Advanced Health Assessment - Essay Example

Introduction Assessment is an essential part of the health care process. It establishes baseline information which will later be used as the basis of the nursing care to be administered to the patient. Each member of the health care team has a different process of assessment. And their assessment of the patient is dependent on their functions in relation to the patient and the patient’s condition. The nurse’s assessment of the patient relates to factors which specifically pertain to nursing care. Other health professionals also have their own aspects of assessment. However, regardless of the type and the areas of assessment, it is imperative to note that the assessment process lays down the groundwork for effective and quality patient care. This paper shall discuss the scope of practice in the surgical ward Surgical Ward Scope of Practice My clinical practice area is the surgical unit. The scope of practice of this area is mostly on caring for pre-operative and post-operative patients who will and who have undergone general surgeries such as appendectomy, cholecystectomy, exploratory laparotomy, and similar surgical procedures. Craven & Hirnle, (2009, p. 637) enumerate various aspects of preoperative care. They emphasize that it initially includes assessing the health of the patient. This assessment would specifically relate to history-taking, establishing baseline vital signs, head to toe assessment, taking history of health and hospitalization, and such other pertinent assessment information. Pre-operative care for the patients also includes checking that the patient has completed and been cleared in all the pre-operative diagnostic tests requested by the surgeons. It also includes checking and verifying blood tests and results of tests. Preoperative care in the surgery ward includes checking that patient’s allergies are entered into the patient’s charts; and that the identification tags and bracelets on the patient are correct. Consent for the surgery also needs to be double-checked. After the patient’s surgery, part of the nurse’s responsibility is to monitor the patient’s vital signs and to monitor for signs of shock and/or arrest. The wound is also monitored for bleeding and infection. Wound care is administered by the nurse. Assisting the registered nurse in the management of pain is also a task in my clinical practice area. It also includes the management of post-operative nausea and vomiting. Health education is also administered by the nurse. The discharge of the patient is also part of postoperative nursing care. Health education during discharge shall include precautions that the patient should take, as well as medications and follow-up visits. The above-mentioned responsibilities of the nurse help to ease the surgical experience for the patient (Alexander, et.al., 2004, p. 829). Part of the preoperative and postoperative nursing care in my clinical practice area also includes assisting the registered nurses in their administration of nursing care to the patient. Some of the responsibilities of the registered nurses are more specialized and they require training which I do not yet have. Hence, my role is more focused on assisting and learning from the registered nurse. Surgical Ward Mission Statement and Objectives The mission statement of the surgical ward that I am working in includes the administration of quality pre-operative and post-operative care. Such general vision is supported by specific objectives which include maintaining the integrity of the nursing profession by treating all people with respect and dignity and valuing the personal and cultural preferences of the patients in preoperative and postoperative surgical care. Another objective of the unit is to maintain professionalism by applying the highest ethical standards and excellence in patient care. The unit also aims to apply the latest evidence-based practice for patients in preoperative and postoperative surgical care. Finally, the unit also aims to establish a strong and coordinated nursing care practice through team work and collective responsiveness in patient care. These aims are commonly seen in various surgical units across the country. Various authors attest to the fact that the surgical unit cares for patients who are about or who have just undergone surgery. Their activities revolve around delivering the best quality of care for the patient before, during, and after the surgery (Pudner, 2000, p. 1968). Practice Area scope of practice The scope of practice of my clinical area is more general as compared to the scope of scope of practice of registered nurses in my practice area. The role of registered nurses in my practice area is more specific. The American Organization of Registered Nurses has enumerated various data fields for nursing preoperative assessment. And the data fields