Concept Analysis

Introduction

As a profession, the development of nursing relies significantly on theories, which provide the framework and guidelines for nursing practice (Walker & Avant, 2010). There are a number of theories applied in nursing practice; however, this paper focuses the Neuman’s nursing theory, which ius typically referred to as the Neuman’s system model. Specifically, the paper draws the concept of patient assessment from Neuman’s systems model. The concept of patient assessment is perhaps one of the most important elements of nursing and medical care. Patient assessment allows the medical practitioner to understand the patient and therefore provide the necessary required services (Fraser, Calvert, Wilkinson, & Freemantle, 2009). It is the very initial step taken in order to evaluate what is wrong with the patient. Patient assessment is particularly important in emergency medical service units in providing first hand medical response (Roberts & Sandy, 2003). The goal of this paper is to undertake a concept analysis on the aspect of patient assessment. The paper highlights the aims of the analysis, a brief review of literature, possible uses of the concept, its defining attributes, model cases, alternative cases, antecedents and consequences, and empirical referents.

Aims of Analysis

The purpose of this concept analysis paper is to provide a framework through which practicing nurses can implement the aspect of patient assessment in the nursing practice. According to Lata & Elliott (2007), nursing theories and concepts are merely descriptions and explanations of a phenomenon of interest; however, their true value lies in the contributions that they make towards ensuring effective nursing practice. In the light of this view, the goal of this concept analysis is to provide nursing practitioners with the knowledge needed to integrate the nursing concept in clinical research and actual nursing practice in order to ensure that they deliver quality patient care.

Literature Review

Lata & Elliott (2007) define patient assessment as “the process of identifying the needs, preferences and abilities of a patient. It involves a review of the patient’s symptoms, ability to perceive and communicate and a brief review of the patient medical history. With regard to signs and symptom depicted by the patient, patient assessment involves evaluating vital signs such as motor functions, sensory perception, skin color, activity, sleep and vital signs. Patient assessment also goes beyond physical attributes (Lata & Elliott, 2007). Everly & Mitchell (2000) assert that patient assessment includes an examination of the social or emotional conditions of the patient such as mood, attitude towards the care giver, emotional tone and family ties.

Scholarly literature indicates the extent to which the concept of patient assessment is central to nursing. James (2008) states that patient assessment is a skill that provides the nurse with the ability to offer vital services at the pristine point in time. The concept of patient assessment prefers the use of acronyms in order to provide a brief but complete analysis of the patient. For instance, the acronym MOI stands for mechanism of injury, which then indicates the extent of medical services required. Another acronym that is used in patient assessment is AVPU, which evaluates the mental state of the patient. The first letter A refers to awake or alert, the second letter v stands for voice, that is, response to voice but is disoriented. The third letter P stands for pain, that is, the patient only response to painful stimuli and finally the letter U stands for total unresponsive patient. Therefore, the nurse can rely on such short but effective means providing patient assessment.

Possible Uses of Patient Assessment

The concept of patient assessment can be used in several aspects and by different professionals in the medical fraternity. One of the most important uses of patient assessment is by Emergency Medical Teams (EMTs) (Lata & Elliott, 2007). Emergency medical teams respond to cases of emergency and therefore have a limited time within which to assess the state of the patient and provide the necessary service. However, should the medical team perform a wrong assessment of the patient it may expose the patient to grave danger. In performing patient assessment, EMTs have to abide by different guidelines provided in assessing the patients. For instance, the Ohio Trauma Triage rule guide the medical teams on how to response to trauma patients (Lata & Elliott, 2007). Other guidelines further define how medical response teams are to either transport patients or provide onsite support.

Besides used in determining as an initial step in care delivery, Everly & Mitchell (2000) assert that patient assessment can be used to monitor the ongoing progress regarding to how a patient responds to treatment. In the light of this view, patient assessment provides the basis through which the treatment can be deemed effective or changed in order to ensure that the patient responds positively to medication. Overall, patient assessment takes place in almost every phases of care giving by nursing professionals (Lata & Elliott, 2007).

Defining Attributes

Attributes that make up patient assessment include the major components of patient assessment. The first component of patient assessment is scene size-up (Everly & Mitchell, 2000). These are steps provided to response teams in order to evaluate the needs of the patients. Scene size-up first involves determining the safety of the scene and noting the mechanism of injury or nature of patient illness. Scene size-up step under patient assessment also includes determining the number of patients and in addition determining additional resources that may be required if any.

