They’re a routine activity carried out every time a new patient signs up with a doctor or clinic, enters a hospital as a planned admission or arrives in an emergency department seeking urgent care. As such, it can be tempting to think of them as purely administrative, but patient health assessments are one of the most useful tools nurses have for getting to know patients, identifying problems and initiating the process of optimizing their health. This article addresses the reasons why they matter so much.
Diagnostic work is often thought of as a matter for doctors, but nurses’ work plays an essential role in identifying symptoms which patients are unaware of themselves or haven’t taken seriously enough. It’s important in identifying minor health conditions which are relatively easy to treat but problematic if left unattended, and it can also identify very serious ones. Health assessments are designed to get a clear overall picture of an individual’s state of health and pinpoint any areas where there might be cause for concern. This can be done through visual observation, smelling suspicious odors, checking vital signs, palpitating the patient or using percussive or auscultative techniques. Conversation during assessments is also a valuable diagnostic aid, as is noting the way that patients move and behave. After working through important diagnostic questions, asking open ended ones and simply listening gives patients the chance to raise any issues which have been worrying them.
Preventative health care
Patient health assessments are a good starting point for all sorts of practical preventative health measures. They’re a chance to find out if a patient has a problem with alcohol or drugs, wants to lose or gain weight, has concerns around healthy aging or needs advice on fertility and reproduction. They give you the opportunity to talk about healthy eating and hydration, and to discuss forms of exercise which might be best suited to improving general fitness or tackling a specific difficulty, such as improving flexibility in the knees. Identifying low level tachycardia might not lead to a diagnosis regarding medication or surgery but might mean it’s time to start work on a cardiovascular exercise plan. Identifying a skin problem might lead to an important discussion about hygiene. These might not be the biggest issues you deal with as a nurse, but they can prevent major health problems from developing in the first place.
Establishing and maintaining a relationship
Carrying out a health assessment is a valuable opportunity to start building a relationship. This may not be enduring in an urgent care context, but it can still give a patient valuable confidence at a vulnerable time. In other contexts it’s the beginning of a process of developing trust which means that patients will feel able to talk to you about sensitive matters and will feel safe with you when receiving treatments which feel frightening or unpleasant. It means that they will pay more attention when you give them advice, and it also means that spending time together will be more enjoyable for you and them – something which is particularly important for elderly and disabled patients who may experience isolation and loneliness in their day to day lives. Getting to know a patient makes it easier for you to detect changes in mood or behavior which may be a sign of developing illness. This is why courses such as Saint Joe’s hybrid ABSN, which makes it possible to qualify in just 15 months, stress the importance of carrying out assessments annually, a process which can be combined with less intensive monitoring of specific symptoms in chronically ill patients whom you see at regular intervals.
Beyond the physical
Patient health assessments go far beyond the identification of physical symptoms which may point to failing health. Experienced nurses also utilize them to monitor mental health and to keep track of patients’ social situations. Talking through family history of illness can give you an idea of the conditions to which a specific patient may be more vulnerable, and can also help you to learn something about the patient’s underlying psychology and anticipate any unusual reactions to parts of the life course like losing a family member. It’s useful to know if a patient is a caregiver because of the impact this can have on mental and physical health over time, and it’s easier to help a patient who is becoming disabled or frail if you know whether or not there are family members around who can care for them. You can also use conversations about family as a means to help patients ask for help if they are experiencing domestic abuse, to find out about wider community support which they may have access to, and to identify any cultural barriers which may complicate access to healthcare.
Having a good set of notes collected during a comprehensive health assessment can prove valuable in the long term even if it doesn’t flag up anything concerning straight away. For instance, having established that a patient is a healthy weight can be useful if they start to lose a worrying amount of weight and claim that nothing has changed. Being aware of minor allergies and roughly how long they have been present may be useful if, in the future, there are indications of a developing autoimmune disease. Notes like this can give you access to vital information which a patient has forgotten or has become unable to communicate. They can also provide you with critical social information which enables you to advocate on the patient’s behalf.
In most cases, patient health assessments don’t point the way to urgent medical treatment, but they are still an extremely valuable tool and over the long term they can contribute to saving lives. They are also a key aide in working with patients to improve quality of life. They give nurses the chance to exercise some of their most important skills and demonstrate the value of a profession which focuses not only on specific ailments, but on the general well-being of the patient.