they have enumerated are very much similar to the scope of practice of registered nurses in my clinical practice area (n.d., pp. 1-2). The roles of the registered nurses include coordinating and monitoring the care of the patient as far as the different members of the health care team are concerned. They coordinate with the doctors, the laboratory technicians, the dietician, the pharmacist, the other nurses, and the student nurses in order to ensure that the patient will receive quality and timely health care. They also make decisions when ethical questions need to be settled. They are also in charge of assigning nurses and student nurses to each patient, distributing tasks, and training new staff and student nurses in clinical skills. The registered nurses are also in charge of IV insertions, IV medications administration, and administration of morphine and other IV pain medications. They are also in charge of supervising and coordinating nursing services for patients. These functions are exemplified in other surgical units in other hospitals. The Oakwood Anapolis Hospital (2009, p. 1) details the various functions of the registered nurses in their surgical unit which are very much similar to the functions enumerated above. The scope of practice of my clinical area is more concentrated on giving assistance to the registered nurses; they also consist of independent nursing care – care which does not require consent from the physician or any other higher supervisory authority. The mission statement of the registered nurses in the surgical ward is about delivering quality and timely preoperative and postoperative nursing care to general surgery patients. Such mission statement is similar to the mission statement in my clinical practice area. The objectives of the registered nurses are also similar to the objectives of my clinical practice area. Nursing roles, scope of practice, mission statement and objectives There is no mismatch between registered nursing roles and scope of practice, mission statement and objectives. The nursing roles and scope of practice complement each other and they provide a continuity of services from theory to practice. The mission statement and objectives also match because the objectives provide more specific goals which seek to complete and complement the mission statement. The objectives are very much in line with preoperative and postoperative care of the general surgery patient. They specify nursing roles and responsibilities from the time that the patient is admitted until he is discharged. They also relate to nursing roles that seek to make the patient comfortable before and after his recovery. And they provide opportunities in identifying “potential problems that the patient may encounter and this improves preoperative planning” (Cope & Hawley, 2001, pp. 44-48). Relevance of health assessment I believe that health assessment is relevant to the scope of practice, mission statement and objectives of my clinical practice area because it helps establish baseline information which will assist in the administration of safe and effective nursing care (Craven & Hirnle, 2009, p. 139). Health assessment is also relevant to the scope of practice because it helps to establish the inclusive responsibilities of the nurse; and it also helps to particularize the role of the nurse in the clinical area where she is assigned to. Health assessment works to the advantage of both the patient and the nurse because it ensures that the patient is getting the care he needs at the time he is at the hospital; for the nurse, health assessment helps to establish patient-based nursing care. The scope of practice should also include adjustments in care depending on the individual circumstances of each patient. Each patient is different; each has his own history, race, culture, and preferences which may contrast the usual care administered to patients in similar situations (White & Duncan, 2002, p. 215). Health assessment is also relevant to the mission statement and objectives because it establishes basic information about the patient which will help define an end-goal in the improvement of his health. By establishing the patient’s condition and expected baseline information, the mission statement and objectives can be fashioned according to each patient’s needs. As was previously mentioned, each patient is different. A surgical patient has different needs from an orthopaedic patient even if they are both postoperative patients. Each field of specialization in the nursing practice must have different objectives and a mission statement which is based on the needs of each individual patient. Health assessment can help classify and specify the goals for each patient, making the nursing care plan more specific and more focused on each patient’s individual needs and condition (Ralph & Taylor, 2005, p. 9-10). Comprehensive