essay on nursing assessment

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StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

StatPearls [Internet].

Nursing admission assessment and examination.

Tammy J. Toney-Butler ; Wendy J. Unison-Pace .

Last Update: August 28, 2023 .

Definition/Introduction

The initial nursing assessment, the first step in the five steps of the nursing process, involves the systematic and continuous collection of data; sorting, analyzing, and organizing that data; and the documentation and communication of the data collected. Critical thinking skills applied during the nursing process provide a decision-making framework to develop and guide a plan of care for the patient incorporating evidence-based practice concepts. This concept of precision education to tailor care based on an individual's unique cultural, spiritual, and physical needs, rather than a trial by error, one size fits all approach results in a more favorable outcome. [1] [2] [3]

The nursing assessment includes gathering information concerning the patient's individual physiological, psychological, sociological, and spiritual needs. It is the first step in the successful evaluation of a patient. Subjective and objective data collection are an integral part of this process. Part of the assessment includes data collection by obtaining vital signs such as temperature, respiratory rate, heart rate, blood pressure, and pain level using an age or condition appropriate pain scale. The assessment identifies current and future care needs of the patient by allowing the formation of a nursing diagnosis. The nurse recognizes normal and abnormal patient physiology and helps prioritize interventions and care. [4] [5]

Nursing Process

Assessment (gather subjective and objective data, family history, surgical history, medical history, medication history, psychosocial history)
Analysis or diagnosis (formulate a nursing diagnosis by using clinical judgment; what is wrong with the patient)
Planning (develop a care plan which incorporates goals, potential outcomes, interventions)
Implementation (perform the task or intervention)
Evaluation (was the intervention successful or unsuccessful)
Issues of Concern

The function of the initial nursing assessment is to identify the assessment parameters and responsibilities needed to plan and deliver appropriate, individualized care to the patient. [6] [7] [8] [9]

This includes documenting:

Appropriate level of care to meet the client's or patient’s needs in a linguistically appropriate, culturally competent manner
Evaluating response to care
Community support
Assessment and reassessment once admitted
Safe plan of discharge

The nurse should strive to complete:

Admission history and physical assessment as soon as the patient arrives at the unit or status is changed to an inpatient
Data collected should be entered on the Nursing Admission Assessment Sheet and may vary slightly depending on the facility
Additional data collected should be added
Documentation and signature either written or electronic by the nurse performing the assessment

Summary Nursing Admission Assessment

Documentation: Name, medical record number, age, date, time, probable medical diagnosis, chief complaint, the source of information (two patient identifiers)
Past medical history: Prior hospitalizations and major illnesses and surgeries
Assess pain: Location, severity, and use of a pain scale
Allergies: Medications, foods, and environmental; nature of the reaction and seriousness; intolerances to medications; apply allergy band and confirm all prepopulated allergies in the electronic medical record (EMR) with the patient or caregiver
Medications: Confirm accuracy of the list, names, and dosages of medications by reconciling all medications promptly using electronic data confirmation, if available, from local pharmacies; include supplements and over-the-counter medications
Valuables: Record and send to appropriate safe storage or send home with family following any institutional policies on the secure management of patient belongings; provide and label denture cups
Rights: Orient patient, caregivers, and family to location, rights, and responsibilities; goal of admission and discharge goal
Activities: Check daily activity limits and need for mobility aids
Falls: Assess Morse Fall Risk and initiate fall precautions as dictated by institutional policy
Psychosocial: Evaluate need for a sitter or video monitoring, any signs of agitation, restlessness, hallucinations, depression, suicidal ideations, or substance abuse
Nutritional: Appetite, changes in body weight, need for nutritional consultation based on body mass index (BMI) calculated from measured height and weight on admission
Vital signs: Temperature recorded in Celsius, heart rate, respiratory rate, blood pressure, pain level on admission, oxygen saturation
Any handoff information from other departments

Physical Exam

Cardiovascular: Heart sounds; pulse irregular, regular, weak, thready, bounding, absent; extremity coolness; capillary refill delayed or brisk; presence of swelling, edema, or cyanosis
Respiratory: Breath sounds, breathing pattern, cough, character of sputum, shallow or labored respirations, agonal breathing, gasps, retractions present, shallow, asymmetrical chest rise, dyspnea on exertion
Gastrointestinal: Bowel sounds, abdominal tenderness, any masses, scars, character of bowel movements, color, consistency, appetite poor or good, weight loss, weight gain, nausea, vomiting, abdominal pain, presence of feeding tube
Genitourinary: Character of voiding, discharge, vaginal bleeding (pad count), last menstrual period or date of menopause or hysterectomy, rashes, itching, burning, painful intercourse, urinary frequency, hesitancy, presence of catheter
Neuromuscular: Level of consciousness using AVPU (alert, voice, pain, unresponsive); Glasgow coma scale (GCS); speech clear, slurred, or difficult; pupil reactivity and appearance; extremity movement equal or unequal; steady gait; trouble swallowing
Integument: Turgor, integrity, color, and temperature, Braden Risk Assessment, diaphoresis, cold, warm, flushed, mottled, jaundiced, cyanotic, pale, ruddy, any signs of skin breakdown, chronic wounds

Initial Assessment [10] [11] [12]

Steps in Evaluating a New Patient

Record chief complaint and history
Perform physical examination
Complete an initial psychological evaluation; screen for intimate partner violence; CAGE questionnaire and CIWA (Clinical Institute Withdrawal Assessment for Alcohol) scoring if indicated; suicide risk assessment
Provide a certified translator if a language barrier exists; ensure culturally competent care and privacy
Ensure the healthcare provider has ordered the appropriate tests for the suspected diagnosis, and initiate any predetermined protocols according to the hospital or institutional policy

Which provides the diagnosis most often: history, physical, or diagnostic tests?

History: 70%
Physical: 15% to 20%
Diagnostic tests: 10% to 15%

History Taking Techniques

Record chief complaint

History of the present illness, presence of pain

P-Q-R-S-T Tool to Evaluate Pain

P: What provokes symptoms? What improves or exacerbates the condition? What were you doing when it started? Does position or activity make it worse?
Q: Quality and Quantity of symptoms: Is it dull, sharp, constant, intermittent, throbbing, pulsating, aching, tearing or stabbing?
R: Radiation or Region of symptoms: Does the pain travel, or is it only in one location? Has it always been in the same area, or did it start somewhere else?
S: Severity of symptoms or rating on a pain scale. Does it affect activities of daily living such as walking, sitting, eating, or sleeping?
T: Time or how long have they had the symptoms. Is it worse after eating, changes in weather, or time of day?

S-A-M-P-L-E

S: Signs and symptoms
A: Allergies
M: Medications
P: Past medical history
L: Last meal or oral intake
E: Events before the acute situation

Pain Assessment

Pain, or the fifth vital sign, is a crucial component in providing the appropriate care to the patient. Pain assessment may be subjective and difficult to measure. Pain is anything the patient or client states that it is to them. As nurses, you should be aware of the many factors that can influence the patient's pain. Systematic pain assessment, measurement, and reassessment enhance the ability to keep the patient comfortable. Pain scales that are age appropriate assist in the concise measurement and communication of pain among providers. Improvement of communication regarding pain assessment and reassessment during admission and discharge processes facilitate pain management, thus enhancing overall function and quality of life in a trickle-down fashion.

According to one performance and improvement outpatient project in 2017, areas for improvement in pain reassessment policies and procedures were identified in a clinic setting. The study concluded compliance rates for the 30-minute time requirement outlined in the clinic policy for pain reassessment were found to be low. Heavy patient load, staff memory rather than documentation, and a lack of standardized procedures in the electronic health record (EHR) design played a role in low compliance with the reassessment of pain. Barriers to pain assessment and reassessment are important benchmarks in quality improvement projects. Key performance indicators (KPIs) to improve pain management goals and overall patient satisfaction, balanced with the challenges of an opioid crisis and oversedation risks, all play a role in future research studies and quality of care projects. Recognition of indicators of pain and comprehensive knowledge in pain assessment will guide care and pain management protocols.

Indicators of Pain

Restlessness or pacing
Groaning or moaning
Gasping or grunting
Nausea or vomiting
Diaphoresis
Clenching of the teeth and facial expressions
Tachycardia or blood pressure changes
Panting or increased respiratory rate
Clutching or protecting a part of the body
Unable to speak or open eyes
Decreased interest in activities, social gatherings, or old routines

Psychosocial Assessment

The primary consideration is the health and emotional needs of the patient. Assessment of cognitive function, checking for hallucinations and delusions, evaluating concentration levels, and inquiring into interests and level of activity constitute a mental or emotional health assessment. Asking about how the client feels and their response to those feelings is part of a psychological assessment. Are they agitated, irritable, speaking in loud vocal tones, demanding, depressed, suicidal, unable to talk, have a flat affect, crying, overwhelmed, or are there any signs of substance abuse? The psychological examination may include perceptions, whether justifiable or not, on the part of the patient or client. Religion and cultural beliefs are critical areas to consider. Screening for delirium is essential because symptoms are often subtle and easily overlooked, or explained away as fatigue or depression.

Safety Assessment

Ambulatory aids
Environmental concerns, home safety
Domestic and family violence risk, human trafficking risks, elder or child abuse risk
Suicidal ideation (initiate suicide precautions as directed by institutional policy)

Therapeutic Communication Techniques Used to Take a Good History

Multiple strategies are employed that will include:

Active, attentive listening
Reflection, sharing observations
Share hope
Share humor
Therapeutic silence
Provide information
Clarification
Paraphrasing
Asking relevant questions
Summarizing
Self-disclosure
Confrontation

What are examples?

