In nursing care, the purpose of this assignment is to discuss and define the role of assessment. Assessment is a crucial part of the nursing process, which involves collecting data on the patient’s health status from various sources. These sources include the patient themselves as the primary source, medical records, family members, and those involved in providing care for them. Additionally, professional journals and medical texts can also be used as secondary sources of information.
According to the American Psychological Association, assessment is defined as judging or estimating the value, character, or other attributes of something.
According to the Oxford Dictionary for Nurses, the first step in the nursing process is collecting data on a patient’s health status and using it to develop a care plan. Traditionally, nurses have focused on recording observations such as blood pressure, pulse rate, body temperature, respiratory rate, and level of consciousness without providing an interpretation. Accurately documenting this information allows nurses to prioritize patient care (Nursing Times.net, 2006). McCormack et al (2004) argue that assessment involves not only technical skills but also a specific relationship between participants who share objectives and practice standards. Assessment plays a critical role in all aspects of nursing care.
The nursing process or problem-solving cycle is not a standalone activity. It involves an ongoing cycle of assessment, planning, implementation, and evaluation. Assessment is a crucial component of nursing and involves gathering information. This information includes baseline observations, appearance or behavior, presentation and performance, and thoughts and feelings. Assessment also includes a person’s overall sense of self, their position in life, and their assets and strengths, not just problems and diagnoses.
Continuously observing for changes, differences, or additional information is an ongoing process in nursing assessment to evaluate the patient’s health. It is crucial as even the smallest detail can indicate a shift in the patient’s needs and require intervention. Different forms of assessment have different names. Global assessment involves gathering general information through structured interviews or creating a Life Map or Timeline. On the other hand, specific assessments focus on individual topics such as the death of a close relative or first experience with substance abuse that may have had a significant emotional impact on the patient’s life. Qualitative information is subjective and personal to the client, holding specific meaning for them by acknowledging “their words, their story.”
According to Hall and Trotter (2008), qualitative data is typically obtained through a more relaxed type of interview, relying on the patient’s self-evaluation. On the other hand, quantitative information is objective since it comes from systematic approaches like assessment tools and rating scales. However, different individuals may respond differently to various types of assessment. Hence, it is crucial to employ an approach that encourages engagement and allows for expression of the person’s viewpoint.
The assessment method should be relevant to the individual being assessed, and they must understand the purpose and reasoning behind the process. Assimilating assessment information can be achieved through diverse methods such as direct observation, logs, diaries, records, questionnaires, rating scales, and interviews. This cyclical systematic approach in nursing practice leads to competent nursing care.
The nursing process provides advantages for both practitioners and patients. Skilled practitioners can experience increased confidence, job satisfaction, personal growth, and the opportunity to share their knowledge. Similarly, patients can benefit from consistent care, improved quality of care, and greater autonomy.
It is important to emphasize that assessment is an ongoing part of the nursing process. The primary goals of this process involve identifying individual and familial needs, gathering information for care planning and reassessment/evaluation purposes, ensuring high-quality care, meeting legal requirements, and contributing to nursing knowledge.
Ultimately, the nursing process involves three main components: assessment (
This includes being accountable for performing regular observations, administering medications and therapies as instructed and prescribed, maintaining a patient’s hydration levels, ensuring the patency of intravenous (IV) access, following a holistic nursing approach, following the appropriate care pathways policies and procedures, adhering to the Code of Professional Conduct, collaborating with other healthcare professionals, families, and significant others, and ensuring a safe and appropriate discharge from the ward.
The NMC (Nursing and Midwifery Council) code of professional conduct (2002) highlights the significance of treating the patient as a unique individual, rather than solely concentrating on their symptoms and diagnosis. This is fundamental to Holistic practice. To develop an effective care plan that enhances well-being, it is crucial to acquire knowledge and comprehension of the patients’ viewpoints and requirements.
According to the text, it is important for healthcare professionals to not only address a patient’s physical needs, but also their sociocultural, spiritual, psychological, and emotional needs. One popular method for effectively assessing and planning a patient’s care is by using a nursing model, such as ‘The Activities of Living Model’.
This nursing model outlines twelve activities of daily living that fulfill basic human needs. These activities cover safety, communication, respiration, nutrition and hydration, elimination, personal hygiene and grooming, regulating body temperature, mobility, engaging in productive activities and recreation, expressing sexuality, sleep, and end-of-life care. The evaluation of a patient undergoing a severe mental health episode is widely acknowledged as a vital responsibility for a mental health nurse.
Sullivan (1990) emphasizes the importance of accurately assessing and understanding a patient’s condition. Failing to do so can lead to delayed treatment and fatal consequences, as the patient may be unable to access mental health services. To ensure successful care planning and implementation of the care pathway program, it is crucial to maintain continuous collaboration with the multi-disciplinary team and provide an all-encompassing and precise description of the patient’s “presentation.”