Health Assessments The registered nurses in my practice area do conduct comprehensive health assessments. They do so whenever there is a new patient in the clinical area. This is very much in keeping with a study by Bray (2006, p. 361) which emphasizes that “thorough assessment of the surgical patient begins in the preoperative phase and extends throughout the perioperative experience”. The assessment is also done in an examination room in order to give the patient and the nurse privacy during the examination process. This privacy lends comfort to the patient, and thoroughness to the nurse. I observed that the registered nurses in my clinical practice area are very diligent, patient, and comprehensive about the comprehensive assessment process. They also take the time to verify details in the patient’s chart that they feel are crucial to the patient’s care. Such crucial details include allergies and blood type. I also noticed that the registered nurses have a very comfortable way of conducting the assessment in order to make the patient feel at ease. They also take their time to build rapport with their patient. And this skill was able to assist them in extracting accurate and comprehensive information from the patient. They also adjusted their assessment techniques based on the patient’s age, gender, race, and condition in order to ensure that individual patient characteristics are factored into the assessment process for variances. The methods employed by the nurses while conducting the comprehensive assessment were important and all inclusive in the elemental process of physical assessment (Crisp, et.al., 2005, pp. 669-674). Ongoing Shift Assessments Each registered nurse who handled a patient did her own shift assessment on the patient. Ongoing shift assessments were also important after surgeries when the patients were most vulnerable (Kaplan, 2009, p. 237). And as the nurses changed at each shift, there was an initial assessment done on the patient. Such assessment included baseline vital signs, pain assessment, and IV bag assessment. Wounds were checked for bleeding and infection at the start of each shift, and levels of IV, catheters, oxygen saturation, and other monitors were also checked at the beginning and end of each shift. Due medications were also endorsed and assessed by each nurse at the beginning of each shift. Laboratory, surgical, and other medical procedures were also coordinated with the departments and medical personnel involved. I assisted the registered nurses during these ongoing shift assessments. I noticed that they were very thorough and skilled in this process. Studies attest to the fact that ongoing shift assessments enabled the nurses to get to know their patients well (Gurbutt, 2006, p. 29). The work dynamic and coordination between the outgoing and the incoming nurses was seamless, allowing for a smooth transition and assessment process. Problem Oriented Assessments The registered nurses in my clinical practice area conducted problem-oriented assessments on their patients. Problem assessments are very specific to each patient’s condition. Preoperative patients are more inclined to be anxious about their surgery; hence, the problem assessment which would be conducted by the preoperative nurse is focused on assessing the level of anxiety of the patient. Vital signs assessment is also vital during this time because it helps to determine the physical and psychological health of the patient prior to the surgery. Mild anxiety is acceptable during this time, but panic on the part of the patient prior to surgery, would be counterproductive. For the postoperative patient, problem assessment would be focused on pain, infection, and bleeding assessment. The registered nurses were very vigilant about the problem assessment of the patients in the surgery ward. I was able to assist the registered nurses during these assessments. They endorsed and coordinated problems with the surgeons and other medical personnel in the hospital in order to ensure that the preoperative and the postoperative patient received timely, effective, and accurate health services before, during, and after their surgery. They also noted the problems which needed immediate attention from the doctors in order to enable prompt medical attention. Such problems usually included postoperative bleeding, pain, and infection. Assessment of these problems included an examination of the wound site, establishment of vital signs, and assessment of the patient’s pain tolerance. Appropriateness of Assessment The different types of assessment which were conducted on the patient were appropriate. In general, assessment is appropriate in nursing because it provides the nurse with information specific to each patient’s needs and condition. Surgical assessment “also enables the nurse to identify the patient’s/client’s gaps in knowledge