Active, attentive listening: Attention to the details of what the patient is saying either in a verbal or nonverbal manner
Reflection, share observations: Repeat the patient’s words to encourage discussion, state observations that will not make the patient angry or embarrassed; i.e., " You seem tired today, sad...," " You have hardly eaten anything this morning."
Empathy: Demonstrate that you understand and feel for the patient, recognition of their current situation and perceived feelings, and communicating in a nonjudgmental, unbiased way of acceptance
Share hope: Ensure in the patient a sense of power, hope in an often hopeless environment, and the possibility of a positive outcome
Share humor: Fosters a relationship of emotional support, establishes rapport, acts as a positive diversion technique, and promotes physical and mental well being. Cultural considerations play a role in humor
Touch: Touch may be a source of comfort or discomfort for a patient, wanted or unwanted; observe verbal and nonverbal cues with touch; holding a hand, conducting a physical assessment, performing a procedure
Therapeutic silence: Fosters an environment of patience, thought and reflection on difficult decisions, and allows time to observe any nonverbal signs of discomfort (the patient typically breaks the silence first)
Provide information: During an assessment and care, inform the patient as to what is about to happen, explain findings and the need for further testing or observation to promote trust and decrease anxiety
Clarification: Ask questions to clear up ambiguous statements, ask the client or patient to rephrase or restate confusing remarks so wrong assumptions are clarifiable and a missed opportunity for valuable information forgone
Focusing: Brings the focus of the conversation to an essential area of concern, eliminating vague or rambling dialogue, centers the assessment on the source of discomfort and pertinent details in the history
Paraphrasing: Invites patient participation and understanding in a conversation
Asking relevant questions: Questions are general at first then become more specific; asked in a logical, consecutive order; open-ended, close-ended, and focused questions may be useful during an assessment
Summarizing: Provides a review of assessment findings, offers clarification opportunities, informs the next step in the admission and hospitalization process
Self-disclosure: Promotes a trusting relationship, the feeling that the patient is not in this alone, or unique in their current circumstances; provides a framework for hope, support, and respect
Confrontation: You may have to confront the patient after a trustful rapport has been established, discussing any inconsistencies in the history, thought processes, or inappropriate behavior

Cultural Assessment

The cultural competency assessment will identify factors that may impede the implementation of nursing diagnosis and care. Information obtained should include:

Ethnic origin, languages spoken, and need for an interpreter
Primary language preferred for written and verbal instructions
Support system, decision makers
Living arrangements
Religious practices
Emotional responses
Special food requirements, dietary considerations
Cultural customs or taboos such as unwanted touching or eye contact

Physical Examination Techniques

Initial evaluation or the general survey may include:

Overall health status
Body habitus
Personal hygiene, grooming
Skin condition such as signs of breakdown or chronic wounds
Breath and body odor
Overall mood and psychological state
Initial vital sign measurements: temperature recorded in Celsius in most institutions, respiratory rate, pulse rate, blood pressure with appropriate sized cuff, pulse oximetry reading and note if on room air or oxygen; accurately measured weight in kilograms with the proper scale and height measurement, so body mass index (BMI) is calculable for dosing weights and nutritional guidelines

Secondary Assessment

Cardiovascular
Gastrointestinal
Musculoskeletal
Neurological
Genitourinary/Pelvic
Integumentary
Mental status and behavioral
Look at all areas of the skin, including those under clothing or gowns
Ensure patient is undressed, allowing for privacy, uncover one body part at a time if possible
Lighting should be bright
Be alert for any malodors from the body including the oral cavity; fecal odor, fruity-smell, odor of alcohol or tobacco on the breath
Compare one side to the other, and ask the patient about any asymmetrical areas
Observe for color, rashes, skin breakdown, tubes and drains, scars, bruising, burns
Grade any edema present
Document pertinent normal and abnormal findings
Consistency
Tenderness
Temperature and moisture (warm, moist or cool, and dry)
Tactile fremitus
Good hand and finger technique
Good striking and listening technique
Especially important in the pulmonary and gastrointestinal systems
Dull, flat, resonance, hyper-resonance, or tympany sounds
Percussion is an advanced technique requiring a specific skill set to perform. Therefore, it is a skill practiced by advanced practice nurses as opposed to a bedside nurse on a routine basis

Auscultation

Listening to body sounds such as bowel sounds, breath sounds, and heart sounds
Important in examination of the heart, blood pressure, and gastrointestinal system
Listen for bruits, murmurs, friction rubs, and irregularities in pulse

What are important things to remember about the physical exam?

Physical exam length can vary depending on complexity
Physical exam extends from passive observation to hands-on
Be systematic and thorough
Ensure privacy and comfort
Warm hands for patient comfort
Avoid long fingernails to prevent patient injury during the exam
Palpate areas that are tender or painful last
Be alert for any signs of maltreatment or abuse, and follow mandatory reporting guidelines
Abdominal assessment follows the techniques in this sequence: inspection, auscultation, percussion, and palpation
Auscultate bowel sounds for at least 15 seconds in each quadrant using the diaphragm of the stethoscope, starting with the lower right-hand quadrant and moving clockwise
If a fistula is present for hemodialysis, assess for a thrill or bruit, document presence or absence. Notify managing healthcare provider immediately if absent
Steps in a comprehensive lung exam include PIPPA; Positioning of the patient, Inspection, Palpation, Percussion, Auscultation

Diagnostic Studies

Driven by findings on the history and physical examination; options include:

Blood tests (CBC, chemistry, bedside glucose, pregnancy test, urinalysis, cardiac enzymes, coagulation studies)
Imaging studies (X-rays, CT, MRI, ultrasound)
Other diagnostic studies (ECG, EEG, lumbar puncture, etc.,)

Discharge Planning

Document mode of transport
Who is accompanying the patient?
Transfer forms/EMTALA considerations
Functional status
Financial considerations
Discharge medications and instructions
Follow up information, referrals, hotline numbers, shelter information
Barriers to learning
Document verbalization that discharge instructions were understood by caregiver or surrogate
Provide translators and language appropriate discharge instructions or paperwork
Clinical Significance

Often the initial history and physical examination lead to the identification of life- or limb-threatening conditions that can be stabilized promptly, ensuring better patient outcomes. The sooner the patient is correctly assessed, the more likely a life-altering condition is recognizable, nursing diagnosis formulated, appropriate intervention or treatment initiated, and stabilizing care rendered. Physiological abnormalities manifested by changes in vital signs and level of consciousness often provide early warning signs that patient condition is deteriorating; thus, requiring prompt intervention to forego an adverse outcome, decreasing morbidity and mortality risk. In the fast-paced, resource-challenged healthcare environment today, thorough assessment can pose a challenge for the healthcare provider but is essential to safe, quality care. The importance of a head-to-toe assessment, critical thinking skills guided by research, and therapeutic communication are the mainstays of safe practice. [13] [14] [15]

Assessment findings that include current vital signs, lab values, changes in condition such as decreased urine output, cardiac rhythm, pain level, and mental status, as well as pertinent medical history with recommendations for care, are communicated to the provider by the nurse. Communicating in a concise, efficient manner in rapidly changing situations and deteriorating patient conditions can promote quick solutions during difficult circumstances. Healthcare providers communicate and share in the decision-making process. The SBAR model facilitates this communication between members of the healthcare team and bridges the gap between a narrative, descriptive approach and one armed with exact details.

Communication using the SBAR Model

Recommendation

Assessment Tools

Activities of daily living scale
Cough assessment
Health questionnaires such as those that address recent travel and exposure risks
Waterlow or Braden scale for assessing pressure ulcer risk
Glasgow coma scale/AVPU for assessment of consciousness
Pain scales such as the Faces Pain Scale (FPS), Numeric Rating System (NRS), Visual Analogue Scales (VAS), Wong-Baker Faces Pain Rating Scale (WBS), and the (MPQ) McGill Pain Questionnaire
CAGE assessment/CIWA scoring
Morse Fall Risk
Standard vital sign flow charts for different age groups
NIH Stroke Scale (NIHSS)
Dysphagia Screen
4AT Assessment for Delirium
The nurse should be familiar with the otoscope, penlight, stethoscope (bell and diaphragm), thermometer, bladder scanner, speculum, eye charts, cardiac and blood pressure monitors, fetal doppler and extremity doppler, and sphygmomanometer
Stretcher or bed for proper positioning during a physical exam
Hand hygiene products, personal protective equipment if required
Alcohol swabs, sanitizer, or soapy water to clean equipment after use, such as with stethoscopes, to decrease the likelihood of cross-contamination of pathogens from inanimate objects (follow any manufacturer guidelines or institutional policies)
Computer or paper chart to document findings
Calculation devices for BMI, conversion from pounds to kilograms, kilograms to pounds, Celsius to Farenheight
Review Questions
Access free multiple choice questions on this topic.
Comment on this article.

Disclosure: Tammy Toney-Butler declares no relevant financial relationships with ineligible companies.

Disclosure: Wendy Unison-Pace declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

Cite this Page Toney-Butler TJ, Unison-Pace WJ. Nursing Admission Assessment and Examination. [Updated 2023 Aug 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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Assessing the patient's needs and planning effective care

Benjamin Ajibade

Senior Lecturer, Mental Health Nursing, Northumbria University

View articles · Email Benjamin

Nurses have an essential role to play in the assessment and planning of patient care. This is emphasised in the Nursing and Midwifery Council's 2018Future Nurse proficiency standards. In this article, the author discusses the importance of person-centred care in assessing needs and highlights the need for all nursing interventions to be evidence based. The topics covered include assessing people's needs, care planning, stages of care planning, benefits of care planning, models of care, care pathways, and care clustering in mental health care. The article also highlights the significance of record-keeping.

The central role of nurses in assessing patient needs and planning care is one of the core areas emphasised in Future Nurse, the Nursing and Midwifery Council's (NMC) (2018a) nursing proficiency standards. The document categorises ‘assessing needs and planning care’ as the third of seven areas of proficiency, which are grouped into ‘platforms’. Future Nurse emphasises that the delivery of person-centred care and evidence-based nursing interventions are vital components for effective patient assessment and care planning. The standards further highlight that the nurse should understand the need to assess each patient's capacity to make their own decisions and to allow them the opportunity to give and withdraw consent.

An assessment is a form of a dialogue between client and practitioner, in which they discuss the needs of the former to promote their wellbeing and what they expect to happen in their daily life ( National Institute for Health and Care Excellence (NICE), 2021 ). Nursing assessment involves collecting data from the patient and analysing the information to identify the patient's needs, which are sometimes described as problems.