The second defining step under patient assessment is initial assessment. This is a vital step that evaluates life threatening conditions and estimating the extent of consciousness of the patient. Initial assessment involves checking the airways of the patient, confirming that the patient is breathing, stabilizing the spinal realigning and confirming the patient heart beat rate (Lata & Elliott, 2007).

The third defining attribute of patient assessment is ongoing assessment. This step of patient assessment is performed throughout the entire time that the patient is being transported to the medical institution. Ongoing assessment allows the medical team to review three aspects regarding the conditions of the patient. First, ongoing assessment allows the team to confirm whether the treatment advanced to the patient is working. Secondly, it allows the medical teams to know whether the condition of the patient is worsening. Finally, ongoing assessment allows the medical team to discover new features or symptoms that develop with time. James (2008) states that, for stable patients, ongoing assessment should be performed every 15 minutes. For unstable patients, ongoing assessment is performed every 5 minutes.

Model Cases

There are model cases that the concept of patient assessment has been applied. One such model is in crisis intervention through Critical incident Stress Debriefing (CISD) model (Everly & Mitchell, 2000). CISD is a crisis intervention strategy that allows a group or individuals who have lived through traumatic event to review the incident and find some closure. Upon arriving at the site of the incident, patient assessment provides the response team with the skill to evaluate on how to debrief the patient. Patient assessment has also been used to model pediatric evaluation of head traumas. Pediatric evaluation of head traumas allows the nurse of medical professional to assess the extent of the head trauma.

Alternative Cases

The concept of patient assessment has several related cases. For instance, the concept of patient care can be very similar and related to the case of patient assessment. (James, 2008)The term patient care may refer to instances or measures take to ensure that the health of the patient is continually improving. Therefore, it implies that the nurses will continually perform patient assessment in order to provide patient care.

On the other, a borderline concept of patient assessment is treating the patient, typically referred to as patient treatment. After the patient assessment has been performed, offering medical assistance by administering treatment is based on the outcome of patient assessment. Attributes such as determination of vitals is both applied in patient assessment and patient treatment however, the two are different concepts.

Antecedent and Consequence

An antecedent to patient assessment patient registration, which involves gathering the basic information from the patient such as address, emergency contacts, existing insurance data and current medications, before performing an assessment on the patient. Patient registering is dome primarily for contact and follow up purposes for the case of out-patients (Lata & Elliott, 2007).

A consequence of patient assessment is the administration of treatment and medication, which depends on the results of the patient assessment process. Patients are treated and medicine prescribed according to the assessment outcome. Therefore, practicing nursing should ensure that the assessment process is accurate and devoid of errors in order to avoid potential errors.

Empirical referent

An empirical referent that may demonstrate the existence of the patient assessment is the Glasgow Coma Scale. Measurements in traumatic head injuries are generally used to evaluate the extent of cerebral impairment or to define the extent to which the brain exhibits deficiency in its cognitive functions (Lata & Elliott, 2007). The Glasgow coma scale is a measure used to evaluate the extent of head injuries in patients. It indicates how the response team can assess a patient and thereby provide required services.

Conclusion

The concept of patient assessment is vast in its application and at the same time vital in the field of nursing. Nurses can employ patient assessment to determine how respond to ill patients who cannot express what ails them. It also provides insights damaged organs due to lack of responses. Overall, it is evident that patient assessment is one of the most crucial stages of care giving because the results of the patient assessment process determine the kind of care given to the patient.

References

Everly, G., & Mitchell, J. (2000). The debriefing” controversy” and crisis intervention: a review of lexical and substantive issues. International Journal of Emergency Mental Health , 211-225.

Fraser, A., Calvert, M., Wilkinson, M., & Freemantle, N. (2009). Standardised patient assessments on consecutive days during high-stakes GP training interviews: is there any evidence of candidates sharing information? Education for Primary Care , 20 (4), 285-290.

James, R. (2008). Crisis intervention strategies. New York: Thomson Learning, Inc.

Lata, P., & Elliott, M. (2007). Patient assessment in the diagnosis, prevention, and treatment of osteoporosis. Retrieved October 7, 2012, from http://ncp.sagepub.com: http://ncp.sagepub.com/content/22/3/261.short

Lynn, M., Bradley, M., & Sidani, S. (2007). Understanding and Measuring Patients’ Assessment of the Quality of Nursing Care. Nursing Research , 159 – 166 .

Roberts, D., & Sandy, J. (2003). Orthodontics. Part 2: Patient assessment and examination. British Dental Journal , 489 – 493 .

Walker, L. O., & Avant, K. C. (2010). Strategies for theory construction in nursing, 5th edition. Upper Saddle River, NJ: Prentice Hall.

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