“I don’t see the point of doing nurse assessments.
After all, the doctors do their assessment, so it’s just doubling up.”
This was the attitude expressed by a colleague recently, and it has made me reflect more deeply on the purpose of the assessments I do as an ED nurse. As primary care nurse, my assessments usually follow a fairly standard pattern. I personally like to use the primary and secondary surveys as a template, focusing particular attention on the body system that matches the patient’s presenting complaint. So if someone presents with abdominal pain, they will get a thorough abdominal assessment. If they present with shortness of breath, I focus more on my respiratory assessment. Working in ED enables me to use all the assessment skills I’d been taught at university.
So is it really all a waste of my time?
I have to answer that question with a passionate “NO”!
Yes, the doctors do an assessment of each patient. Yes, similar questions are asked by nurses and doctors (up to a point). However, the purpose of our assessments are not identical. I would not be comfortable implementing any form of treatment without having a good baseline assessment of my patients. You simply cannot evaluate the effect of interventions if you haven’t obtained a thorough picture of your patient’s starting point. Nurses are the ones who will return to the bedside countless times – both to provide care and to assess the efficacy of the care. Nurses are at the front line when it comes to picking up a deterioration in patients, but you can’t do that without ongoing physical assessment. In fact, I would say that not only should we do our initial “nursing assessment”, but we should be constantly re-assessing our patients.
As nurses, we need to be proactive about improving our assessment skills. How confident are you that you could identify fluid overload in its early stages? Do you know how to measure JVP? We should aim to be sherlockian observers of our patients, noticing tiny details that can provide important information about their health and illness. Are their fingernails clubbed? Do they have scars that point to previous surgeries or injuries? Use all the resources at your disposal to learn all you can about your patients. Learn to use the techniques of inspection, palpation, auscultation and percussion to your advantage. Become a keen detective and use all the information you gather to provide sterling care to those whose lives depend on it.
Here are a few resources to get you going:
- From Ian Miller at impacted nurse – a quick respiratory assessment guide
- Jarvis’s Physical Examination and Health Assessment textbook (available in Australia from Elsevier. I do not have any affiliation with this company or the authors of the textbook – it’s just a great resource)
- YouTube: search for any assessment skills you want to learn more about (e.g. JVP examination)
- Vital Signs and Resuscitation handbook (hat-tip to @JoeLex5 for sharing this link on twitter)
If you know of any outstanding assessment resources, please let me know in the comments or via twitter @tamara_hills