The process of planning care employs different strategies to resolve the needs identified as part of an assessment. Ideally, this will include the selection of appropriate evidence-based nursing interventions. When planning care, the patient's needs and wishes should be prioritised, and the individual must be involved in the decision-making process to ensure a person-centred approach. The planned care must take into account the patient's conditions, personal attributes and choices. It is worth noting that the principles of care planning are transferable between hospital, home and care home settings.

Section 2 of the NMC Code highlights the importance of partnership working with patients to ensure the delivery of effective high-quality care and of involving them in their care, which includes empowering patients by enabling them to make their own decisions ( NMC, 2018b ). The patient should be viewed holistically, with importance placed on the physical, psychological, social and spiritual aspects of the person's life, which are inextricable.

The intrinsic factors of a patient's condition will often affect their concordance with the advice and treatment offered. Consequently, it is important to understand the reasons for non-concordance and to tailor treatments/recommendations to each individual, which will improve the quality of care delivered.

Brooker (2007) developed the acronym VIPS to address some of the confusion surrounding what should or should not be perceived as person-centred care. VIPS stresses the following:

V is a value base that affirms the value of each human being, irrespective of age and cognitive ability. This is the foundation for individualised care
I is individualised care that considers the individual's distinctiveness and holistic needs
P is about seeing the world from the patient's perspective, to ensure that the health professional takes the patient's point of view into account when providing care
S is about maintaining a social environment that supports the patient's psychological needs, including their mental, emotional and spiritual needs.

Health professionals should endeavour to involve the patient in decision-making and enable them to make choices as much as possible, using a range of approaches to achieve this ( Lloyd, 2010 ). Unless proven otherwise, a nurse must assume that a patient has the capacity to make their own decisions, in line with the Mental Capacity Act 2005.

The following draws on the author's experience in mental health nursing but can be applied to other areas of nursing care.

Care planning

Planning care is essential in the delivery of appropriate nursing care. Following assessment of a patient's needs, the next stage is to ‘plan care’ to address the actual and potential problems that have been identified. This helps to prioritise the client's needs and assists in setting person-centred goals. Planned care will change as a patient's needs change and as the nurse and/or other health professionals identify new needs. Care planning assists professionals to communicate information about the patient's care to others ( Department of Health (DH), 2013a ; NICE, 2021 ), to facilitate continuity of care. Communication may be predominantly verbal, but it will also always involve documentation in a variety of formats, including computer-based, handwritten or preprinted care plans.

It is essential for nurses to consider their consultation style when developing a care plan in order to reduce the risk of paternalism when communicating with the patient and discussing their needs. Collaborative consultation encourages patients to participate in their care and improves rapport, while a paternalistic approach will generally minimise an individual's part in, and responsibility for, their own care needs and may compromise care outcomes and concordance ( Leach, 2010 ). A collaborative/partnership consultation style facilitates a person-centred approach by the practitioners and involves the patient in their care. Such an approach can include asking questions such as: ‘We have different types of treatment approaches that could be considered, what are your preferences?’ This is in contrast to a paternalistic consultation style with the health professional announcing any decisions with a statement such as: ‘I am going to prescribe a certain treatment for you.’

When drawing up a care plan with a patient the nurse should take into account a number of considerations ( Box 1 ).

Box 1.Nursing considerations

The patient should know the reason for the assessment
The assessment should be flexible and adaptable to the needs of the individual
The patient must be fully involved and their dignity, independence, and interests should be paramount
The patient can have someone with them, if preferred
Appropriate language and terminologies should be used throughout the consultation
The diversity of the individual client, their beliefs, values, culture and their circumstances must be considered
It is essential to consider the patient's gender, sexuality, ethnicity, disability and religion as part of the assessment
Be open to listening to the patient's personal history and life story
The entire family's needs should be considered, inclusive of the patient and their carers: remember the importance of providing holistic care
Cost-effectiveness should also be taken into account

Sources: Department of Health, 2011; National Institute for Health and Care Excellence, 2021

Stages of care planning

Care planning has been described as the third stage of the nursing process ( NMC, 2018a ; Toney-Butler and Thayer, 2021 ). It includes assessing the patient's needs, identifying the problem(s), setting goals, developing evidence-based interventions and evaluating outcomes ( Matthews, 2010 ). This will require the health professional to apply high-level critical thinking, decision-making and problem-solving skills. It is important to note that a care plan can be prescriptive: it is devised after a patient has been assessed through the prescription of nursing actions ( Hogston and Simpson, 2002 ) or through collaborative working involving the multidisciplinary team.

In some situations there will be differences between what the nurse sees as a priority in terms of the patient's needs and what the patient wants. An example of this would be a patient with mental health problems who may be at high risk of self-harm, who may need to be put on intermittent 15-minute observation. In such cases, a patient would be deemed as not having capacity to make decisions and the nurse will need to use their clinical judgement to prescribe the best treatment option. The care plan can still be agreed in conjunction with the patient once the nurse has explained the reasons for the interventions and acknowledged in the care plan that this is not the patient's preferred choice.

In situations where the patient has capacity to make decisions, the care plan should be agreed in collaboration with the service user ( NHS England, 2016a ).

Identifying needs

As part of the care planning process, the nurse will identify a patient's needs/problems and propose a set of interventions to address them in order of priority, ensuring that everything is in agreement with the patient. To ensure that appropriate goals are set, a patient's needs will be classified as high, intermediate and low.

Each goal provides an indication as to the expected outcome, along with the proposed interventions required to meet the patient's problems/needs, all of which must be patient centred. It is important, in collaboration with the patient, to set both short-term, achievable goals and longer-term goals that may take days, weeks or months to accomplish. One way nurses can ensure this is to apply the SMART goal-setting approach to ensure that the goals are ( Revello and Fields, 2015 ; NurseChoice, 2018 ):

M easurable
A chievable
T imely (within a defined time frame).

Interventions

Interventions are nursing actions/procedures or treatments built on clinical judgement and knowledge, performed to meet the needs of patients. The actions should be evidence based and indicate who will carry them out, when and how often ( Hogston and Simpson, 2002 ). The scheduled interventions will have been agreed with the patient with the aim of improving their health condition, and each subsequent action should strive to meet the goals set at the previous stage. Brooks (2019) outlined three types of intervention:

Those independently initiated by nurses
Those that are dependent on a physician or other health professionals
Those that are interdependent, that is, those rely on the experience, skills and knowledge of multiple professionals.

Independent nursing interventions are planned and actioned by nurses autonomously ( NMC, 2018a ), and these actions do not require the nurse to have direction from another health professional. When actioning interventions dependent on other health professionals, the nurses must determine the appropriateness of any directions from other health professionals before carrying them out because the nurse remains accountable for the actions, for example, the administration of prescribed medication ( NMC, 2018a ). Due to developments in the nursing profession, some advanced nurse practitioners can now prescribe interventions, eg prescription of medication can be done by nurse independent prescribers or nurse supplementary prescribers ( Royal College of Nursing, 2014 ). Interdependent interventions are usually recorded in collaborative care plans reviewed in multidisciplinary (MDT) meetings and must be agreed by all parties involved. Both the goals and interventions must be communicated in a timely manner to all those involved in the patient's care.

This is the stage when a planned intervention is evaluated to assess whether or not it has been achieved. This can be an ongoing process, and the care plan should document the frequency and time frame for evaluating the intervention. If the initial goal becomes unachievable, the nurse will be required to reassess the patient's needs, and review and revise the interventions.

Benefits of care planning

The DH (2011) highlighted that the aim of care planning is to improve the quality of care and outcomes by respecting individual wishes and enabling patients to acknowledge the ownership of their condition and ensuring they have the ability to influence the outcomes. Health professionals should engage individuals in decision-making and facilitate them to take control of their health by agreeing common goals to improve outcomes. This will have additional benefits for both the patient and health services as it should reduce the number of GP appointments and emergency admissions the patient may require. Promoting self-management of long-term conditions can also help slow progression of illness.

Care planning empowers patients to care for themselves when they are self-managing their health and when they may have difficulty accessing a health professional. This became evident during the pandemic, with patients often having to go for extended periods between appointments with their health professionals. Care planning has really come into its own in community care in the past few years, which became evident during the pandemic—particularly in the field of mental health—because it leads to better patient concordance with treatment and other care needs without the need for constant input by health professionals. This benefits both health professionals and the NHS: it increases job satisfaction, brings efficiency savings and improves the quality of patient care ( DH, 2011 ).

Model of care

Models of care are used to deliver best practice in health care. An integrated services care model is multifaceted and enables the co-ordination of care by different health and social care professionals to meet individual patient needs. It encompasses patient-centred care and enables care staff across different providers to reduce duplication, confusion, delay and gaps in services ( Monitor, 2015 ). In the modern NHS, this is the preferred model of care.

The care plan is an integral part of this model because it enables the creation of shared care plans that map different care processes. It becomes a point of reference for various providers involved in the care of the patients, ensuring the co-ordination of care across services ( Curry and Ham, 2010 ; World Health Organization, 2016 ).

Care pathways

Care pathways, which are also known as critical pathways, clinical pathways, integrated care pathways, care paths and care maps, are used to describe a specific patient journey that dictates the care to be provided or process to be followed for a patient's particular condition or needs. An evidence-based care process is established for specific conditions by considering expert opinion that takes into account the evidence to recommend interventions that have been shown to achieve better health outcomes cost-effectively ( Centre for Policy on Ageing, 2014 ).

Care pathways are often developed at local level and have been shown to be efficacious at meeting local needs. They are also known to improve cross-setting collaborations. Clinical pathways are aimed at providing effective health care appropriate for the patient group of conditions, thereby reducing hospital stays, leading to cost-effective health care ( Kozier et al, 2008 ).

Care clusters

Care clustering is a needs assessment tool that is used to rate a patient's care need against specific scales:

‘A cluster is a global description of a group of people with similar characteristics as identified from a holistic assessment and then rated using the Mental Health Clustering Tool (MHCT).’

NHS England, 2016b

This framework is used to plan and organise mental health services, including the care and support provided to individuals based on their illness and individual needs. One of the care clustering tools used in the NHS is the Health of the Nations Outcome Scales (HoNOS) ( Wing et al, 1998 ; Yeomans, 2014 ; NHS England, 2016b ).