and the need for health education” (Heath, 2004, p. 594). They are appropriate because they were able to lay down basic and baseline data about the patient. Since most of the patients in the surgery ward are either about to undergo or were discharged from surgery, it is important to conduct a complete and comprehensive assessment of their physical and psychological health. Assessment conducted by the perioperative nurse is appropriate because the nurse, as compared to other medical personnel, usually spends more time with the patient. During the surgery, the O.R. nurse can use the information gathered by the perioperative nurse in order to deliver patient-based care (Spry, 2005, p. 3). Information established by the assessment will be used to plan a specific nursing care plan based on the condition, physical, psychological, and personal preferences of the patient. A comprehensive health assessment is appropriate because “the nurse in the preoperative hospital period is in a position to perform the required comprehensive assessment to plan and initiate interventions from admission to discharge” (Long, et.al., 2004, p. 226). The different types of assessment conducted on the patient are also appropriate processes because they provided the basis for diagnostic and therapeutic interventions on the patient. The shift assessment was able to establish improvements or deterioration in the patient’s condition (Barker, 2002, p. 93). The problems assessment was appropriate because it specified aspects in the patient’s care which needed focus and attention. Cost-benefit analysis of holistic assessment skills In analysing the cost and the benefits of introducing holistic assessment skills in any clinical practice area, the likely costs would be in the skills training that the nurses would undergo in order to acquire assessment skills. Costs would also include medical equipment for assessment. This would include a stethoscope, thermometer, sphygmomanometer, tuning fork, reflex hammer, examination table, nasal speculum, vaginal speculum, tongue depressors, gloves, and such other medical equipment needed for assessment. The benefits which would be seen in introducing skills for holistic assessment would include: decreased medical errors, decreased medical malpractice lawsuits, decreased patient medical cost, and increased profits for the hospital. Enabling Factors and Perceived Barriers Enabling factors include management support in improving the skills of the nurses in holistic assessment. It also includes available training officers and highly skilled registered nurses in the perioperative setting already employed by the hospital. Various medical equipment used for assessment are also available in the hospital. Such enabling factors, according to the American Organization of Nurse Executives, are vital factors needed in order to strengthen the work environment (2003, p. 93). Perceived barriers to the introduction of skills in holistic assessment in the surgery unit are barriers which relate to difficult nurses who do not wish to participate in the acquisition of new skills in assessment. These nurses usually insist on the skills that they have been using for many years. Another barrier in the implementation of this policy is that there is presently limited funding in health care. The training of nurses in holistic assessment skills will likely take up the time and resources of the hospital. Budget constraints often prompt the hospital to prioritize the most important needs of the hospital over other goals which have lower priority (Bronzino, 2006, p. 43-9). Another possible barrier in the introduction of holistic assessment skills is the fact that the healthcare sector has entered into the age of computer technology. And yet, many nurses still lack the necessary computer skills. Many studies have accounted for this as fact. Personal barriers related to computer technology include lack of understanding of electronic databases, difficulty accessing information, and limited skills in synthesizing information from electronic databases (Bronzino, 2006, p. 43-9). Comprehensive Holistic Assessment A firm strategy which will help introduce comprehensive nursing assessment into the surgical unit of the hospital is to require each nurse to fill-up a comprehensive assessment sheet for each patient admitted in the surgical ward. Such strategy can be strictly enforced to each nurse by scheduling a weekly reporting of assessment on patients admitted into the surgical unit. This strategy will help encourage registered nurses to conduct regular and comprehensive assessments of their patients. This reporting strategy will also serve as a monitoring technique in nursing skills assessment. Teaching Plan Name: Naomi Williams; Age: 38 years old; Marital Status: Married, 4 children Address: 1611 West Lake dr. Novi, MI.USA Occupation: Teacher Religion: