Nursing Process And Critical Thinking: Importance Of Nursing Assessment Skills

Physical assessment framework

Discuss about the Nursing Process and Critical Thinking.

Nursing intervention plays a critical role in the patient care plan. One of the costly processes is the nursing assessment that has a systematic practice. It has four assessment tools of inspection, palpation, auscultation, and percussion. These skills play an important method in nursing care (Coombs & Moorse, 2002, pp.3). Therefore, nurses should learn the techniques how to gather all necessary data such as psychological, physiological and sociocultural information from the patient (Lewis & Foley, 2014, pp. 25). This paper will discuss the interview between an old adult patient, Mr. Makan who had an Aortic valve replacement surgery and a specialist nurse, Len working in the Emergency department. It will analyze the physical assessment framework. Also, it will also discuss the main strengths of the assessment. Furthermore, the limitations of this nursing assessment will also be discussed.

Weber & Kelley (2014, pp. 6) provide researches with some important evidence that the assessment has used. In this case, focused or problem- oriented assessment is discussed. This means the nurse focus on the specific health problem that affects the patient health life and the nurse ask specific questions such as:  How do you feel? When did that happen? Were you doing anything different than usual when they start? (Taylor & Carol, 2008, pp.15)

There is a large unit of published nursing assessment books describing the Head- To –Toe assessment framework (Lewis & Foley, 2014, pp. 5).It is highly recommended for patients who are admitted to hospital wards because Head-To-Toe Assessment is focused on appropriate physical and psychological nursing assessment. Therefore, several lines of evidence suggest that Head-To-Toe framework is a critical tool that establishes baseline information for patients (Haugh, 2015, pp.58-61).

First of all, the nurse introduces herself clearly, explains her job and takes a verbal consent from her patient. This is the first phase of an interview with any patient and it is essential to build trust (Weber and Kelley, 2010). According to Belcher and Jones (2009, pp. 142-152) trust is the key to enhance the patient so that one feel comfortable, cooperative and confident to provide all important data about the past and present medical history.

In the second strength, three categories of nursing assessment are used like formal assessment, informal assessment and silent assessment. Formal assessments are tools or activities that could measure or record vital signs. Informal assessments are activities that observe and chat with the patient because this could assist the nurse to take more notes about the patient. Silent assessment is the intuition of nurse that explores health issues during the conversation (Wendy et al., 2015, pp. 7). According to Sharpe & Hemsley,  (2016, pp. 228-236) using different kinds of assessment approach in nursing assessment help nurse as well as provide good quality care and improve patient outcomes.

Strengths of nursing assessment

Thirdly, contemporaneously, one of the advanced skills is used by the registered nurse. According to Adlersberg & Winslow, (2007, pp.1) “It is something existing, occurring or beginning at the same time." "To illustrate the medical record in nursing assessment during the conversation with the patient, it is compensatory to ensure effective communication, decision making, patient safety, and legal investigations" (Pezaro & Lilley, 2015, pp. e171-e176).

Finally, any physical examination requires different types of instruments or machines to examine different body systems (Weber and Kelley, 2010). Therefore, the nurse prepares effectively for the physical examination such as for the vital signs, machine, stethoscope, alcoholic gel and torch.

Nursing interaction plays a critical role in the nursing care plan of patients, but it is clear that the nurse does not collect essential information to establish a strong baseline patient file especially biographical data such as education level, occupation and family support (Lewis & Foley, 2014 p. 13).

Another obstacle in this assessment is the patient interruption. The nurse asked the close-ended question as for when did that happen? , but, the nurse should ask the open-ended question as tell me about your accident? (Wilkinson, 2012 pp. 84-87)Because of this, open-ended questions could encourage older adult patients to speak freely and explain their health status and that could help to improve the medical outcomes for them (Secrest, Norwood & Dumont, 2005, pp. 114-118). Therefore, careful interviewing could assist nurse to obtain relevant information that describes the patient feeling, emotional needs and in seeking social support (Hogstel & Mildred, 1994 pp. 85-86).

There was a physical examination error because the nurse does not think logically while examining her patient. According to Haugh, (2015, 58-61) suggests that “when the patient is lying supine, you can assess the patient’s head, neck, anterior thorax, abdomen, and extremities of the patient." Then finish the examination by making the patient sit up or assist the patient to one side to assess the posterior thorax. Throughout the examination, observe the skin for color, lesions, temperature, and dryness or moisture".

There is a large volume of published studies describing the role oftaking vital signs into consideration which include temperature, pulse respiratory and blood pressure (Perry et al. 2012). The temperature must carefully be managed because it usually becomes abnormal after any operation especially cardio surgery or wound healing. Nevertheless, in this assessment, the temperature is not taken into account by the nurse during the assessment (Nussmeier, 2005,472-476).