Mental health services were brought under the scope of Payment by Results (PbR) in the NHS in 2012-2013.

‘Payment by Results (PbR) is the transparent rules-based payment system in England under which commissioners pay healthcare providers for each patient seen or treated, taking into account the complexity of the patient's healthcare needs.’

Consequently, as part of the care planning process, nurses need to take into account the cost-effectiveness of any interventions in order to consider how much funding is likely to be available for an initial completion of assessments, during scheduled reassessment and at any subsequent reassessment after a significant change in the patient's needs.

Box 2.Importance of complying with guidelines when undertaking assessment and planning care

You must be compliant with the Nursing and Midwifery Council (2018b ; 2021 ) guidelines for record and record-keeping
Adhere to the employing local organisation's policy on record-keeping, eg local trust policy
Follow the NHS trust Care Programme Approach (CPA) policy ( Department of Health, 2008 )
Collaborate with all those involved in a patient's care planning process

Importance of record-keeping

Accurate record-keeping is essential in the assessment of needs and planning care. This complies with the NMC (2018b) which states that record-keeping is fundamental to nursing practice, emphasising that records must be accurate and precise.

Health professionals should be aware of the need for legal accountability when documenting care in a written record because such records could be used in any legal proceedings ( Dimond, 2005 ). A record refers to not only a patient's record, but encompasses all records related to an individual nurse's range of practice. It is important to include the person being cared for in the record-keeping process, who should be asked to sign the plan of care, if they have capacity to do so ( NMC, 2021 ).

It is good practice to make an entry in the care documentation if a service user is unable to sign or agree to their planned care and state the reason for this ( Butterworth, 2012 ). In addition to paper-based records, care plans can be entered into the electronic health/patient record system used in the practitioner's service ( NHS website, 2019 ).

Best practice in writing care plans

There are some critical factors to consider when writing a focused person-centred care plan. One of these is to clearly document in detail the needs of the patient and to use the patient's language whenever possible, for example: ‘Mr D likes to dress smart every morning, but has been finding it difficult to make the choice of clothing to wear.’ An example of a poor way to record the same issue might be: ‘Mr D is unable to dress by himself’ and the aim is ‘Mr D will appear to dress smartly’.

The documented goal/aim of the care plan should be determined by applying the SMART acronym. It is therefore vital to ensure that the aim is specific by focusing on issues that can be measured, with goals that are achievable and realistic. It is also important to suggest and record a time frame within which a patient's short-term and long-term goals could be achieved. In relations to Mr D's clothing, a daily time frame might be appropriate. To come to an agreement over this issue, Mr D might be asked: ‘Mr D, would you like to be able to make your own choice of clothes to wear every day with the support of staff?’ The projected daily goal would then be recorded as part of the care plan documentation.

An intervention must specify how a goal/aim will be achieved, including who will be responsible for implementing each task. This could be the staff nurse on duty, team nurse, team leader, the nurse in charge and/or the patient (please put the patient's name). Evaluation should be carried out regularly and documented, and should conform with the proposed time frame outlined as part of the suggested intervention. Evaluations should be undertaken whenever actions are performed in accordance with each proposed intervention, and details of the progress of the patient's problem/needs documented.

In conclusion, the article has discussed the importance of assessing patients' needs, emphasising person-centred care using the VIPS acronym devised by Brooker (2007) . It has stressed the notion for all nursing interventions to be evidence based. The stages of care planning were discussed, and the application of the SMART goal-setting approach was highlighted. Record-keeping is an integral part of care planning in the communication of patient's care and progress. The benefits of care planning in improving quality of care and outcomes, respecting individual wishes, thereby empowering the patient was recognised.

LEARNING OUTCOMES

Nurses must ensure that assessment of patient needs and care planning are always focused on the person
All nursing interventions must be evidence based
The goals set out in a patient's care plan must be achievable and measurable, and should include time frames within which both short- and long-term goals can be achieved
Record-keeping is a vital component of care planning and is part of communicating aspects of a patient's care, and their progress towards their goals, with other health professionals involved in their care

CPD reflective questions

In the context of a patient's health, what should you aim to do when care planning?
Who should you involve in the care planning and why? Should the patient have a copy of the care plan?
Is it acceptable to destroy care plans or other records?
When should care plans be reviewed?

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Essay: Nursing care assessment

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This assignment will discuss and analyse the nursing care given to an 85 year old female patient, during a four week hospital practice placement. In order to fully comply with the Nursing and Midwifery Council (NMC) Code of Conduct (2008), full consent has been verbally granted by the patient to utilise personal clinical information for the purpose of this case study. To ensure patient anonymity, throughout this assignment the patient will be referred to as Rose (Swift). Chapelhow et al (2005) states, in order for a novice to become an expert practitioner there are several enablers which are fundamental to the nursing care that Rose received. These are: communication, assessment, managing risk, documentation, decision making and managing uncertainty. For the purpose of this assignment, the enablers of assessment and communication in relation to the care that Rose received will be discussed. Background Rose Swift is a retired teacher, a widower and is a mother of two sons. Rose was admitted to the accident and emergency department (A&E) via ambulance following an unexplained fall at home. Upon admission to A&E, Roses’ medical notes stated Rose had recently been diagnosed with Dry Macular degeneration, which is an age related chronic eye disease, causing loss of vision in the centre field (Samuel, 2008, Watkinson, 2010). After a short stay in a general medical ward for treatment of a urinary tract infection, Rose was transferred to an intermediate care ward for further rehabilitation, before being discharged home with a care package. Prior to admisson Rose lived alone, was independantly mobile with a stick and would cook her own meals. Assessment The Royal Marsden (2011), regards initial nursing assessments as a step to providing an individualised patient centered nursing care plan. By conducting nursing assessments, key information is obtained to aid the improvement of Roses’ health and develop a plan of care, which will ultimatly enable Rose to establish control of her own health (The Royal College of Nursing (RCN), 2004). However, as cited by Chapelhowe et al (2005) nursing assessments are far from static. As part of the nursing assessment process, a set of individualised outcomes are agreed, in collaboration with the nurse, Rose and the multidisiplinary team. These outcomes are continously evaulated by the nurse, in order to moniter Roses’ progress and where nessescary clincal judgement will be used to adjust these outcomes to suit the needs of Rose (Estes & Ellen, 2013). For a successful assessment to take place, it is argued a sufficient baseline knowledge is required by the nurse (Peate, 2012). In contrast however Chapelhowe, et al (2005) argue that base line knowledge alone is not enough. Irrespective of how knowledgeable a nurse maybe, without effective communication and interpersonal skills, the care the nurse provides to Rose will be limited as Roses’ individual needs may not be met. It is therefore considered that a combination of the two is thus required (NMC, 2010). Throughout Roses’ hospital journey, there are several assessments that took place. During Roses’ initial admission to A&E, the nurse conducted a systematic `mini’ assessment to obtain a rapid outline of Rose from both a visual and physical point of view (The Royal Marsden NHS Foundation Trust, 2011). As the resusitation council (2005) points out, inital nursing assessments in acute settings enable preservation of life, by providing fast intervention where required, using the Airways, Breathing and Circulation (ABC) algorithm. By asking Rose questions and obtaining qualitive information, the nurse established that Rose was breathing, had a clear airway and brain perfusion as well as establishing vital background information to aid diagnosis (Fawcett & Rhynas, 2012). In addition, the nurse was also able to quickly access Roses neurologial state using the Modifed Glasgow Coma Scale (MGCS) (Jennett & Teasdale, 1977). When a patient such a Rose sustains a head injury, the National insititute of Health and Care Excellence (NICE) (National Insitiute for Health and Care Excellence, 2014) recommends the use of MGCS. According to Pillay (2013), MGCS provides a tangible way of noting the concious state of Rose, it is a widely recognised and accepted standarised practical assessment tool, designed for ease of use (Jennett & Teasdale, 1977) which has been used for many years at both a national and international level. When used repeatedly, MGCS can indicate the progression of a brain injury (Teasdale, et al., 2014), this in turn can aid decision making (Nursing Times, 2014). Recently however, there has been some criticism against MGCS regarding the tools ease of use (Mattar, et al., 2013). McLernon (2014) questions if the MGCS tool is still fit for purpose, citing reduced reliability due to lack of clinical consistency and poor communication between professionals. It is therefore suggested that a remedy of a uniformed approach and concise communication between professionals is essential, to ensure safe theraputic practice. Whilst conducting Roses’ MGCS assessment the nurse noted a reduced score on account of Rose presenting symptoms of delirium. Farne, et al., (2010) states new confusion in patients can often be caused by underlying medical conditions. By utalising this knowledge, this enabled the nurse to apply her professional decision making skills, in order to continue with further assesssments which included a set of observations. Observations (also known as vital signs) enables the nurse to check Roses’ basic bodily functions such as temperature, pulse, respiration rate and blood pressure (The Royal Marsden NHS Foundation Trust, 2011). A fundamental part of the asessment process, observations allow the nurse to obtain a baseline figure in order to carry out a continous assessment and evaluation, and enable the nurse to establish the level of care that Rose requires (Wheatly, 2006). To identify the risk of Rose deteriorating further, as per Nursing and Midwifery Council (2008) guidelines, each quantitive result was charted correctly, concisely and legiblibly by the nurse and given a score using a modified early warning score (MEWS) (Department of Health, 2000). After combining all results, the nurse was then able to establish that Rose was scoring a MEWS for a raised temperature and increased pulse in addition to a reduced MGCS. By drawing on previous experience and knowledge, the nurse was able to evaluate the overall asssessment, to establish that the presenting symptoms could indicate Rose has some form of an infection. This could be the reason for the fall and delerium (Schroeder, 2010). To rule out a urinary tract infection, a urine dip stick test on a midstream urine sample was conducted. This test showed positive for leukocytes and nitrates, indicating a positive infection result (Little, et al., 2009). In order to treat Roses’ symptoms the doctor prescribed antibiotics, providing treatment under the biomedical model. Considered a dualistic approach, this model treats the mind and body as separate entities. Fast acting in its approach it treats the immediate problem (Mehta, 2011). However, in order to provide truly effective care the biomedical model alone is simply not enough. It is considered by many professionals that a holistic viewpoint should be taken (The Royal Marsden NHS Foundation Trust, 2011). Id est, in addition to Roses’ physical requirements, consideration should also be given to her emotional and social needs (Chapelhowe, et al., 2005). The psychosocial model should therefore also be considered, in order to treat Rose from a holistic perspective (Chapelhowe, et al., 2005). Given Roses’ confused state of mind, unsteady gait and MEWS score it was decided to admit Rose to a general medical ward. In order to assess Roses’ psychosocial and cultural needs, the Activities of Daily Living (ADL’s) model (Roper, et al., 2000) was used. ADL’s is a systematic framework, which recognises Roses individuality and beliefs. It considers twelve fundamental concepts and provides a continuum in recognition that dependency can change throughout time (Roper, et al., 2000). Kearney (2001) argues however, that the care Rose receives maybe jeopardised using this model, due to its inflexibility and complex structure. To alleviate this, The Royal Marsden (2011) therefore advises that the nurse should use a pragmatic approach, and use the ADL framework as a guideline for professional decision making. In Roses’ case the nurse was able to utilise the ADL framework to identify a change in care needs. Due to Roses confused state and unsteady gait, assistance would now be required with washing, dressing, mobilising and other essential care needs as defined by the Department of Health (2010) in the Essence of Care guidelines. Communication Effective communication is an essential skill which enables the expert nurse to build a therapeutic relationship with Rose (Chapelhowe, et al., 2005). According to Dwamena, et al., (2012), communication is considered to be a significant factor in the rapid recovery of Rose. Throughout Roses hospital journey there are many ways in which the nurse interacts with Rose. However, as cited by The Royal Marsden (2011), interpersonal communication skills are the most widely used medium in nursing and arguably the most important skill. In order for interpersonal skills to be effective Arnold & Underman Boggs (2011), states the nurse must consider several elements such as, verbal and non-verbal exchanges of information, active listening and observation skills. As the initial assessment process is often the first interaction Rose may have with the ward staff, Rose maybe reluctant to share information (Perry Black, 2013). The Royal Marsden (2011), recognises this could be a potential barrier for the nurse to deliver effective care to Rose and key communication factors such as environmental and nurse time restraints maybe contributory to Roses’ unwillingness to share information. To aid the nurse in overcoming this issue, (Cotoi & Ilkiescu, 2013) suggests a trusting environment should be created. Trusting environments enable Rose to feel safe and supported and provide a platform where Rose will feel comfortable and confident in sharing information with the multi-disciplinary team (The Royal Marsden NHS Foundation Trust, 2011). In order to assimilate meaningful information from Rose, the nurse utilised her communication skills effectively in a number of different ways. An example of this would be, during the initial assessment process. When Rose was admitted to the ward, in line with NMC (2010) Code of Conduct to ensure privacy and dignity is maintained, the assessment took place in a cubicle, with the door closed thus creating a quiet environment. The Royal Marsden (2011) states a quiet environment during assessments is essential to enable Rose to maintain optimum concentration and remain complicit in her responses. Past research has shown discrepancies can often occur between the nurses understanding and that of Rose during assessments (Lauri, et al., 1997). A quiet environment therefore enables the nurse to focus solely on Roses responses, to maintain a meaningful interaction and deliver effective individualised therapeutic care (The Royal Marsden NHS Foundation Trust, 2011). To ensure effective non verbal communication takes place, body language should also be considered. White, et al., (2011) states body language can be a powerful means of sending a message to Rose, therefore a postive open posture should always be maintained. Throughout Roses hospital journey it was noted the nurse positivly adapted her body language to suit the needs of Rose. An example of this would be when conducting assessments the nurse sat facing Rose, kept an open posture and maintained regular eye contact. These interations are considered by Egan (2002), to be fundamental elements of non verbal exchanges, in order to achieve optimum levels of communication. As specified by the nursing and midwifery Code of Conduct (2008) optimum communication is an essential nursing skill. To be proficient, the nurse should respect Roses right to be involved in the decisions of her care (NMC, 2010). During discharge planning the nurse demonstated the proficient use of communication, when a conflict occurred between Rose and her family. Acting as an advocate, the nurse conveyed the wishes of Rose to return to her home against her sons wishes. Xxx xxx states during discharge planning, conflict can often occur due to lack of communication. To remedy this, the nurse utalised her commuication skills by asking open ended questions to asscertain the reasons behind the familys anxieties. Questions that are open ended allow the answer given by the receiver to be expanded and explored xxxxx xxxx. However XXX XXX states questions alone are not enough. In order to gauge the true meaning of the answer, non verbal signals should also be observed xxx xxxx. In conclusion in order to provide effective nursing care to Rose the nurse must ensure that a thourgh assessment is conducted. This cannot be fully completed however, without effective communication skills, concise documentation and decision making. Each enabler is therefore interlinked to provide individualised holistic nursing care to Rose. As a nurse, good communication is vital to build a positive theraputic relationship with Rose and to enhance the relationship there are a number of factors the nurse should be aware of such as enviroment and non verbal communication prompts. Good interpersonal skills are therefore an essential nursing skill to aid the recovery of Rose.

