Chapter 1
Understanding Health
Assessment
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What Is Health Assessment?
 Nursing is a practice profession.
 Health assessment is an essential skill to
nursing practice.
 A key goal of health assessment is to identify
patient cues for normal from abnormal
findings.
 Person-centered care is the ultimate goal of
health assessment.
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Definition of Health
What is your definition of Health?
What does “being healthy” mean to you?
 Nurses should have an understanding of
each patient’s definition of health.
 Cultural practices influence an individual’s
behavior to promote, maintain, and restore
health.
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Assessing the Patient
 Nurses collaborate with patients as copartners in care.
 Interpersonal skills are needed to
communicate with each patient.
 Holistic caring process integrates cultural
considerations.
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Healthy People 2030
 Healthy People 2030 is a science- and
research-based framework
 Updated every ten years by U.S. Department
of Health and Human Services
 Identifies health and risk factors for diseases
 Nurses have a key role to educate patients
across the lifespan and be aware of Healthy
People 2030 objectives and goals.
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U.S. Preventive Services Task Force
(USPSTF)
 Goal: use evidence-based medicine to
improve the health of all Americans
 Provide evidence-based recommendations
about clinical preventive services
• Screenings, counseling services, or preventive
medications
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Levels of Health Prevention
 Primary: health promotion strategies
• Example: annual physical exams, immunizations
 Secondary: early screenings, detection, and
treatment of diseases
• Example: colonoscopy to screen for colon cancer
 Tertiary: restoration of health after illness or
disease
• Example: rehabilitation programs
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Assessment Is a Skill
 Health assessment requires each nurse to be
a detective, to investigate everything
reported by the patient.
 Nurses need to be able to recognize and
analyze cues, formulate hypotheses,
generate solutions and a plan of action.
 Assessing a patient requires using perceptual
senses.
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Characteristics of Health Assessment
 Collects, validates, and clusters data to assess
the whole patient.
• Must be organized
• Utilizes patient resources (e.g., past medical
history, diagnostics, verbal and written reports)
• Establishes baseline information about the patient
• Identifies factors influencing health and well-being
• Identifies normal and abnormal findings, relevant
and irrelevant data
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Nursing Process
 Nursing process, a problem-solving method,
organizes the assessment systematically to
identify information about an individual’s
health and risk factors.
 The nurse uses those results to develop a
plan of care.
 Five steps of the nursing process
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ClickerCheck
A patient presents at the ambulatory care clinic
for complaints of an upper respiratory
infection. While assessing this patient, the
nurse needs to identify:
A.
B.
C.
D.
Physical assessment findings only
Normal from abnormal assessment findings
Basic anatomy and physiology
Diagnostic values
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ClickerCheck Answer
Correct answer: B
Health assessment is a skill to identify normal
from abnormal findings. Nurses need to identify
normal and abnormal variants that may indicate
the patient has an upper respiratory infection.
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ClickerCheck (continued_1)
What is the federal initiative that is a sciencebased framework updated every ten years by
the U.S. Department of Health and Human
Services, which has goals and objectives for
health promotion?
A.
B.
C.
D.
World Health Organization
Healthy People 2030
U.S. Preventative Services Task Force
Robert Wood Johnson Foundation Initiative
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ClickerCheck Answer (continued_1)
Correct answer: B
Healthy People 2030 identifies health and risk
factors for disease and has goals and objectives
for health promotion and disease prevention
(see Box 1-1).
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Critical Thinking
 Purposeful reflection
 Problem-solving
 Multidimensional thinking
 Reflective thinking
 Requires the nurse to analyze and synthesize
information
 A process to prioritize patient needs and
problems
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Clinical Reasoning
 Looks for patient cues to develop hypotheses
 Clinical Reasoning uses patient’s history,
physical signs, symptoms, laboratory data, and
diagnostic imaging.
 Arrives at a diagnosis and formulates a
treatment plan based on that information;
development of alternative solutions to a
problem.
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Clinical Judgment
 Interpretation or understanding a patient’s
needs, concerns, or health problems.
 Generates solutions
 Modify and/or improvise plan of care.
 Decision to take or not take action.
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Intuitive Thinking
 Intuitive inner sense about a clinical
situation
 “Gut feeling” about what may be occurring
in a patient situation.
 Requires the nurse to be open to patient
cues.
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ClickerCheck (continued_2)
A 34-year-old patient is about to deliver her first baby. Her
husband appears to be supportive but appears worried and
nervous. The patient has come to the hospital since her
contractions are 8 minutes apart. She has been in labor for 8
hours and has a past medical history of high blood pressure.
She states, “I never took prenatal classes and don’t know
what to do.” What cognitive skill should you begin to
implement?
A.
B.
C.
D.
Nursing Process
Nursing Assessment
Critical Thinking
Intuitive Thinking
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ClickerCheck Answer (continued_2)
Correct answer: C
Critical thinking is a problem-solving, reflective
process that uses a process of purposeful and
creative thinking about resolving problems.
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Psychomotor Skills
 The “doing” process of assessment.
 Four assessment techniques are:
•
•
•
•
Inspection
Percussion
Palpation
Auscultation
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Communication Skills
 Therapeutic communication skills are
needed to obtain data and develop a
person-centered relationship.
 Exchange information
• Verbal and nonverbal
• Oral and written
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Patient Protection and Affordable Care Act
 Provides higher-quality, safer, more
affordable and accessible care.
 Health care insurance increases accessibility
to health care.
 Nurses have a leading role to assess, teach,
and advocate.
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Best Practice Assessments
 Nursing research and evidence-based
practice guides assessments and clinical
decisions to provide safe and effective care.
 Evidence-based practice guides nurses to
make the best clinical judgments.
 Quality and Safety Education for Nurses
(QSEN) identifies six core competencies.
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ClickerCheck (continued_3)
A patient was recently diagnosed with type 1
diabetes and needs teaching about the
importance of skin and foot care. This is an
example of what level of health prevention?
A.
B.
C.
D.
Primary
Secondary
Tertiary
None of the above
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ClickerCheck Answer (continued_3)
Correct answer: C
Tertiary prevention encompasses the
restoration of health after illness or disease has
occurred. Skin care and foot care help prevent
complications of diabetes.
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ClickerCheck (continued_4)
A patient with Alzheimer’s Dementia is wandering in and
out of other residents’ rooms. You redirect the patient to
the common area where there are other patients
watching television and staff supervision. The patient has
a wander guard on her ankle, and she is using a walker
because she has an unsteady gait. What QSEN
competency is being integrated in this case scenario?
A.
B.
C.
D.
Patient-Centered Care
Safety
Teamwork and Collaboration
Quality Improvement
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ClickerCheck Answer (continued_4)
Correct answer: B
The nurse has the knowledge and skill to
redirect the patient to an area where she can be
supervised. She is wearing a wander guard to
prevent her from leaving the facility and has a
walker to prevent falls since she has an
unsteady gait.
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