Importance of Comprehensive Health Assessments in Nursing - Term Paper Example

Name: Topic: Reflective Essay Tutor: Date: Introduction Comprehensive Health Assessment is a successful clinical system usually used to provide comprehensive medical history for patients. The information collected is stored in an essential location for easy access in the future (Lenox, 2007). Furthermore, a comprehensive health assessment is a process of steadily collecting and analyzing data to be used in making important judgments about patient’s health and other life processes for individuals and families. It includes critical analysis of data in order to come up with diagnosis and to recognize mutual problems (Phil and Alyson, 2009). Health assessment plays a major role in the identification of individual’s strengths so that they are assimilated into healthcare planning. Although health assessment is not restricted to any physical assessment of body systems, it includes inspection, auscultation, and palpation (Phil and Alyson, 2009). On the other hand, risk assessment is in most cases a logical method of evaluating patient’s health condition, taking into consideration what may go wrong and making right decisions on appropriate control procedures aimed at preventing further development of a disease (Phil and Alyson, 2009). Assessment always seeks to come up with an effective framework on how to reduce or minimize further exposure to risks. Assessment strategies in nursing have great influence from the intention to have a general problem-solving outline of the entire process of nursing models (Janet, 2009). Assessing the need of prevention is essential to the nursing process and receives much attention in concern to the development of eligibility methods for long-term care. Hardly would many people disagree with the allegation on the use of all-inclusive client specific assessment influences good quality and efficient nursing. Assessment earns great enhancement by the complete participation of client and their caretakers to the assessment process to make sure that the client’s wishes are considered the foremost and, wherever possible, the client’s own contributions used to reflect on their individual needs (Janet, 2009). Components of Risk Assessment The components of risk management largely depend on the extent to which a patient is sick. Conducting assessment may vary depending on the nature of the objectives in question. However, it is a general requirement that assessments must cover everyone likely to suffer any risks of infection. Pressure injury ulcer Systematic and sensitive evaluation is a key requirement in most government policies that relate to primary health and community healthcare. Multi-agency and multidisciplinary joint venture facilitate patient care, prevents the waste of important resources and have many positive impacts on health and systems that concern social care for the general society (Russo, 2008). In the wake of converging dependence on management of care for patients and the aiming of proper management of public funding, assessment for nursing patients has increasingly become a vital policy tool. In defining risk or pressure injury, Lyder (2008) puts it that pressure injury is a localized injury that affects the skin or the underlying tissues and usually over a bony eminence. This condition usually results from pressure. Typically speaking, pressure injury results in very devastating pain, long hospital stays, severe infection and even the risks of death at extreme conditions (Pieper, Langemo & Cuddigan, 2009). Pressure ulcers are quite a common and one of the most painful health conditions and especially among elderly or physically impaired people (Lyder, 2008). Additionally, a pressure ulcer has higher chances of impeding patients’ recovery to total functioning and can as well add to the length of hospitalization. The hospitalization length for pressure ulcers is approximately three times long compared to other non-pressure ulcer diagnosis (Russo, 2008). Long periods of constant pressure applied on the skin, muscle, soft tissue and bone is the major cause of pressure ulcer, resulting in the formation of localized ischemia, inflammation of the tissues, necrosis and finally tissue anoxia. Furthermore, there are quite a number of factors that increase the chances and risk of developing pressure ulcer. These factors include physiological factors that most likely impede microcirculation and lastly non-physiologic factors such as impairment of mobility, age, and urinary incontinence (Lyder, 2008). Numerous tools that have been recognized for assessment of risk for pressure ulcers are already in use. However, three of these tools dominate nursing practice and of the widely used scales include Braden Scale, the Norton Scale and the Waterlow Scale (Spilsbury et al., 2007). The Norton Scale, developed in the United Kingdom, has five items, which include physical and mental condition, mobility, activity, and incontinence. Of the many risk factors included in almost all of these tools, some factors such as activity, nutrition/malnutrition, mobility, cognition and incontinence overlap (Spilsbury et al., 2007). The purpose of pressure ulcer assessment therefore is to help assess a patient’s susceptibility to risk of pressure ulcer development. It is also to determine the extent of pressure damage to patients (Janet and Jane, 2009). Despite their longevity, there is scarcity of research that is available to support risk assessment and thus resulting in a lack of agreement among experts and practitioners as well (Spilsbury et al., 2007). Importance of this assessment to person’s comprehensive health assessment The importance of this assessment is that it helps identify individuals who are more at risk of developing pressure