ready for use different models let nurses pick the model that best reflects their area of work and patients as this will benefit the team and the patient as well. One such model is the biopsychosocial model which looks at the whole person and any illness can have consequences on other aspects of health (Jasemi et al 2017). As Mckenna, Pajnkihar and Murphy (2014:122) pointed out that nursing tools permit nurses to understand complex issues in simple ways for example, Roper-Logan and Tierney’s activities of daily living. The way in which a person go about with his activities of daily living are as a result of biological control and the community he lives in. In adding to the way, a person carries out the task is the independent or dependent they are or what they can or cannot do for themselves. people need to carry out. The nurse’s role is to take care of the patient to attain their independence (Roper et al 2000:15).
Although Roper et al model is commonly used within the UK, critics argue that it is too simplified and concentrate on dealing with biological factors at the cost of other, equally important factors (Bellman 1996). Whereas Orem (2001) believed that individuals should have the skills, knowledge, motivation and behaviour to look after themselves. This self-care model put the patient at the centre of the care planning and this fits well with the views of the NMC (2018) requiring nurses to give patients-centred care. Critics argue that although it is claimed to be holistic, cultural and socio-economic aspects are not explored by Orem.
Nurses in the field must accept and answer adequately towards worsening in patients’ condition. The ‘track and trigger’ systems including the National Early Warning Score (NEWS 2) (RCP, 2017) is important as it rely on periodic measurements of observations and actions taken when certain thresholds are met. The NEWS2 looks at the temperature, pulse, respiration, oxygen saturation, systolic blood pressure, oxygen delivery and conscious level. What is not included in the NEWS2 that the nurse should be aware of is the age of the patient, urine output, pain and diastolic pressure. Reporting findings from NEWS2 could be in the form of SBAR (Situation – explain the problem, Background- patient history, Assessment- observations, Recommendation-? requires urgent review). This system improves the detection and response to clinical deterioration and is a key factor of patient safety and improving patient results. However, NEWS2 cannot be used for pregnant women and children under sixteen years of age instead a paediatric early warning sign (PEWS) is used. (RCP 2017). Also, it well known that nurses should not rely entirely on NEWS2 but use it to assist their clinical judgement (British journal of Nursing, 2018:27.11).
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Another type of tool, the waterloo score is a useful tool for predicting early detection of patients from developing pressure ulcer (Peate 2013:66). Nurses questioned patients on admission, rate the risks between low to high on the scoring scale. Also, a MUST (malnutrition universal screening tool) needs to be completed for each patient. The tool looks at certain factors which influence an individual’s vulnerability to tissue damage. This will allow the nurses to reduce the risks by repositioning, application of barrier creams or the use of pressure redistributing equipment. However, critics argue that nurses having little or no knowledge, rely entirely on the tool resulting in incorrect clinical judgement.
The NMC (2018) code demand nurses communicate in such a manner to reach the desired result. Practical, good communication and showing respect is important when caring for patients. Therefore, nurses must be non-judgemental to the needs of their patients as this builds trust, enables them to feel safe and give out important information towards their diagnosis and treatment (Hewitt et al 2005). Clinical judgement considers all options available to reach at a decision for good outcome. For example, the NMC code (2018) guide nurses to take responsibility in seeking relevant information, analyse, respond accordingly and document accurately for best results.
Finally, it is worth pointing out that, assessment plays an important function in delivering high quality care. This essay has looked at how different tools can be used to provide good services and results for patients. Promoting good communication skills is important in delivering high quality care and this is accomplished by putting together all six elements of the whole assessment of the patient into the first stage of the nursing task.
- Aldridge, J., Eshun, A., and Meurier, C. (2005) ‘Nursing assessment and care planning’ in Health Assessment. Ed by Crouch, A. T., and Meurier, C. Oxford: Blackwell
- Ballantyne, H. (2016) ‘Continuing Professional Development: Developing Nursing Care Plans’. Nursing Standard 30 (26), 51-60
- Bellman, M. L., (1996) ‘Changing nursing practice through reflection on the Roper, Logan and Tierney model: the enhancement approach to action research’. Journal of Advanced Nursing (24) 129-138
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- Mckenna, P. H., Pajnkihar, M. and Murphy, A. F. (2014) Fundamentals of Nursing Models, Theories and Practice 2nd ed. Oxford: Wiley Blackwell
- National Advisory Group on the safety of patients in England. Improving the safety of patients in England (London: Crown Publishers, 2013).
- Nursing and Midwifery Council. (2018). Nmc.org.uk. [online] Available from <https://www.nmc.org.uk/standards/safeguarding/training-toolkit/>[18 July 2019]
- Peate, I. (2013) The Student Nurse Toolkit: An Essential Guide for Surviving Your Course. Oxford: Wiley Blackwell
- Resuscitation Council UK (2019) The ABCDE Approach: the underlying principle [online] available from < https://www.resus.org.uk/resuscitation-guidelines/abcde-approach/> [30 January 2019]
- Roper, N. (2000) The Roper-Logan-Tierney Model of Nursing: Based on Activities of Living. Edinburgh: Churchill Livingstone
- Royal College of Physicians (2017) National Early Warning Score [online] available from www.rcplondon.ac.uk/projects/outputs/national-early-warning-score-news-2 [18 July 2019]
- Sibson, L. (2010) ‘Assessing Needs and the Nursing Process’ in Nursing Care and the Activities of Living. ed by Peate, I. Oxford: Wiley Blackwell
- Standing, M. (2011) ‘Clinical Judgement and Decision Making for Nursing Students. Exeter: Learning Matters
- Townsend, M. (2015) Psychiatric Nursing: Assessment, Care Plans and Medications 9th ed. Philadelphia: F.A Davis
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