Page 364 - Encyclopedia of Nursing Research

NuRSING ASSeSSMeNT n 331

hurry, give complete attention and full con- assessment. Observations have found that
sideration . . . Always sit within the patients’ nurse–patient interactions are superficial,
view” (pp. 48–49). Nightingale also advo- routinized, and task related and that nurses N
cated obtaining detailed and useful assess- create barriers in communication. Patients
ment data—for example, reporting the with complex communication needs pre-
number of hours a patient slept rather than sent additional challenges (Finke, Light, &
an opinion about how well the patient slept. Kitko, 2008).
This is best achieved by cultivating good Surveys of nurses revealed that most had
interviewing skills (e.g., avoiding leading received training in communication skills,
questions and eliciting descriptive responses felt they were fairly effective in using these
from patients). skills, and felt that the skills are important to
Assessment begins the nurse–patient their jobs. However, they also thought they
relationship and determines how the nurse needed and were willing to receive addi-
and patient will work together. Considerable tional training. Communication training
research has been conducted on factors programs have had mixed results, includ-
that influence interpersonal relationships. ing that benefits did not persist, that changes
Several classic works in nursing have dealt were limited, and that nurses taught commu-
with the process of establishing these rela- nication skills did not improve in their ability
tionships, including the roles in nursing to elicit and identify patient concerns despite
at various phases in relationships and the increased use of the skills learned. The Study
importance of observation and communi- to understand Prognoses and Preference for
cation, including use of self-disclosure and Outcomes and Risks of Treatment (SuPPORT)
empathy, in establishing relationships (e.g., was a striking example of a communication
Peplau, 1952). intervention that did not improve outcomes
Communication is essential in assess- (Lynn et al., 2000).
ment and is both the means for nurses Physical assessment skills are routinely
and patients to influence each other and included in nursing curricula. They include
the process that leads to therapeutic and (a) a general survey of patients’ appear-
supportive influences on patients’ health. ance and behaviors; (b) assessment of vital
Patients’ successful communication of signs, temperature, pulse, respiration rates,
their needs to nurses is vital to individual- and blood pressure; (c) assessment of height
ized care. Individualized patient care has and weight; and (d) physical examination to
been found to produce more favorable out- assess patients’ structures, organs, and body
comes and to reduce the cost of health care systems. Physical assessment can be com-
(Attree, 2001). plete, assessing all of the persons’ organs and
Although assessment and communi- body systems, or modified to focus only on
cation skills have been taught for decades, areas suggested by the persons’ health his-
many studies have found that nurses tory or symptoms.
have difficulty facilitating communica- Perceptions of symptoms and quality of
tion and that the patients’ perspective is life are important areas for assessment. Both
not adequately elicited. A variety of fac- symptoms and quality of life are primarily
tors are associated with poor communica- subjective experiences, influenced by many
tion, including increased patient volume, factors but knowable primarily through
lower nurse-to-patient ratios, and lack of patients’ descriptions of their experiences.
attitudes, desires, confidence, and skills Moreover, symptoms that are not properly
needed to effectively communicate (Raica, managed can be life threatening.
2009). Nurses have also been found to be Nurses need to explore the meaning of
confused about the purpose of nursing illness from patients’ perspectives to help