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Completing a Health Assessment in Nursing

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What is a Comprehensive Health Assessment?
Beginning an Assessment

Conducting the Physical Exam

Are you ready to earn your online nursing degree.

It’s a common occurrence in any health facility: nurses walk into a room and make a head-to-toe assessment of the patient. This is a critical part of creating a healthcare plan, but what does a nursing health assessment actually entail?

Keep reading to learn more about health assessments in nursing and why they matter.

What is a Comprehensive Health Assessment in Nursing?

Nurses conduct health assessments in clinics, physician offices, hospitals, and emergency rooms. How a nurse performs an assessment depends on the case, namely the person’s age and condition.

All nursing health assessments include paperwork and physical exams. Nurses systematically work on the patient from head to toe, beginning with the least invasive procedure.

Health assessments in nursing begin the moment a nurse walks into the room. Nurses note nonsocial cues. They use their sight and smell to look for symptoms. From there, nurses take a patient’s vital signs — temperature, heart rate, and blood pressure.

Advanced practical nurses (APRNs) may conduct an annual physical exam, while registered nurses (RNs) complete problem-focused exams for patients admitted into hospitals or urgent care departments.

Nursing health assessments help health professionals diagnose diseases and illnesses. Assessments also inform preventative care plans. Through nursing health assessments, nurses can provide guidance and gain patient trust.

Beginning a Nursing Health Assessment

Nursing programs teach students how to conduct nursing health assessments, but nurses often fine tune their skills on the job. Each nurse develops their own style to build patient relationships.

1 Build Patient Rapport

Patients often face social, emotional, and/or cultural barriers in accessing healthcare. Nurses have the power to calm patients — especially from historically excluded communities — who feel anxious or worried about their health.

A nurse’s mannerisms and the questions a nurse asks can build trust. For instance, when nurses start an assessment, they can develop a relationship through an introduction and by explaining what they are about to do. At this point, nurses can also assess a patient’s preference for the physical exam and make an effort to address any fears.

2 Family and Past Health History

On an initial patient visit, nurses ask about family and past medical histories. This information can help shape nursing care plans. During this process, nurses learn of any chronic illnesses, past surgeries, medications taken, sexual activity, and social habits such as smoking or drug use.

During this process, nurses can put patients at ease and build rapport by showing empathy and allowing patients to answer in their own time.

3 General Status and Vital Signs

After a nurse records a patient’s health history, they move to the physical exam. The first part of the physical exam entails the general status check-up. Nurses take vital signs, checking a patient’s heart rate, blood pressure, temperature, and respiratory rate.

Nurses can assess a patient at first sight by taking into account the patient’s posture, emotional state, speech, and hygiene. After nurses take a patient’s vital signs, the physical exam begins. Nurses examine the patient methodically from head to toe, beginning with the head, ears, eyes, nose, and throat (HEENT).

Palpating the head and scalp to check the shape, size, and symmetry can provide information about underlying issues or trauma such as concussions. Nurses also examine facial expressions for drooping or asymmetry, which can help in the diagnosis of a stroke or other conditions that cause facial paralysis. The head assessment also includes:

Moving hair in sections to look for injuries
Observing the scalp to look for lice, dandruff, or lesions
Inspecting the head for masses or tenderness
Checking that facial movements are symmetrical by asking patients to move their eyebrows or smile

Inspecting the ears using an otoscope can provide insight on hearing loss, vertigo, or tinnitus. Nurses can also identify any cancers or lesions on the outer ear. Ear assessments may also involve:

Using an otoscope to look for discharge or skin discoloration
Hitting a tuning fork to test for hearing loss
Investigating cerumen (earwax) impaction as a cause of hearing loss
Asking patients about any medications they take
Checking the inner ear for perforations or swelling in the membrane

Testing the eyes can provide information about a patients’ brain function. A pupil examination can offer signs about head injury. Nurse uses an ophthalmoscope to inspect the external eye functionality. They also:

Visually inspect the eyes for excessive discharge, redness, or growths
Record eyesight aids patient uses, including contacts or eyeglasses
Check the pupils for PERRLA — Pupils: Equal, Round, Reactive to Light, and Accommodation (transitioning focus between close and far objects)

A nose assessment begins by inspecting the exterior for discoloration, symmetry, swelling, malformations, or lesions. For instance, a nurse may note if they find a lesion or dark spot. Using a penlight or the light from an otoscope, nurses examine the nasal cavities for discoloration, discharge, and symmetry. They may continue assessing the nose by:

Using their thumb to palpate one sinus at a time to identify pain or tenderness
Closing one nostril at a time to check for normal airflow
Checking to make sure that the nose is the same color as the patient’s face

A throat inspection can lead to early detection of oral cancer and potentially save someone’s life. Assessments can also help nurses detect strep throat or dysphagia.

