Importance Of Health Assessment In Nursing Care: Components And Clinical Reasoning Framework

Components of Health Assessment

Health assessment can be considered as the key component of the nursing practice and is essential for the planning and for the provision of a patient and a family centred care (Forbes & Watt, 2015).

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This essay would focus upon the importance of the health assessment in the planning and the delivery of a safe care, the different components of the health assessment and how they are important. It would further focus on the objective or the purpose of the health assessment with reference to the framework of clinical reasoning cycle. Finally the paper would provide health assessments in two clinical settings- With a child in a community situation and with an ageing person in an elderly care facility.

A health assessment can be defined as a plan of care for a person that determines the specific requirements of a person. It is a deliberative and a systematic process by which the nurses utilise their critical thinking process for the collection, validation and analysis and synthesis of the collected information for making judgement about the health status of the patients, families or the communities (Forbes & Watt, 2015). A health assessment includes the physical examination of a patient or the use of various tools and the techniques for the diagnosis of diseases. It is the health assessment based on which the health care professionals make decisions about the interventions that has to be taken for the care of the patient.

The major components of a health assessment includes-

Patient history, Physical, mental, social and spiritual assessment and Consideration of the laboratory results. While assessing the health of the patient, it is essential to obtain the health history (Estes, 2013). The main objective is to gather subjective data from the patient or the family such that a treatment plan can be constructed fir the promotion of health or treating acute health care problems or minimisation of the chronic health care conditions. Health assessment involves the overall assessment of the patient’s physical, emotional and the behavioural state of the patient. The general appearance of the patient should be seen at first. Consideration of all kinds of patients should include body symmetry, facial features, mood and affect, gross and the motor skills and personal hygiene (Estes, 2013).

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A primary assessment consists of Airway, breathing, Circulation and disability. Nurses should asses for a clear and open airway, obstruction, respiratory distress or for any edema or bleeding. After the airway, the ventilation is observed by auscultating the lungs, observing the chest movement and by counting the respiratory rate. Adequate circulation is required for the maintenance of the tissue perfusion and cellular oxygenation (Estes, 2013). A neurological assessment should be done for assessing any sort of motor or sensory deficit in the patient. It is necessary to assess the level of consciousness, the time and orientation of the person and the place, assessing the response to pain stimulation and more. Secondary assessment refers to the assessment of the vital signs like blood pressure, temperature, oxygen saturation, pain, blood glucose levels, cardiac enzymes and diagnostic reports.

Clinical Reasoning Framework in Health Assessment

In nursing, health assessment is a plan of care that identifies specific mental and physical needs of a person. Depending on these needs, the therapy planning is framed. One of the important approaches of performing health assessment highlights the use of the clinical reasoning framework. Clinical reasoning framework helps to generate positive health outcome (Weber & Kelley, 2013). The Levette Jones Clinical Reasoning Cycle is composed of eight different steps.  The first aspect highlights the consideration of the patient’s situation in the domain of his age and current unrest within the body (Hoffman et al., 2011). According to Fayers and Machin (2013) patient situation is the first step towards drafting the care plan. The second step of the clinical reasoning cycle includes collection of cues of the information. This mainly deals with review of the current information, gathering of new information based on the current situation of the patient and recall of knowledge in order to link the available resources with the past information (Weber & Kelley, 2013). Weber and Kelley (2013) highlighted that collection of the information in the domain of patient’s health must be done in reference to the past and the present medical history. This helps in the avoidance to encountering error in therapy planning. The third step in the clinical reasoning is processing of the information. Information processing is important in health assessment as prediction of the current health status from available data will help to draft the care plan (Weber & Kelley, 2013). Suppose a patient is having high blood pressure and high respiratory rate along with high level of cholesterol then it can inferred that the his current health condition is due to certain level of cardiac complications (Byrd et al., 2013). The fourth step of the clinical reasoning cycle includes identification of the problem (Weber & Kelley, 2013). Identification of the problem helps in drafting person-centred care plan. The fifth step of the clinical reasoning cycle, for performing health assessment includes establishments of goals. These goals must be framed in such a manner that specifically captured the health needs of concerned patients (Weber & Kelley, 2013). This further highlights the importance of the proper health assessment. The sixth and the seventh step include taking proper actions in fulfilling the goals and evaluation approaches in order to ascertain the whether the goals have been successfully achieved (Weber & Kelley, 2013). The last step of the clinical reasoning cycle includes reflection on the overall process stating the main learning outcomes (Weber & Kelley, 2013). According to the Code of Professional Conduct for Nurses in Australia (2018), it is the duty of the nursing professional to practice via reflection and this helps in improve the overall professional approach of nursing.

  • Health assessment of a child in a GP practice  

Health Assessment in Clinical Settings

Situation- A 6 years old boy has been brought to the primary care setting with high respiratory distress and wheezing.

Age- 6 years old boy

Primary Assessment (ABCDE Assessment)

Airway- The boy should be assessed for any wheezing noise from the airways. If the child is unable to answer, it is necessary to assess for an airway obstruction (Pijnenburg et al., 2016).

