NR 305 Assessment Techniques

NR 305 Assessment Techniques

NR 305 Assessment Techniques

This week’s lesson focuses on assessment of families and introduces specific assessment opportunities for racially diverse, same sex, and adoptive families. Select one of these three non-traditional families. How would your assessment technique change to be sure that you were competently caring for a member of this type of family unit? This may include questions you would add to the health history, or ways in which you would communicate.

I did the alternative assignment and I believe that there is a time to gather all that information, but that inpatient during an initial assessment, we may not have that time. Our hospital system goes over a checklist. Half the time I am interrupted by a doctor coming in to do his assessments. Funny thing is that my background information may end up helping the doctors a bit getting to know the patient, but they have more patients than I do.

As a new nurse, I was more task oriented and focused on getting all my check marks done. Now I have the initial assessment memorized so that I could even ask the right questions if my computer was not functioning to fill in later. Attentiveness as well as trying to get through that assessment efficiently is important to getting into the care that the patient needs. I often find myself having small talk with patients to talk about where they are from, family life, etc. while passing meds or maybe just getting up to go to the bathroom.

If there is a way to address someone properly, that is a way to instantly build rapport. Let us say I have a patient who identifies as lesbian and her significant other is her “spouse”, “partner”, or “wife”, I can then respectfully and correctly honor that relationship. Simple validation goes a long way. Also recognizing these people as a family or couple is important in assessment. Something we always ask our patients about during our initial assessment is whether the patient is living in a safe and unthreatening environment. Those intimate questions are asked privately and without a domestic partner in the room (Weber & Kelley, 2018). A lesbian patient needs to be asked those questions just the same as a heterosexual patient. In fact, according to Mick (2006) “gay male couples and lesbian couples have similar prevalence rates and similar patterns of abuse as heterosexual couples”. Ignorance may make assumptions about the patient in the room, but we cannot know about a person unless we ask questions and actually assess that patient.

References

Mick, J. (2006). Identifying signs and symptoms of intimate partner violence in an oncology setting. Clinical Journal of Oncology Nursing 10(4): 509-523.

Weber, J.R. & Kelley, J.H. (2018). Health assessment in nursing (6th ed.). Philadelphia, PA: Wolters Kluwer.

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Sorry for pasting some of the actual question!  Here’s what my post should look like:

I did the alternative assignment and I believe that there is a time to gather all that information, but that inpatient during an initial assessment, we may not have that time. Our hospital system goes over a checklist. Half the time I am interrupted by a doctor coming in to do his assessments. Funny thing is that my background information may end up helping the doctors a bit getting to know the patient, but they have more patients than I do.

As a new nurse, I was more task oriented and focused on getting all my check marks done. Now I have the initial assessment memorized so that I could even ask the right questions if my computer was not functioning to fill in later. Attentiveness as well as trying to get through that assessment efficiently is important to getting into the care that the patient needs. I often find myself having small talk with patients to talk about where they are from, family life, etc. while passing medications or maybe just getting up to go to the bathroom.

If there is a way to address someone properly, that is a way to instantly build rapport. Let us say I have a patient who

NR 305 Assessment Techniques
NR 305 Assessment Techniques

identifies as lesbian and her significant other is her “spouse”, “partner”, or “wife”, I can then respectfully and correctly honor that relationship. Simple validation goes a long way. Also recognizing these people as a family or couple is important in assessment. Something we always ask our patients about during our initial assessment is whether the patient is living in a safe and nonthreatening environment. Those intimate questions are asked privately and without a domestic partner in the room (Weber & Kelley, 2018). A lesbian patient needs to be asked those questions just the same as a heterosexual patient. In fact, according to Mick (2006) “gay male couples and lesbian couples have similar prevalence rates and similar patterns of abuse as heterosexual couples”. Ignorance may make assumptions about the patient in the room, but we cannot know about a person unless we ask questions and actually assess that patient.

References

Mick, J. (2006). Identifying signs and symptoms of intimate partner violence in an oncology setting. Clinical Journal of Oncology Nursing 10(4): 509-523.

