Health Assessment in Nursing Practice

It involves collection of subjective data about the client’s perception of his or her health of all body parts or systems, past health history, family history, and lifestyle and health practices (which includes information related to the client’s overall function) as well as objective data gathered during a step-by-step physical examination.

• Initial comprehensive

  assessment

• Ongoing or partial assessment

• Focused or problem-oriented

  assessment

• Emergency assessment

According to American Nurses Association (ANA) (a)   defines as "the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human responses and advocacy in the care of individuals, families, communities and populations.

Nursing: Scope and Standards of Practice

states as

"The Registered Nurse collects comprehensive data pertinent to the patient's health or situation."

• Standard 1

• Standard 2

Nursing: Scope and Standards of Practice

states as

"The Registered Nurse analyzes the assessment data to determine the diagnoses or issues"

• Standard 1

• Standard 2

To accomplish this pertinent and comprehensive data, the nurse:

• Collects data in a systematic and ongoing process

• Uses analytical models and problem-solving tools

• Validates the diagnoses or issues with the client, family, and other healthcare providers when possible and appropriate

• Uses appropriate evidence-based assessment techniques and instruments in collecting pertinent data

First and most critical phase of Nursing Process

• Assessment

• Planning

• Diagnosis

• Intervention

Considered to be the interdependent factors that affect a person's level of health

• Body

• Mind

• Heart

• Spirit

Validation of assessment data is a crucial part of assessment that often occurs along with collection of subjective and objective data.

• True

• False

It forms the database for the entire nursing process and provides data for all other members of the health care team.

(a)  

Analysis of data (often called nursing assessment) ?

• True

• False