Nurses inspect the throat for abnormalities. Throat examinations involve checking the teeth and gums, tongue, uvula, and tonsils, inner lining of the lips and cheeks, and the soft and hard palates. Nurses also:

Use a tongue depressor to inspect the cheeks for abnormalities such as lesions
Examine the top and underside of the tongue for discoloration
Visually inspect the lips for lesions
Check the coloration of the lips and gums
Note fouls smells or a fruity scent that could be a sign of ketoacidosis

Nurses inspect the neck to check for jugular venous distention, range of motion, and to see if patients can easily shrug with resistance. A neck examination begins with nurses looking at the location of the trachea to make sure it’s center, and then includes:

Palpating the sides of the neck to check for swollen lymph nodes
Checking the neck for tenderness and lumps
Inspecting thyroid size and shape
Examining the back of the neck for signs of spinal column injuries
Looking at the neck for lesions and lumps

Respiratory

Nurses need to know the basics of the respiratory system to recognize signs of respiratory deterioration. Checking the lungs for tenderness and masses, and listening to the lung sounds can provide clues about underlying health issues. Respiratory assessments also include:

Making visual assessments of a patient’s respiratory rate
Asking patients if they experience shortness of breath or have a cough
Placing their hand to the patient’s back to evaluate symmetrical chest rise.
Using the stethoscope to listen for full inspiration and expiration
Inspecting the size, shape, and symmetry of the chest

It takes a stethoscope and keen observation skills to perform a cardiac assessment, which provides crucial data about cardiovascular system function. Nurses use palpation and visual cues to look for the quality of cardiac blood flow. The exam often includes:

Using a stethoscope to auscultate the five points of the heart: Erb’s point and the aortic, pulmonic, tricuspid, and mitral valves
Palpating the chest wall, looking for vibratory sensations
Listening for normal heart rates and rhythms

From a supine position, nurses can begin an abdomen examination. This includes auscultation, percussion, and palpation. Nurses may perform abdomen assessments on patients with percutaneous endoscopic gastrostomy feeding tubes or with ostomy pouches. Otherwise routine abdomen assessments include:

Asking questions about any pain in bowel and urination movements
Inspecting the abdomen to look at contours and pulsations
Looking for masses or wounds
Using the stethoscope to listen to bowel sounds at all four quadrants
Listening to vascular sounds using the stethoscope’s bell

Pulse assessments tell nurses about a patient’s health status. Nurses look for pulses in different areas of the body — the neck, arms, legs, and feet — depending on the case. During CPR, nurses may check the carotid artery for a pulse to determine if the brain and head are receiving blood flow. Where a nurse looks for a pulse also depends on the patient’s age. Nurses can:

Check the temporal artery for a pulse
Find the apical pulse point
Assess the blood pressure by checking the brachial artery
Palpate the radial, femoral, posterior tibial, and dorsalis pedi pulse points

Extremities

An essential part of the head-to-toe includes examining the extremities: the arms, hands, legs, and feet. Nurses look for lesions, redness, swelling, injuries, and — in the case of hospitalized patients — they may check the entrypoint of an intravenous line.

A proper assessment can help doctors diagnose gout, diabetes, or deep vein thrombosis. Nurses during an assessment may:

Palpate the radial artery and joints — the elbows, wrists, and hands — to check skin temperature
Ask the patient to move and flex their arms and legs against resistance
Check the color of the legs and toes
Test extremities for a range of motion
Inspect the strength and musculature of extremities

Neurological

An examination of coordination, balance, and sensory response can provide information about neurological trauma and prevent long-term damage. In the emergency room and hospital neuro units, patients receive neurological assessments. Nurses also perform neuro exams in other departments. The exams include:

Using the Romberg test to assess balance
Checking the gait, including posture
Examining olfactory and optic nerves
Checking a patient’s level of consciousness by using the Glasgow Coma Scale
Assessing orientation and memory by asking a patient routine questions

Frequently Asked Questions About Health Assessments

What is a complete health assessment.

A complete nursing health assessment requires a health professional to examine a patient in a systematic fashion, from head to toe. Nurses rely on self-reported symptoms, visual observation, reported health histories, and a physical medical examination to make a health assessment. This data then informs the nursing care plan.

When are health assessments performed in nursing?

A nursing health assessment helps nurses and other health professionals in a variety of settings to understand a patient’s mental and physical health. In the emergency room, a patient may receive a neurological assessment to test their level of consciousness.

Patients also receive health assessments during their annual physical checkups. At outpatient clinics or long-term care facilities, nurses use health assessments to identify trauma or injury, or to treat disease and illnesses.

Why are nursing health assessments important?

A proper nursing health assessment can lead to early intervention, which saves lives. Nurses also use health assessments to start conversations about social or cultural barriers that patients face in assessing healthcare.

A verbal and physical nursing health assessment helps nurses to gather information about a person’s symptoms, pain, and mobility level. A problem-focused assessment can also direct analysis to specific areas: cardiac, extremities, respiratory, or throat.

What are the four techniques used in physical nursing assessments?

Nurses have a set of skills and tools that they rely on to conduct a nursing health assessment. Health assessments include observation and inspection, palpation, percussion, and auscultation. Nurses perform these techniques sequentially, except during abdominal assessments.

Nursing Diagnosis Guide

How do I use the nursing process and nursing diagnosis in my practice? In this guide, you will learn what is a nursing diagnosis, how to write and use a nursing diagnosis, and the difference between a nursing and medical diagnosis.

The Value of Critical Thinking in Nursing

Some experts describe a person’s ability to question belief systems, test previously held assumptions, and recognize ambiguity as evidence of critical thinking. Others identify specific skills that demonstrate critical thinking, such as the ability to identify problems and biases, infer and draw conclusions, and determine the relevance of information to a situation. Nicholas McGowan, BSN, …

Cultural Competence in Nursing

Cultural competency is a vital skill for delivering quality nursing care across culturally diverse groups. Our guide offers tips from nursing professionals on incorporating it into nursing culture and practice.

Whether you’re looking to get your pre-licensure degree or taking the next step in your career, the education you need could be more affordable than you think. Find the right nursing program for you.

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How to Write a Nursing Essay with a Quick Guide

Ever felt the blank-page panic when assigned a nursing essay? Wondering where to start or if your words will measure up to the weight of your experiences? Fear not, because today, we're here to guide you through this process.

Imagine you're at your favorite coffee spot, armed with a cup of motivation (and maybe a sneaky treat). Got it? Great! Now, let's spill the secrets on how to spin your nursing tales into words that not only get you that A+ but also tug at the heartstrings of anyone reading. We've got your back with nursing essay examples that'll be your inspiration, an outline to keep you on the right path, and more!

What Is a Nursing Essay

Let's start by dissecting the concept. A nursing essay serves as a focused exploration of a specific aspect of nursing, providing an opportunity for students to demonstrate their theoretical knowledge and its practical application in patient care settings.

Picture it as a journey through the challenges and victories of a budding nurse. These essays go beyond the classroom, tackling everything from tricky ethical dilemmas to the impact of healthcare policies on the front lines. It's not just about grades; it's about proving, 'I'm ready for the real deal.'

So, when you read or write a nursing essay, it's not just words on paper. It's like looking into the world of someone who's about to start their nursing career – someone who's really thought about the ins and outs of being a nurse. And before you kick off your nursing career, don't shy away from asking - write my essay for me - we're ready to land a professional helping hand.

How to Start a Nursing Essay

When you start writing a nursing essay, it is like gearing up for a crucial mission. Here's your quick guide from our nursing essay writing service :

Choosing Your Topic: Select a topic that sparks your interest and relates to real-world nursing challenges. Consider areas like patient care, ethical dilemmas, or the impact of technology on healthcare.

Outline Your Route : Plan your essay's journey. Create a roadmap with key points you want to cover. This keeps you on track and your essay on point.

Craft a Strong Thesis: Assuming you already know how to write a hook , kick off your writing with a surprising fact, a thought-provoking quote, or a brief anecdote. Then, state your main argument or perspective in one sentence. This thesis will serve as the compass for your essay, guiding both you and your reader through the rest of your writing.

How to Structure a Nursing Essay

Every great essay is like a well-orchestrated performance – it needs a script, a narrative that flows seamlessly, capturing the audience's attention from start to finish. In our case, this script takes the form of a well-organized structure. Let's delve into the elements that teach you how to write a nursing essay, from a mere collection of words to a compelling journey of insights.

Nursing Essay Introduction

Begin your nursing essay with a spark. Knowing how to write essay introduction effectively means sharing a real-life scenario or a striking fact related to your topic. For instance, if exploring patient care, narrate a personal experience that made a lasting impression. Then, crisply state your thesis – a clear roadmap indicating the direction your essay will take. Think of it as a teaser that leaves the reader eager to explore the insights you're about to unfold.

In the main body, dive into the heart of your essay. Each paragraph should explore a specific aspect of your topic. Back your thoughts with examples – maybe a scenario from your clinical experience, a relevant case study, or findings from credible sources. Imagine it as a puzzle coming together; each paragraph adds a piece, forming a complete picture. Keep it focused and let each idea flow naturally into the next.

Nursing Essay Conclusion

As writing a nursing essay nears the end, resist the urge to introduce new elements. Summarize your main points concisely. Remind the reader of the real-world significance of your thesis – why it matters in the broader context of nursing. Conclude with a thought-provoking statement or a call to reflection, leaving your reader with a lasting impression. It's like the final scene of a movie that leaves you thinking long after the credits roll.

Nursing Essay Outline

Before diving into the essay, craft a roadmap – your outline. This isn't a rigid skeleton but a flexible guide that ensures your ideas flow logically. Consider the following template from our research paper writing service :

Introduction

Opening Hook: Share a brief, impactful patient care scenario.
Relevance Statement: Explain why the chosen topic is crucial in nursing.
Thesis: Clearly state the main argument or perspective.

Patient-Centered Care:

Definition: Clarify what patient-centered care means in nursing.
Personal Experience: Share a relevant encounter from clinical practice.
Evidence: Integrate findings from reputable nursing literature.

Ethical Dilemmas in Nursing Practice

Scenario Presentation: Describe a specific ethical challenge faced by nurses.
Decision-Making Process: Outline steps taken to address the dilemma.
Ethical Frameworks: Discuss any ethical theories guiding the decision.