Weber, J.R. & Kelley, J.H. (2018). Health assessment in nursing (6th ed.). Philadelphia, PA: Wolters Kluwer.

Great reflection about your assessments and how you have changed over time. I do that same with  asking questions and charting later. I like to have the patient feel I am really listening and not just staring at the computer. I also appreciate the thoughts on caring for families. One thing I think about as I combine the idea of assessments and family is whether or not giving report on the family during a shift change is appropriate. I think sometimes nurses can tend to say too much and sway the next person’s opinion. For example, one might say “the father is at the bedside and he is very demanding with the staff” when instead they should simply share “the father is currently at the bedside.” Does anyone have experiences with this that they would want to share?

Thank you for any additional thoughts!

When I first began my assessments in clinical rotation, I was extremely nervous and often missed steps. I must admit I took a long time, and this really agitated the patients. There were times where I even had to go back into the room to assess the patient again because I skipped an important part of the assessment. In comparison to my performance today, I can now perform an assessment with confidence and finish in less than half the time I spent in the past. It comes more natural for me now and I usually do not skip any areas to physically assess. I find that I can now hold a casual conversation with the patient, and this makes my assessment flow a lot better now. The patient responses are a lot more positive than in the past. Weber & Kelley 2018 states, “The more you practice, the faster you will perform the assessment” (Weber & Kelley, 2018, p. 672).

Based on observation I feel that assessments performed in practice are not always as through as they should be. I have noticed patients arriving from the Emergency Department with critical missed findings like skin integrity, muscle strength, and mobility. Being that the Emergency Department is often a fast-paced and chaotic setting, I can understand how this may happen. However, that is when I realize my assessment must be very through and non-reliant on another nurse’s findings. While I was working as a unit clerk on a medical surgical unit, I observed a situation that I will never forget. A new admission arrived on the unit and the nurse who accepted the patient went in to perform her assessment. I happened to be walking by the room, and the nurse called me over. She said the patient was difficult to rouse and she needed assistance immediately from the other nurses. I took a glance at the patient, and she was sitting up and appeared lifeless with a glazed look in her eyes. I immediately ran to the nurses’ station to get help seeing as the situation looked serious. After all the commotion that followed it turned out the patient’s blood sugar was dangerously low. The hospitalist came, the patient was given a bolus and she ended up being transferred to the critical care unit. What followed was a lot of conversations on the unit on how the Emergency Department sent the patient up without assessing her critical condition before transport. This is something that I will never forget, and it reminds me how important the reassessment is in providing patient care.

If I were assessing a same-sex family, my technique would need to be sensitive, respectful, and attentive toward enhancing therapeutic communication. To build on self-esteem and communication, as stated in Weber & Kelley 2018, “offer at least one or two commendations during each meeting with family” (Weber & Kelley, 2018, p. 861). I would commend the family for their strengths and efforts based on information provided during the assessment. This would build up their self-esteem and hopefully make them feel open to sharing further information. I believe it would be critical to determine the gender roles in the family and not make any assumptions. As mentioned in Weber and Kelley 2018, “Ask each family member the following: What are the expected behaviors for men in your family? For women?” (Weber & Kelley, 2018, p. 862).  Some small techniques that can help make the family feel respected are asking their preferred name or how they would like to be addressed. Making the family feel safe and ensuring necessary areas are uncovered for referrals and support groups are essential in providing quality care. I was saddened to learn that, “The health disparities among LGBTQI patients range from bullying and physical assault to refusal of healthcare and housing” (Landry, 2017, p. 42). One must recognize the long history of discrimination and how it has impacted this population in the health care environment. I believe providing a safe and judgement free environment would be critical in providing competent care to same-sex families.

Resources:

Weber, J.R. & Kelley, J.H. (2018). Health assessment in nursing (6th ed.). Wolters Kluwer.

Landry, J. (2017). Delivering culturally sensitive care to LGBTQI patients. The Journal for Nursing Practitioners. 13(5). P. 342-347. doi: https://doi.org/10.1016/j.nurpra.2016.12.015