ulcer. Once individuals have been identified, they undergo early treatment to avoid further developments of the ulcer. Additionally, avoiding the pain and the unpleasant health agonies that come with pressure ulcers, assessment of risk and injury ulcer helps practitioners to come up with strategies to prevent pressure ulcers (Janet and Jane, 2009). Treatment of pressure ulcer may cost substantially less when the condition is identified at early stages as prevention measures will help reduce the development. By estimation, treatment costs for injury ulcer may be as much as close to 2.5 times the cost of prevention (Janet and Jane, 2009). A number of strategies propose various preventive measures, which majorly fall into the categories of repositioning to patient, characteristics and setting. The success of a particular preventive strategy may vary according to the patient characteristics or settings. For example, a nutritional enrichment may not be applicable to a patient who is not underfed, and distress about the necessary fit of a wheelchair for a patient with an injury in the spinal cord would not apply to individuals who do not use a wheelchair (Spilsbury et al., 2007). Research also indicates that pressure ulcers alongside treatment negatively influence various dimensions of a patient’s life. These dimensions include emotional, physical, mental and social (Spilsbury et al., 2007). One study posited that patients experience unending pain, and those patients in another researches complained that nursing staff did not acknowledge and treat their pain and distress. Challenges that may arise Since the sensory perception subscale constitutes two areas for consideration that include the patient’s level of perception and their being aware of pain, the lower of the two should be assigned. For example, an individual suffering from stroke and is alert but possesses sensory deficits in a single limb because of disease need to receive a score of 3 for that specific subscale (Spilsbury et al., 2007). It is challenging to accomplish an accurate assessment for the nutrition subscale. This subscale commonly attains “usual” intake in its score and is applicable to eating and feeding methods such as ivs, total parenteral nutrition, or tube feeding. Assessment of oral intake requires understanding of the patient’s eating habits, so data must be gathered over a long period to attain the best information and the most accurate one (Phil and Alyson, 2009). If a patient fails to respond positively upon admission and family or friends do not have the information expected on intake, nutritional status can be assessed using BMI and serum albumin level (Phil and Alyson, 2009). The assessment will also consider current plans for the patient’s nutrition. By taking a good example, if the patient has an injury that will most likely rule out intake then the patient is to take nothing by mouth for long time as the assessment (Spilsbury et al., 2007). Clinical judgment is applicable in assigning a score. The rule of thumb is to “do no harm,” and therefore, if the data are medium, a lower risk score is necessary (Phil and Alyson, 2009). Similarly, because it mostly takes a good number of days to reach the target goals for tube feeding, the patient may eventually be undernourished. In this case, a score of 2 should be assigned because the patient is attaining “less than optimum amount of liquid diet or tube feeding (Spilsbury et al., 2007). Conclusion Because patients constitute a very crucial part of the health care team, they need assessment of their pressure ulcer risk status at all times. It is also very important to give them an overview and summary of explanation of the prevention strategies available. With the patient’s approval, family members need appraisal of this information to help with prevention efforts. The patient’s permanent record becomes useful in communicating pressure ulcer risk to other health care professionals. Report at change of shift is also another very important aspect (Spilsbury et al., 2007). Concerning risk assessment, advanced epidemiological research is a very useful move and should aim in coming up with a better insight on risk factors. It is recommended that the information collected by possible researches in the future conducted in different healthcare settings, could result in an ‘item pool’ that might then be used to build up a new risk assessment scale (Phil and Alyson, 2009). Evaluation of the usefulness of such developed scale is paramount before utilization. References Janet, R. (2009). Nurses’ Handbook of Health Assessment, ed. 7. New York: Lippincott Williams & Wilkins. Janet, R. and Jane, K. (2009). Health Assessment in Nursing, ed 4. New York: Lippincott Williams & wilkins. Lennox, N. (2007). Effects of a comprehensive health assessment programme for Australian adults with intellectual disability: a cluster randomized trial, International Journal of Epidemiology, 36(1), p.139-146, Retrieved 23rd Sept. 2012 http://ije.oxfordjournals.org/cgi/content/full/36/1/139 Lyder, C. and Ayello, E. (2008). Pressure ulcers: A patient safety issue. In Hughes R. G., edition, Patient safety and quality. Patient Safety and Quality: An evidence-based handbook for nurses. Rockville, MD: AHRQ. Phil, W. and Alyson, K. (2009). Risk Assessment and Management in Mental Health Nursing. London: Blackwell Publishing Ltd. Russo, C., Steiner, C. & Spector, W. (2008). Hospitalizations Related to Pressure Ulcers among Adults 18 Years and Older. HCUP Statistical Brief 64. Retrieved 23rd Sept. 2012 http://www.hcup-us.ahrq.gov/reports/statbriefs/sb64.pdf Spilsbury, K. et al. (2007). Pressure ulcers and their treatment and effects on quality of life: hospital inpatient perspectives. Journal of Advanced Nursing, 57(5), p. 494-504. Read More