Roman Catholic Next of Kin: Marty Williams, husband of same address Admittance Problems: Right lower abdominal quadrant pain, dyspnoea on exertion, tender abdomen on palpation. Ultrasound confirms appendicitis Learning Needs Priority 1. Understand the meaning of ruptured appendix. High 2. Learn the implications of surgery and postoperative precautions. Very High 3. Understand the risks involved in the case of a ruptured appendix. Very high Objective Teaching Method Teaching Aid 1. Client will be able to describe what a appendicitis is a. Describe the digestive system b. Pinpoint the location and function of the appendix c. Describe what can cause infection and/or inflammation of the appendix 1. Illustration/model of the digestive system 2. Client will be able to appreciate the significance of the surgery and the postoperative complications involved a. Explain the possible risks that an appendicitis can bring b. Explain to the patient the importance of complying with the postoperative precautions in order to prevent infection and bleeding in the incision site. 1. Illustration of the appendectomy process 2. Illustrations of possible risks that appendicitis can bring-includes pictures of systemic infection, and effects of a ruptured appendix 3. Illustrations of process of infection form wound incisions 4. Illustrations of possible causes and effects of surgical blood loss Evaluation 1. Interactive discussion with the client and his family, clarifying areas which seem to be unclear to the patient 2. Assess the patient’s anxiety level by asking her to share feelings about the upcoming surgery. Conclusion The assessment process in the surgical ward is important because it lays down baseline information on the patient which will help establish a plan of care and help prevent medical errors. The scope of practice of my practice area and that of the registered nurses in my area complement each other. They provide a continuity of theory and practice which will help ensure that, as a student, I will be equipped with the necessary skills to later practice in the surgical unit. The nurses in my unit conduct comprehensive, ongoing, and problems based assessment. And these types of assessment make quality health services more than a possibility in the surgical unit. The process of assessment is still very much strong in actual practice, and this fact is a heartening thing to note in my clinical practice area. Works Cited Alexander, M., et.al., 2004, Nursing practice: hospital and home : the adult, p. 829, Spain: Elsevier Limited American Organization of Registered Nurses, (n.d), Proposed Data Fields for a Nursing Preoperative Assessment for a Preoperative General Surgery Adult Patient, pp. 1-2, Perioperative Nursing Data Set, 2nd edition, , viewed 08 August 2009 from http://www.aorn.org/docs_assets/55B250E0-9779-5C0D-1DDC8177C9B4C8EB/A3C4F84F-17A4-49A8-864CE85E4179A8AB/Nursing_Preoperative_Assessment_Data_Fields.pdf Barker, E., 2002, Neuroscience nursing, p. 93, Pennsylvania: Elsevier Health Sciences Publication Bray, A., June 2006, Preoperative nursing assessment of the surgical patient, Nursing Clinics of North America, Vol. 41, no.2: pp. 361-377. Bronzino, J., 2006, Medical devices and systems, p. 43-9, Florida: Taylor & Francis Cope, S. & Hawley, R., 08 June 2007, Needs of the Older Patient in the ICU: Implications for Nursing, pp. 44-48, Progress in Cardiovascular Nursing, Vol. 16., no. 2: pp. 44-48 Craven, R. & Hirnle, C., 2009, Fundamentals of Nursing: Human Health and Function, p. 139, 637, Pennsylvania: Lippincott Williams & Wilkinson Crisp, J., et.al., 2005, Potter & Perry’s Fundamentals of Nursing, pp. 669-674, New South Wales: Elsevier Australia. Enabling Factors and Impediments, May 2003, American Organization of Nurse Executives, p. 93, viewed 08 August 2009 from www.aone.org/aone/docs/hwe_excellence_factors.pdf Gurbutt, R., 2006, Nurses' clinical decision making, p. 29, Oxon, UK: Radcliffe Publishing Heath, H., 2004, Potter and Perry's foundations in nursing theory and practice, p. 594, Pennsylvania: Elsevier Health Sciences Publication Kaplan, 2009, Kaplan CCRN, 2009 Edition: Certification for Adult, Pediatric, and Neonatal Care, p. 237, New York: Kaplan Publishing Long, B., et.al., 2004, Adult nursing, p. 226, London: Lyndon House Pudner, R., 2000, Nursing the surgical patient, p. 1968, Philadelphia: Elsevier health Sciences Ralph, S. & Taylor, C., 2005, Nursing diagnosis reference manual, pp. 9-10, Pennsylvania: Lippincott Williams & Wilkins Spry, C., 2005, Essentials of perioperative nursing, p. 3, London: Jones and Bartlett Unit Descriptions, 2009, pp. 1-3, Oakwood Anapolis Hospital, viewed 08 August 2009 from http://www.oakwood.org/documents/faculty_nursing/OAH_site_descriptions.pdf White, L. & Duncan, G., 2002, Medical-surgical nursing: an integrated approach, p. 215, New York: Cengage Learning Read More