Limitations of nursing assessment

For Thorax and Lungs examination, the nurse should prepare specific equipment, palpate and auscultator that determines points to find the exact abnormalities. To illustrate that nurse did not bring skin marker and metric ruler, she did not palpate anterior chest expansion. Also, auscultation for anterior chest wall is completely wrong because she did not listen to lung sound in correct point and there are ten specific areas where a nurse listens to it; however, she just listened to 6 areas (Weber and Kelley, 2010).

Lane, Chong & Lip, (2005) suggests that psychological nursing assessment for older adult patients is highly recommended to alleviate depression symptoms. It is done because main subjective data from the patient is palpitation. According to Viars, (2009) heart palpitation is the intensive symptom of anxiety. Furthermore, all of the studies reviewed here support the hypothesis thatthere is a direct connection between cardiac heart diseases and negative psychosocial factors. It might help to improve the risk of depression and increase the quality of life (Arthur, 2006, pp. S2-S7).

Conclusion:

The current data highlights the importance of physical nursing assessment skills that contribute to providing high quality of care delivery and in monitoring the body system changes. The main weakness of this assessment in older adult was ineffective communication which includes incomplete basic patient information and registered nurse interrupting her patient. Another challenge is nursing physical assessment mistakes that lack logic examination, incomplete vital signs, incorrect thorax and lung assessment and unfocused psychological assessment. The main positive phenomenon for this assessment is to build a relationship between patient and nurse, effective communication skills and preparation for equipment and contemporaneous skill. The nurse should document the assessment findings from each patient before moving to the next patient and avoiding interruptions.

Reference list:

Adlersberg, M., & Winslow, W. (2007). Contemporaneous learning. Nursing BC / Registered Nurses Association of British Columbia, 39(2), 24.

Arthur, H. M. (2006). Depression, isolation, social support, and cardiovascular disease in older adults. The Journal of Cardiovascular Nursing, 21(5 Suppl 1), S2-S7.

Belcher, M., & Jones, L. K. (2009). Graduate nurses' experiences of developing trust in the nurse-patient relationship. Contemporary Nurse, 31(2), 142-152. doi:10.5172/conu.673.31.2.142

Coombs, M. A., & Moorse, S. E. (2002). Physical assessment skills: A developing dimension of clinical nursing practice. Intensive & Critical Care Nursing, 18(4), 200-210. doi:10.1016/S0964339702000447

Haugh, K. H. (2015). Head-to-toe: Organizing your baseline patient. Nursing, 45(12), 58-61. doi:10.1097/01.NURSE.0000473396.43930.9d

Lane, D., Chong, A., & Lip, G. (2005). Psychological interventions for depression in heart failure. Cochrane Database of Systematic Reviews, (1), CD003329. doi:10.1002/14651858.CD003329.pub2

Lewis, P., Foley, D., Weber, J., & Kelley, J. (2011). Weber &kelley's health assessment in nursing (1st Australian and New Zealand ed.). Broadway, N.S.W: Lippincott Williams & Wilkins.

Nussmeier, N. A. (2005). Management of temperature during and after cardiac surgery. Texas Heart Institute Journal, 32(4), 472-476.

Penney, W., Poulter, N., Cole, C., & Wellard, S. (2016). Nursing assessment of older people who are in hospital: Exploring registered nurses' understanding of their assessment skills. Contemporary Nurse, 52(2-3), 313-325. doi:10.1080/10376178.2015.1111152

Perry, A. G., Potter, P. A., & Elkin, M. K. (2012). Nursing interventions & clinical skills (5th ed.). St. Louis, Mo: Mosby.

Pezaro, S., & Lilley, L. (2015). Digital voice recorders - A conceptual intervention to facilitate contemporaneous record keeping in midwifery practice. Women and Birth : Journal of the Australian College of Midwives, 28(4), e171-e176. doi:10.1016/j.wombi.2015.04.008

Secrest, J. A., Norwood, B. R., & Dumont, P. M. (2005). Physical assessment skills: A descriptive study of what is taught and what is practiced. Journal of Professional Nursing, 21(2), 114-118. doi:10.1016/j.profnurs.2005.01.004

Sharpe, B., & Hemsley, B. (2016). Improving nurse–patient communication with patients with communication impairments: Hospital nurses' views on the feasibility of using mobile communication technologies. Applied Nursing Research, 30, 228-236. doi:10.1016/j.apnr.2015.11.012

Taylor, C., CSFN. (2008). Fundamentals of nursing: The art and science of nursing care (6th ed.). Philadelphia: Lippincott Williams & Wilkins.

Viars, J. (2009). Anxiety and open heart surgery. Medsurg Nursing : Official Journal of the Academy of Medical-Surgical Nurses, 18(5), 283-291.

Weber, J., & Kelley, J. (2014). Health assessment in nursing (Fifth ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Wilkinson, J. M., 1946. (2012). Nursing process & critical thinking (Fifth ed.). Upper Saddle River, New Jersey: Pearson.