Health Assessment Practice in the Clinical Setting of Medical-Surgical Ward - Assignment Example

The Scope of Assessment in Practice: An Analysis in Medical Surgical Ward A nurse in the Medical Surgical clinical setting is uniquely positioned to develop and synthesize the holistic care plan of a client. By the process of health assessment practice, the nurse can virtually direct a successful plan of care through a more revealing relationship-based approach. The psychosocial factors that are so closely related to any medical and surgical disease are given due weight, and a combination of the clinical skills and skills of interviewing can marvel any other unidirectional approach to this end. A systematic and methodical documentation of all subjective and objective findings that are procured by the nurse will clearly establish the plan of care and will excel as a tool to develop a successful multidisciplinary approach of management of these complicated patients. When the goal of the whole system is to develop an efficient health care, a Medical Surgical nurse, by her informed and trained know-how, empathy and relation- building approach, her interactive assessment, personal learning approach, and critical and reflective thinking, can play a pivotal role in this process. We have explored all these in this analysis to enumerate the scope of health assessment practice in the clinical setting of Medical Surgical Ward. Introduction A competent nursing process is considered a pillar of any health care delivery system, whether in the clinical setting or in the community. Health assessment, a crucial and very important component of the science and art of nursing (Hogstel & Curry, 2005) builds up a foundation for quality nursing care or even maybe, efficient health care. This also guides the nursing plan for final delivery of the product, health care, to the client (Fuller and Schaller-Ayres, 2000). This very process sets up a cascade of events depending on the patient's needs, the clinical problems the patient suffers from, and evolution of a nursing diagnosis(Fuller and Schaller-Ayres, 2000). In the work a nurse is subjected to do, this translates into a detailed and methodical history of the patient's health and the skillful art of eliciting it, past and present; a psychosocial history; a physical, functional, and mental status examination; and an informed investigation of the cultural, familial, and environmental (White 2002) factors that might have subtle implication in the disease process concerned. In the field of Medical Surgical nursing, the methodology of accurate and thorough health assessment record not only reflects the knowledge and competency of the nurse (Fuller and Schaller-Ayres, 2000) , also points to the most appropriate possible management to that specific patient. The whole process involves documented critical thinking and informed scientific analytic skill (Wurzbach, 1992) on the part of the nurse who is doing the assessment. One might raise the legitimate objection that a physician is better privileged to have this assessment done, but there are hidden factors of close association, ability to provide more time, close proximity to the suffering, and ability to interact with the family of the client (Barkauskas et. al, 1994). These play roles in a successful health assessment resulting in delivery of quality nursing care with tremendous scope if the nurse is trained, well informed, and knowledgeable (Weber and Kelly, 2003). We shall analyze this from our daily practice. Most of the initial encounters with a patient happens through communication. A good communicator will elicit more. An efficient assessor will suit him/herself with patients of different age, different needs, and with patients from different cultural backgrounds (Mirka & Viverais-Dresslar). An experienced and intelligent investigator will look for details that are exposed through family communication and assessment (Barry, 1996). Ideally, apart from that, the nurse should have basic orientation to physical assessment techniques and tools. The goal is to provide the nurses and other health care personnel with a systematic method of collecting data, both subjective and objective, that relates to the clients (Kozier B., et al., 2003). Apart from the clinical techniques of inspection, palpation, percussion, auscultation, and Position (Wilson, 2001), the assessor nurse should be quite an artist in the technique of interviewing (Barry, 1996), should be conversant and trained on the methods of eliciting information that are practical and important. The answers become significant when one knows what to ask and how to ask. This interviewing process that serves as a prelude to the next big thing, that is, physical examination proper, builds up the right note of co-operation and openness (Daly-Nee, Brunt, and Jairath, 1999) once the client understands that all this is to alleviate his suffering. To have a fruitful and focused interview, the nurse should be aware of the cultural and ethnic factors (Jorg, F. et al, 2002) that influence a conversation. The nurse should consider the importance of religious factors and values and beliefs that can affect the delivery of health care either positively or negatively (Jacelon, 1997). As this progresses to physical assessment of the patient, the nurse will develop an effective tailored plan for supporting the activities of daily living for the specific client. She, in a unique position to see the whole of the client's disease, will be in the most favorable position to germinate a holistic therapeutic care plan for the client (Yacone-Morton, 1991) . As