The Mini-Mental State Examination or ‘M.M.S.E’ (Folstein, 1975) is a frequently used tool in the field of Mental Health. It is often used to detect cognitive impairment and monitor its progression, particularly in individuals with dementia or Alzheimer’s Disease (AD). Its simplicity and directness make it ideal for regular and repeated use in this domain.
The M. M. S. E., developed by Folstein in 1975, is a test that aims to evaluate the cognitive function of adult patients across six areas: orientation, attention, immediate recall, short term recall, use of language, and ability to follow simple verbal and written commands. It comprises eleven questions divided into two parts with a maximum score of 21 for the first part and 9 for the second part. To achieve these scores, participants must correctly answer all questions and reproduce simple patterns. For further details about this test, please consult Nursing Times (2007).
The examiner uses the resulting score to grade the patient’s cognitive function on a scale. A score above 27 (30) is considered normal, while a score below 24 suggests dementia. Mild dementia is indicated by a score rating of 23-21, moderate dementia by 20-11, and severe dementia by less than 10 (Norman, Ryrie,1990). Before administering the Folstein (1975) test, it is important to have a baseline knowledge of the patient’s history. This can be obtained by reviewing the patient’s case notes, talking to other professionals, and speaking with family members (Bush 2007). The cognitive assessment of older dementia patients can vary among practitioners, with different criteria, tools, and scales being used. However, these assessments have flaws that may affect their accuracy and validity as diagnostic tools (Bush 2007).
Despite advancements in the field, healthcare professionals still require a guide for prescribing and evaluating care. It is crucial to assess patients individually to develop a comprehensive approach to their care and treatment. The Mini-Mental State Examination (M.M.S.E.), created by Folstein et al. in 1975, can be completed in less than ten minutes. Its primary aim is to evaluate elderly patients with limited cooperation abilities, often lasting just a few minutes at most. According to Mungas (1991), the M.M.S.E. was specifically developed for this particular demographic. Nice (2007) points out that the M.M.S.E. has been widely used as the main assessment tool.
Bush, Nursing Times (2007) claims that while the M. M. S. E, Folstein (1975), is considered the benchmark for measuring cognitive function in dementia patients in Europe and the U.S.A., there are doubts regarding its suitability. Some researchers argue that its accuracy depends on variables like age, ethnicity, and educational background. Boustani et al. note that the test is more accurate for white individuals with a high school education. Similarly, Yebenese et al. assert that accurate completion of the M. M. S. E, Folstein (1975) requires a fundamental level of learning, literacy, and numeracy, potentially excluding individuals from different cultural, ethnic, or social backgrounds from obtaining an honest assessment. NICE Guidance (2011) recommends ensuring culturally appropriate and accessible information for individuals who have additional needs or do not speak or read English when administering the M. M. S. E., Folstein (1975).
There are external factors that can negatively affect test results, such as the time of day the test is conducted. As the day goes on, stress levels may rise and older patients may become tired and have trouble concentrating. This could lead to a lower performance and potentially give the examiner an inaccurate score. Dewing (2003). Bender (2003) suggests that the administration of the M.M.S.E. Folstein (1975) and the test environment can also impact the results.
According to Bush (2007), mental health practitioners commonly use the test for assessing older patients with Alzheimer’s disease, despite questioning its accuracy. Moby’s Medical Dictionary (2009) defines ‘therapeutic communication’ as the nurse consciously influencing a client’s better understanding through verbal and nonverbal communication. However, it is believed that a quiet area is more conducive to producing accurate results compared to a busy dayroom.
The Nursing and Midwifery Council (NMC) stresses the significance of effective communication in building a positive, professional relationship with patients or clients. Nurses are responsible for developing and maintaining appropriate relationships by listening to and addressing the concerns of those under their care (NMC, 2008). When evaluating a patient, it is crucial to communicate effectively and establish empathy. Creating an environment of genuineness, acceptance, and unconditional positive regard is essential for a successful therapeutic relationship. Empathy can be expressed through verbal and non-verbal means. One useful technique is “Active” listening, which involves employing the SOLER acronym as a reminder of behaviors that aid communication and enhance information reception (Egan, 1986).
This involves directly facing the other person, adopting an open posture, leaning slightly towards the patient to create a sense of intimacy, maintaining eye contact to demonstrate interest, and being relaxed to make the patient feel at ease. This approach can benefit the patient by suggesting that the assessor genuinely cares about them and their information. A verbal listening strategy is “reflective listening,” in which the nurse listens to and repeats what the patient has said to reflect their own thoughts and emotions. Egan (2002) states, “If we could all just learn to listen, everything else would fall into place.”
According to McWhinney (1989), the key to being patient-centered is listening. This assignment has examined the importance of assessment in nursing and how a particular assessment tool can be used in Mental Health practice. While there are multiple tools available for use in the assessment process, it is crucial to prioritize treating each patient as a unique individual and to actively listen to their personal needs and preferences.
References
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