Impact of Technology on Nursing

Current Trends: Highlight technological advancements in nursing.
Case Study: Share an example of technology enhancing patient care.
Challenges and Benefits: Discuss the pros and cons of technology in nursing.
Summary of Key Points: Recap the main ideas from each section.
Real-world Implications: Emphasize the practical significance in nursing practice.
Closing Thought: End with a reflective statement or call to action.

A+ in Nursing Essays Await You!

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Nursing Essay Examples

Here are the nursing Essay Examples for you to read.

Writing a Nursing Essay: Essential Tips

When it comes to crafting a stellar nursing essay, a few key strategies can elevate your work from ordinary to exceptional. Here are some valuable tips from our medical school personal statement writer :

Connect with Personal Experiences:

Approach: Weave personal encounters seamlessly into your narrative.
Reasoning: This not only adds authenticity to your essay but also serves as a powerful testament to your firsthand understanding of the challenges and triumphs in the nursing field.

Emphasize Critical Thinking:

Approach: Go beyond describing situations; delve into their analysis.
Reasoning: Nursing essays are the perfect platform to showcase your critical thinking skills – an essential attribute in making informed decisions in real-world healthcare scenarios.

Incorporate Patient Perspectives:

Approach: Integrate patient stories or feedback into your discussion.
Reasoning: By bringing in the human element, you demonstrate empathy and an understanding of the patient's experience, a core aspect of nursing care.

Integrate Evidence-Based Practice:

Approach: Support your arguments with the latest evidence-based literature.
Reasoning: Highlighting your commitment to staying informed and applying current research underscores your dedication to evidence-based practice – a cornerstone in modern nursing.

Address Ethical Considerations:

Approach: Explicitly discuss the ethical dimensions of your topic.
Reasoning: Nursing essays provide a platform to delve into the ethical complexities inherent in healthcare, showcasing your ability to navigate and analyze these challenges.

Balance Theory and Practice:

Approach: Connect theoretical concepts to real-world applications.
Reasoning: By bridging the gap between theory and practice, you illustrate your capacity to apply academic knowledge effectively in the dynamic realm of nursing.

Highlight Interdisciplinary Collaboration:

Approach: Discuss collaborative efforts with other healthcare professionals.
Reasoning: Acknowledging the interdisciplinary nature of healthcare underscores your understanding of the importance of teamwork – a vital aspect of successful nursing practice.

Reflect on Lessons Learned:

Approach: Conclude with a thoughtful reflection on personal growth or lessons from your exploration.
Reasoning: This not only provides a satisfying conclusion but also demonstrates your self-awareness and commitment to continuous improvement as a nursing professional.

As we wrap up, think of your essay as a story about your journey into nursing. It's not just about getting a grade; it's a way to share what you've been through and why you want to be a nurse.

Imagine the person reading it – maybe a teacher, a future coworker, or someone starting their nursing journey. They're trying to understand your passion and why you care about nursing.

So, when you write, remember it's more than just an assignment. It's your chance to show why nursing matters to you. And if you ever need help – there's always support from our essay writer online .

Ready to Excel in Your Nursing School Essay?

Order now and experience the expertise of our professional writers!

How to Write a Nursing Essay?

How can a nursing essay effectively address ethical considerations, what are some examples of evidence-based practices in nursing essays.

Daniel Parker

is a seasoned educational writer focusing on scholarship guidance, research papers, and various forms of academic essays including reflective and narrative essays. His expertise also extends to detailed case studies. A scholar with a background in English Literature and Education, Daniel’s work on EssayPro blog aims to support students in achieving academic excellence and securing scholarships. His hobbies include reading classic literature and participating in academic forums.

is an expert in nursing and healthcare, with a strong background in history, law, and literature. Holding advanced degrees in nursing and public health, his analytical approach and comprehensive knowledge help students navigate complex topics. On EssayPro blog, Adam provides insightful articles on everything from historical analysis to the intricacies of healthcare policies. In his downtime, he enjoys historical documentaries and volunteering at local clinics.

Nursing Assessment Essays

Changing view of the client and the role of nursing assessment, nursing note on major depression, case study for mr. m, popular essay topics.

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Common Assignments: Writing in Nursing

Although there may be some differences in writing expectations between disciplines, all writers of scholarly work are required to follow basic writing standards such as writing clear, concise, and grammatically correct sentences; using proper punctuation; demonstrating critical thought; and, in all Walden programs, using APA style. When writing in nursing, however, students must also be familiar with the goals of the discipline and discipline-specific writing expectations.

Nurses are primarily concerned about providing quality care to patients and their families, and this demands both technical knowledge and the appropriate expression of ideas (“Writing in nursing,” n.d). As a result, nursing students are expected to learn how to present information succinctly, and even though they may often use technical medical terminology (“Writing in nursing,” n.d.), their work should be accessible to anyone who may read it. Among many goals, writers within this discipline are required to:

Document knowledge/research
Demonstrate critical thinking
Express creative ideas
Explore nursing literature
Demonstrate understanding of learning activities. (Wagner, n.d., para. 2)

Given this broad set of objectives, nursing students would benefit from learning how to write diverse literature, including scholarly reports, reviews, articles, and so on. They should aim to write work that can be used in both the research and clinical aspects of the discipline. Walden instructors often ask nursing students to write position and reflective papers, critique articles, gather and analyze data, respond to case studies, and work collaboratively on a project. Although there may be differences between the writing expectations within the classroom and those in the workplace, the standards noted below, though more common in scholarly writing, require skills that are transferrable to the work setting.

Because one cannot say everything there is to say about a particular subject, writers present their work from a particular perspective. For instance, one might choose to examine the shortage of nurses from a public policy perspective. One’s particular contribution, position, argument, or viewpoint is commonly referred to as the thesis and, according to Gerring et al. (2004), a good thesis is one that is “new, true, and significant” (p. 2). To strengthen a thesis, one might consider presenting an argument that goes against what is currently accepted within the field while carefully addressing counterarguments and adequately explaining why the issue under consideration matters (Gerring et al., 2004). The thesis is particularly important because readers want to know whether the writer has something new or worthwhile to say about the topic. Thus, as you review the literature, before writing, it is important to find gaps and creative linkages between viewpoints with the goal of contributing innovative ideas to an ongoing discussion. For a contribution to be worthwhile you must read the literature carefully and without bias; doing this will enable you to identify some of the subtle differences in the viewpoints presented by different authors and help you to better identify the gaps in the literature. Because the thesis is essentially the heart of your discussion, it is important that it is argued objectively and persuasively.

With the goal of providing high quality care, the healthcare industry places a premium on rigorous research as the foundation for evidence-based practices. Thus, students are expected to keep up with the most current research in their field and support the assertions they make in their work with evidence from the literature. Nursing students also must learn how to evaluate evidence in nursing literature and identify the studies that answer specific clinical questions (Oermann & Hays, 2011). Writers are also expected to critically analyze and evaluate studies and assess whether findings can be used in clinical practice (Beyea & Slattery, 2006). (Some useful and credible sources include journal articles, other peer-reviewed sources, and authoritative sources that might be found on the web. If you need help finding credible sources contact a librarian.)

Like other APA style papers, research papers in nursing should follow the following format: title, abstract, introduction, literature review, method, results, discussion, references, and appendices (see APA 7, Sections 2.16-2.25). Note that the presentation follows a certain logic: In the introduction one presents the issue under consideration; in the literature review, one presents what is already known about the topic (thus providing a context for the discussion), identifies gaps, and presents one’s approach; in the methods section, one would then identify the method used to gather data; and in the results and discussion sections, one then presents and explains the results in an objective manner, noting the limitations of the study (Dartmouth Writing Program, 2005). Note that not all papers need to be written in this manner; for guidance on the formatting of a basic course paper, see the appropriate template on our website.

In their research, nursing researchers use quantitative, qualitative, or mixed methods. In quantitative studies, researchers rely primarily on quantifiable data; in qualitative studies, they use data from interviews or other types of narrative analyses; and in mixed methods studies, they use both qualitative and quantitative approaches. A researcher should be able to pose a researchable question and identify an appropriate research method. Whatever method the researcher chooses, the research must be carried out in an objective and scientific manner, free from bias. Keep in mind that your method will have an impact on the credibility of your work, so it is important that your methods are rigorous. Walden offers a series of research methods courses to help students become familiar with the various research methods.

Instructors expect students to master the content of the discipline and use discipline- appropriate language in their writing. In practice, nurses may be required to become familiar with standardized nursing language as it has been found to lead to the following:

better communication among nurses and other health care providers,
increased visibility of nursing interventions,
improved patient care,
enhanced data collection to evaluate nursing care outcomes,
greater adherence to standards of care, and
facilitated assessment of nursing competency. (Rutherford, 2008)

Like successful writers in other disciplines and in preparation for diverse roles within their fields, in their writing nursing students should demonstrate that they (a) have cultivated the thinking skills that are useful in their discipline, (b) are able to communicate professionally, and (c) can incorporate the language of the field in their work appropriately (Colorado State University, 2011).

If you have content-specific questions, be sure to ask your instructor. The Writing Center is available to help you present your ideas as effectively as possible.

Beyea, S. C., & Slattery, M. J. (2006). Evidence-based practice in nursing: A guide to successful implementation . http://www.hcmarketplace.com/supplemental/3737_browse.pdf

Colorado State University. (2011). Why assign WID tasks? http://wac.colostate.edu/intro/com6a1.cfm

Dartmouth Writing Program. (2005). Writing in the social sciences . http://www.dartmouth.edu/~writing/materials/student/soc_sciences/write.shtml

Rutherford, M. (2008). Standardized nursing language: What does it mean for nursing practice? [Abstract]. Online Journal of Issues in Nursing , 13 (1). http://ojin.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/Health-IT/StandardizedNursingLanguage.html

Wagner, D. (n.d.). Why writing matters in nursing . https://www.svsu.edu/nursing/programs/bsn/programrequirements/whywritingmatters/

Writing in nursing: Examples. (n.d.). http://www.technorhetoric.net/7.2/sectionone/inman/examples.html

Didn't find what you need? Email us at [email protected] .