a result, she will derive the most out of the practical physical assessment or examination in the clinical environment of a Medical Sugical ward, and she can develop a custom-made communication and personal interaction strategy involved in the assessment. In this way, she will be the architect of the standard decision making framework, and will plan, implement, evaluate, and care for the client she might have assessed. In this intricate process ideally, she must be able to identify and utilize culturally relevant and age- specific strategies that would display immense respect to the patient's independence, self- esteem, and dignity (Weber and Kelly, 2003) . This is more of an art than a skill, as the nurse matures to be an expert in the health assessment process, she will be able to develop the ability to integrate scientific knowledge and nursing practice. To have this method successful, the nurses in the clinical setting needs to be equipped with a comprehensive clinical knowledge base and expert physical assessment skills. The nurse is required to pursue an innovative systemic approach in the whole exercise of complete physical examination process as it relates to nurses in clinical practice (Barkauskas et al. 1994) in Medical Surgical ward. The most important skill set would be to be able to validate and synthesize the information collected using critical thinking skills to identify, judge, and pin point client's problems, both immediate and remote. This is very important since this will be instrumental in implementation of an interdisciplinary plan of care (Bates, 1987). For doing this, the nurse should be an expert is subjective and objective data collection as applicable to clinical nursing practice backed by proficiency in identifying both normal and abnormal findings. The normal findings are nothing less important since borderline findings may create enough confusion while analyzing, and a little deviation from normal may indicate deep-seated critical pathological change signifying evolution of a life-threatening emergent situation. This happens to be a systematic, deliberative, and interactive process (White, 2002) that facilitates a judgment about the health status and life process of the individual. Now, the question is why the nurse The answer is simple, the nurses are able to observe and assess the patient's health and disease, both from the physical and emotional perspectives over long periods of time in the context of family and community. To summarize, the areas of assessment range from the physical divided into body systems, through nutritional, social, psychological assessment ending with cultural and spiritual assessment. Nursing health assessment and the subsequent development of the nursing data base is the first step in the nursing process (Barry, 1996). An accurate and timely health assessment provides a strong basis and foundation of nursing care. One might argue, just the medical history would suffice. The answer to this question is "medicine is allopathic, linear model"( (Mirka & Viverais-Dresslar) and fails to take care of the other holistic factors that may predict the client's health. A nursing model elaborated here will facilitate the identification of the patient's and his family's strength. This approach is unique in the sense that this can almost behave as a tool while invoking the nursing or multidisciplinary care in a particular case, and this can always act as an escalator for higher levels of holistic care to result into positive health (Woods et al., 2000). Contrary to popular belief among nurses, the nursing process is really a process; it is no longer just mechanical planning of care by just leads from the physical examination and a cursory history taking and taking more care in filling in the different headings of the admission form. This is now a process of assessment which assimilates multifarious experiences and personal meanings that demand efficiency and skill. It is not merely critical clinical reasoning on the backdrop of knowledge of body systems or knowledge of clinical features of a disease or knowledge of subjects like Anatomy, Physiology, Pathology, Physiology, Medicine, or Surgery. Carefully executed and written care planning is invaluable since it imparts a care that is consistent, goal-directed, and above all, relationship or family centered (Daly-Lee et.al, 1999). The nurse in a unique position to accomplish this since the nurse can execute it through personal learning activity and interactive learning activity, both, and she has time, position, and exposure to all the resources necessary for this in the clinical setting of a Medical Surgical Ward. The process of health assessment has thus tremendous potential to reveal hitherto unforeseen data, information, and to develop a customized care plan by imparting a holistic life to an, otherwise, mechanical and lifeless process of allopathic medical care, and on the apt and best hands of the nurse who has closer encounter with the ailing patient and who is the final common pathway for implementation of care, this can turn into the speediest vehicle for nursing care focused mainly on a relationship-based care (Cauthorne-Burnett, T. and Estes, M., 1998). The health assessment process includes data collection, documentation, and evaluation of the patient's health status and health needs and the patient's responses to health problems and interventions. It is mandatory for every nurse to undertake this on every person under his/her care. Ethically, the patient should be providing spontaneous consent to this. The best assessment is "clear, concise, specific, and