Page 363 - Encyclopedia of Nursing Research

330 n NuRSING ASSeSSMeNT

simultaneous factors impacting on client
outcomes in nurse practice settings. The NursiNg assessmeNt
N findings of the staffing–outcomes research
literature that low staffing levels tend to be
correlated with risks of poor outcomes, albeit Assessment is widely recognized as the
imperfect, are consistent with the contention first step in the nursing process. Nurses use
that avoiding low levels of coverage and staff assessment to determine patients’ actual
mix relative to norms for similar care settings and potential needs, the assistance patients
is a necessary, but not sufficient, condition require, and the desired outcomes to evalu-
for minimizing adverse outcomes in nursing ate the care provided. There is consensus that
care. Management, leadership, and intradis- nursing assessment is crucial as the starting
ciplinary and interdisciplinary teamwork in point for establishing relationships and for
clinical practice settings have been repeat- determining how patients and nurses will
edly raised as important moderating factors subsequently interact. Assessment begins
influencing the effectiveness of staffing mod- with the initial nurse–patient encounter; it
els, but formal study has been limited at pre- involves validating information previously
sent. expansion of staffing investigations to obtained and collecting additional infor-
also encompass the delivery of chronic care, mation to plan care. It is an important basis
particularly in the community, as well as for determining which interventions can be
outcomes across longer episodes of care are delegated to other providers. Information
important research directions. collected includes social and health history
Staffing is destined to remain an active data, which come directly from patients, and
area of research, although the focus will likely physical assessment data, which are derived
change. Cost considerations are becoming from physical assessment techniques and
increasingly prominent in most health care diagnostic studies.
systems internationally. Further turbulence in The purposes of assessment are to begin
the nursing workforce is expected, with deep to establish a therapeutic relationship and
and widespread regional and often national to identify the patients’ strengths and prob-
shortages of professional nurses expected in lems to determine appropriate interventions.
many societies before the end of the current Both the process and content of assessment
decade. Although randomized trials of staff- are important. Process includes using com-
ing models in various practice settings would munication and physical assessment skills to
be extremely difficult to develop from meth- establish a relationship and to gather needed
odological, practical, and ethical standpoints, information. The important content will vary
close longitudinal evaluations of carefully with the patient but generally includes physi-
developed models of meeting client needs cal assessment, other diagnostic data, assess-
using different coverage levels and combi- ment of the meaning of the health experience,
nations of staff are possible and very much quality of life, symptoms, and cultural factors
needed for effective local and national policy- that may affect health.
making. Such evaluations will require better Florence Nightingale was among
data on a broader range of outcome measures the first to discuss nursing assessment
than are currently conventionally used in (Nightingale, 1860/1969). She believed that
managing health care facilities research, as observation was essential, and she provided
well as the capacity to link and analyze these specific guidance about nursing assess-
data alongside staffing parameters. ments. Nightingale noted that the best pro-
cess for interactions (including assessment)
Sean P. Clarke was to “always sit down when a sick person
Raquel M. Meyer is talking business to you, show no signs of