Breathing and ventilation- The oxygen saturation of the child should be checked. Auscultation with the help of a stethoscope can be helpful in determining wheeze. A high flow oxygen should be given for breathing difficulties (Pijnenburg et al., 2016).

Circulation- Cardiovascular assessment is necessary as trauma due to trauma can add up complications.

Disability- It is necessary to check that the motor and the sensory skills of the boy is functioning.

Nebulisers like salbutamol can be given and oxygen therapy should be given in case of low oxygen saturation.

  • Health assessment of an elderly patient in the aged care setting

Situation- 65 years old James who have had a history of cardiovascular disease and was found to be having chest tightness and mild pain over 2 days.  

Age – 65 years.

Past health history- It is essential to know about the past health history such as hypertension, cholesterol, elevated blood pressure.

Physical examination

Thorax- It is necessary to check the skin colour of the thoracic region.

Eyes- Identification of yellowish plaques

Palpation- It is necessary to palpate the radial pulse.

Percussion- Percussion can be helpful in locating the cardiac borders. It is necessary to percuss across the anterior axillary line and continue towards the sternum (Kristensen & Knuuti, 2014).

Auscultation- Auscultation of the heart sounds can be helpful in determining cardiovascular diseases. Heart murmurs can be used to detect complications.

Furthermore it is also necessary to find out the quality of the pain and the exact location of the pain and other symptoms like dyspnoea, fatigue, light-headedness and the current medications. Vital signs like the blood pressure, temperature, heart rate and respiratory rate should be measured.

Conclusion

In conclusion it can be said that a proper health assessment is the basic step in the nursing procedure that helps in the development of an ideal treatment regimen for the patients. A proper health assessment enables a health care professionals to identify the predisposing factor of the clinical condition and avoid them during the planning of the interventions. Health assessment are person centred and varies with age and clinical complications. In this assignment it could be seen that the cardiovascular assessment for the elderly patient is totally different from that of the child suffering from asthma. However, a health assessment has to be done properly by adhering to the clinical guidelines to avoid any clinical errors. 

References

Byrd, J. B., Vigen, R., Plomondon, M. E., Rumsfeld, J. S., Box, T. L., Fihn, S. D., & Maddox, T. M. (2013). Data quality of an electronic health record tool to support VA cardiac catheterization laboratory quality improvement: the VA Clinical Assessment, Reporting, and Tracking System for Cath Labs (CART) program. American heart journal, 165(3), 434-440. https://doi.org/10.1016/j.ahj.2012.12.009

Estes, M. E. Z. (2013). Health assessment and physical examination. Cengage Learning. https://books.google.co.in/books?hl=en&lr=&id=wTcXAAAAQBAJ&oi=fnd&pg=PR6&dq=HEALTH+ASSESSMENT&ots=00lIBshfiG&sig=skejnE5R_-tlQqOWYmlUYqLCWvU#v=onepage&q=HEALTH%20ASSESSMENT&f=false

Fayers, P. M., & Machin, D. (2013). Quality of life: the assessment, analysis and interpretation of patient-reported outcomes. John Wiley & Sons. Retrieved: https://books.google.co.in/books?hl=en&lr=&id=pqX6WKgHKJsC&oi=fnd&pg=PA1&dq=analysis+of+patient+situation&ots=z58UFhm3e3&sig=h1k6M_pIemkqHuKcUOULTFGDXLo#v=onepage&q=analysis%20of%20patient%20situation&f=false

Forbes, H., & Watt, E. (2015). Jarvis’s Physical Examination and Health Assessment. Elsevier Health Sciences. https://books.google.co.in/books?hl=en&lr=&id=clZ3CwAAQBAJ&oi=fnd&pg=PP1&dq=health+assessment&ots=7SoTNYkY63&sig=lGWlVpsUTzQ0FOoB6_zCgM8_R6M#v=onepage&q=health%20assessment&f=false

Hoffman, K., Dempsey, J., Levett-Jones, T., Noble, D., Hickey, N., Jeong, S., … & Norton, C. (2011). The design and implementation of an Interactive Computerised Decision Support Framework (ICDSF) as a strategy to improve nursing students’ clinical reasoning skills. Nurse Education Today, 31(6), 587-594. https://doi.org/10.1016/j.nedt.2010.10.012

Kristensen, S. D., & Knuuti, J. (2014). New ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management. https://doi.org/10.1093/eurheartj/ehu285

Nursing and Midwifery Board of Australia. (2018). Code of Professional Conduct for Nurses in Australia. Access date: 6th September 2018. Retrieved from: https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx

Pijnenburg, M. W., Baraldi, E., Brand, P. L., Carlsen, K. H., Eber, E., Frischer, T., … & Mantzouranis, E. (2015). Monitoring asthma in children. European respiratory journal, 45(4), 906-925. DOI: 10.1183/09031936.00088814

Weber, J. R., & Kelley, J. H. (2013). Health assessment in nursing. Lippincott Williams & Wilkins.