current" (Fuller J. & Schaller-Ayers, 2000), and it is more than possible when the nurse sincerely commits and arranges for confidentiality of the information. This assessment to be a willing and successful one, the nurse must demonstrate a caring attitude, respect, and concern for the client (Estes, M.1998). Whenever there is a nurse-client interaction, especially in a health care setting like Medical Surgical Ward, health assessment is practiced. The data is elaborated by various techniques and tools, such as, history taking, reviewing medical records, having a thorough, systematic, and meticulous physical examination, and interpreting the results of the diagnostic tests. Ability and training to recognize and interpret data is always a plus point. Most cases, the tools are less important, only used to make appropriate inferences and judgments regarding the patient's condition and to formulate a care plan. The best tool the nurse possesses is her experienced brain and its ability to perform a critical assessment of the whole situation (Malasanos, L., Barkauskas, V., and Stoltenberg-Allen, K., 1990). Let us take an example of a patient who presented with respiratory distress on exertion after an emotional excess at home. The process begins with an interview that elicits the background history of the patient. The nurse should establish herself in front of the patient and would clarify her role in the process in a private and quiet environment. The patient should be engaged and involved by conveyance of "interested, attentive, unhurried, and empathic attitude" (Weber J., 1988) of the nurse. The vocabulary used should be careful and at par with questions that are appropriate and open ended, and the interview process should be controlled and guided in manner that the patient provides all the details. Both verbal and nonverbal cues should be picked up by the nurse. For example, while answering something else, the patient may appear breathless, restless, inattentive with a very short attention span, may appear depressed or excited, yawning and feeling sleepy, may appear fatigued and tired, may appear intelligent yet having a slow mentation. While history taking is subjective, a physical examination is objective, involving identifications of signs of the disease, but the nurse while doing an assessment has no such rigidity. An intelligent nurse would keep collecting both subjective and objective information during the whole process of the health assessment. In the Medical Surgical, this patient with respiratory distress may appear in different forms. On the one hand, it can be direct question asking for whether the patient has respiratory distress or not. This, in all likelihood, would generate an answer that might or might not be implicative. The basic principles of health assessment, which we discussed just now may reveal many unknown but significant facts in relation to this. If the nurse asks, "How far can you walk without feeling short of breath"; the patient may reply, "Not at all, I am most of the time bedridden, even I have difficulty breathing while sitting, mostly at the nights." (Jarvis 2000). This immediately points to dyspnea at rest and would also reveal paroxymal nocturnal dyspnea. This data will be analyzed by the nurse. From her knowledge, she will recollect, how Jarvis has shown that recumbent position increases the flow of blood to the thorax when the heart is weak and failing. This will promote the nurse to look for other evidences in support of her inference about the patient's diagnosis of congestive heart failure, and she might discover just on inspection pallor or cyanosis, edema, and she may become interested in eliciting a personal history of smoking or other cardiovascular risk factors. She may find distended jugular veins, a positive hapatojugular reflux, a cardiomegaly, or different heart sounds and mumurs. This is when the nurse may plan the care, a semi reclined position on the bed or a salt-restricted diet. Conclusion: Health assessment is performed by the nurse to obtain objective and subjective data about the patient's health that will be critically analyzed to synthesize and formulate a nursing diagnosis and nursing care plan. The process of this assessment involves three phases, the interview, the physical examination, and documentation. In the Medical Surgical Ward, the nurse can play a vital role in collecting current and historical data and can begin developing a vital and trusting relationship toward a holistic care. If it is not at all possible to interview the patient, the nurse may take help of the history, progress notes, nurse's notes, and the patient's family. The interview should include present, past, social and family, personal history, and history of current management, the client's understanding of medical and nursing plans and his illness. The physical examination should be systemic in approach. The usual inspection, percussion, palpation, and auscultation will be applied to all the systems of the body, but a general examination outlining the vital signs and psychosocial system is a must. This may happen over days as the relationship develops or as the situation demands, but documentation of all the data and the nursing assessment, specific plans, and goals of nursing care related to problems must be recorded. The nurse as highlighted remains at the center of this assessment process, and it is her assessment that will reveal most of her holistic approach, and that is going to deliver the maximum and most efficient care (Parrott, R. and Cendit, C., 1996). 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