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Open access
Published: 28 May 2024

Design and practice of blended teaching of internal medicine nursing based on O-AMAS effective teaching model

Anyan Duan 1 , 2 ,
Fen Jiang 1 ,
Ling Li 3 ,
Qun Li 1 , 2 &
Wei Chen 1 , 2

BMC Medical Education volume 24 , Article number: 580 ( 2024 ) Cite this article

91 Accesses

Metrics details

Self-directed learning (SDL) ability is the basis for cultivating nursing students’ ability to find and solve problems, lifelong learning, and providing high-quality nursing talents for healthcare. The O-AMAS (Objective, Activation, Multi-learning, Assessment, Summary) model adheres to the teaching philosophy of student-centered, result-oriented, combines the advantages of online and offline teaching, enriching teaching resources and learning channels, diversifying teaching and evaluation methods, and emphasizing integrating and applying knowledge conducive to improving students’ SDL ability and achieving teaching objectives. This study explored the course design, practical, and application effects under the O-AMAS effective teaching model in internal medicine nursing to provide a basis and reference for combining effective teaching models with blended teaching in future nursing courses.

This study is a self-controlled before-after trial. The participants were 76 nursing undergraduates from Hunan Normal University. This study utilizes the O-AMAS effective teaching model to design internal medicine nursing courses and implement blended online and offline teaching. Main links: The overall course design and application are student-centered, after clarifying macro and micro multi-dimensional learning objectives, with online and offline blended teaching environments activated students’ learning behavior and diversified teachers’ teaching activities, then based on instant and dynamic provide effective feedback; finally, students take the initiate to make a brief and potent summary under the teacher guidance. After the course, a unified assessment of the learning effect of nursing students was conducted, including the evaluation of the SDL ability of nursing students, a final comprehensive evaluation grade, and a teaching satisfaction survey.

The nursing students’ SDL ability scores are higher than before teaching, and the results were statistically significant ( P < 0.05). The final average comprehensive evaluation grade of nursing students was 78.38 ± 7.12. More than 96% of the students are satisfied with this course.

Applying for internal medicine nursing blended teaching integrated with the O-AMAS effective teaching model is conducive to improving nursing students’ SDL ability, academic grades, and teaching satisfaction.

Peer Review reports

The overall purpose of internal medicine course is to cultivate high-quality nursing talents with multi-field adaptive learning ability, cross-field practical ability, and interdisciplinary comprehensive thinking ability to improve the quality of nursing services, meet the increasingly diversified and differentiated nursing needs of people, and achieve the goal of “universal health coverage by 2030” [ 1 , 2 , 3 ]. With the rapid update of medical knowledge and technology, nursing students must constantly improve their knowledge, ability, and quality in theoretical teaching and clinical practice, which puts higher requirements for their self-directed learning ability [ 3 , 4 , 5 , 6 ]. The self-directed learning ability of nursing undergraduates is the ability of undergraduate nursing students to obtain and master the necessary knowledge and skills of nursing services with meta-cognition and objective human and material resources. Its main components are the three abilities of self-management, information, and learning cooperation [ 7 ]. Self-directed learning ability is a core competence that equips nursing students with lifelong learning [ 6 , 8 , 9 , 10 ]. Relevant studies show that the SDL ability enables nursing students to enhance their professional nursing values, self-efficacy, meta-cognitive ability, critical thinking, academic performance, academic resilience, time management tendency, problem-solving ability, health education ability, and resilience [ 11 , 12 , 13 , 14 , 15 , 16 , 17 ]. However, because nursing students in the process of learning are still influenced by the traditional teaching concept, nursing students’ learning mainly depends on teachers’ classroom teaching, still a passive accept knowledge role, lack of learning initiative, do not understand discipline dynamic and master essential knowledge, especially difficult to use theory knowledge analysis and solve the problem of clinical practice, the nursing students overall SDL ability and SDL readiness is still at a low to medium level [ 11 , 15 , 18 , 19 ]. Therefore, educators must reform the traditional teaching mode according to the growth law and the learning needs of contemporary students.

O-AMAS, an online and offline hybrid interactive teaching model, was independently developed and launched by the effective teaching team of Nankai University in 2017. The model has five links: Objective, Activation, Multi-learning, Assessment, and Summary [ 20 ]. The model is oriented by learning results and driven by benign interaction. After clarifying multi-dimensional goals, it realizes the teaching objectives and objects are deeply penetrated and participate in the course, advocates student-centered, pays attention to contextualization, gives full play to students’ enthusiasm and initiative, and inspires students to become knowledge builders and problem solvers. The model has been applied in pharmacology, microbial physiology, and community pharmacist training and achieved good results in improving study objects’ self-directed learning ability, academic grades, and satisfaction [ 21 , 22 , 23 ].

In recent years, blended learning strategies have become the most potential teaching strategy in nursing education [ 24 ]. In 2022, China launched the educational digitization strategy, built an online national intelligent education platform for higher education, and an intelligent overpass for teachers and students to teach and learn [ 25 ]. In 2023, China’s Ministry of Education proposed that the digital reform of higher education should pay great attention to content reform and thus provide high-quality educational content to effectively support the steady development of digital education [ 26 ]. Therefore, the Internet-based online and offline mixed teaching mode offers new ideas for promoting the construction of nursing “golden courses” [ 27 , 28 ]. So, this study combines the O-AMAS effective teaching model and online and offline blended teaching to design the internal medicine nursing course. Given the problems existing in the current teaching, analysis and grasp the students learning characteristics and cognitive way, optimize the online teaching resources construction and offline teaching methods, rebuild the internal medical nursing teaching process, use diversified teaching mode, implement effective evaluation and feedback, finally through a brief but potent summary to promote deep learning, fully arouse the students’ learning, improve students’ SDL ability.

Study design

This study is a self-controlled before-after trial.

Participants

Through cluster sampling, the study defined participants as 76 second year nursing undergraduates from Hunan Normal University, including 11 males and 65 females. All subjects signed an informed consent form before participating in the study.

Tools and measurements

Self-directed learning instrument for nursing students

Self-directed learning instrument for nursing students (SDLI for nursing students) consists of 20 items, using the Likert 5-point scoring method; each item is 1 ~ 5 points, the total score is 20 ~ 100 points, the higher the score, the stronger the self-directed learning ability. The scale contains four dimensions (learning motivation, learning plan and implementation, self-management, and interpersonal communication) [ 29 ].

Curriculum academic grades

According to the course design, the course team has developed a comprehensive assessment and evaluation system, which combines the process evaluation and final evaluation from online and offline, including classroom performance, chapter test, topic discussion, group activities, clinical internship, and final examination, with each part taking different weights.

Teaching satisfaction for nursing student’s questionnaire

The teaching team of this study designed the questionnaire through an extensive review of the literature, examined other satisfaction questionnaires, interviewed nursing students, consulted with academic experts, and then adjusted it according to the course design and practice. The questionnaire comprises eight items on three options (approval, neutrality, and disapproval); the questionnaire assesses aspects such as increased learning interest, engagement, and efficiency. In the current study, the Cronbach’s alpha coefficient was 0.916, indicating a high level of reliability.

Internal medicine nursing is a core and practical clinical course in nursing, but learning it is challenging for most students. On the one hand, the complicated and scattered course content, abstract mechanism, and uneven difficulty hindered learners from activating learning interests and focusing on learning objectives; on the other hand, tight class hours, limited classroom learning resources, and learners cannot reasonably arrange learning resources and formulate learning strategies aren’t conducive to cultivate self-directed learning ability and innovation consciousness [ 30 , 31 ]. So this study chooses internal medicine nursing to explore the application effects of the O-AMAS effective teaching model and provide a basis and reference for combining effective teaching models with blended teaching in future nursing courses.

The internal medicine nursing course adopts the O-AMAS effective teaching model to design and mainly includes five parts. The design is summarized in Fig. 1 . Internal Medicine Nursing (6th edition) is the primary textbook, edited by You Liming and Wu Ying and published by People’s Medical Publishing House. Besides, this course quoted Internal Medicine (9th edition) and relevant literature as references, using the MOOC and Chaoxing of online learning applications to assist teaching.

Flow chart of the design of blended teaching of internal medicine nursing based on the O-AMAS effective teaching model

Assemble a teaching team

This study’s teaching team includes 1 department head, 2 pedagogy experts, 5 internal medicine nursing teachers, and 1 teaching assistant from the Chaoxing learning platform. The department head is responsible for the overall design, implementation, adjustment, and summary of internal medicine nursing; pedagogy experts are responsible for guiding and analyzing students’ learning situation, integrating O-AMAS effective teaching model and blended teaching method design; teachers are responsible for building online teaching platform, course teaching, communicating with students and course evaluation; the teaching assistant is responsible for the smooth combination of online teaching platform and offline courses.

Combining blended teaching with the O-AMAS model effectively

Design effective teaching objectives.

The goal of traditional teaching is unclear; most nursing students aim to pass examinations and get a bachelor’s degree certificate, which leads them to neglect often to cultivate their self-directed learning ability. In the long run, it is not conducive for individuals to adapt to the rapidly changing clinical environment and long-term benign development. Therefore, the course team analyzed the students’ learning characteristics and cognitive methods, and under the guidance of the O-AMAS effective teaching model, according to the SMART principles (Specific, Measurable, Achievable, Realistic, Timed) studied and revised the teaching objectives of the internal medicine nursing course, and formulated the macro objectives of the course. The overall teaching objectives of the course: ① Knowledge objectives: Master the basic theory, knowledge, and skills of internal nursing; master the clinical manifestations, nursing diagnosis, nursing plan, nursing measures, and nursing evaluation of common internal diseases; be familiar with the pathologic and physiological change process, diagnostic points and prevention points of common internal diseases; understand the etiology, pathogenesis, and the related frontier research dynamics. ② Ability objectives: Cultivate the ability of nursing students to exert nursing procedures to achieve holistic care; apply interpersonal communication skills to educate medical patients and their families; and learn internal medicine nursing and other related disciplines independently. ③ Quality objectives: Cultivate students’ professional spirit and professional quality; cultivate a rigorous and realistic scientific attitude and an innovative scientific spirit; possess a high degree of patriotic feelings and cultural, legal, moral, and professional literacy.

Based on understanding the course’s overall teaching objectives and Bloom’s Taxonomy of educational objectives, this study from six bands, including knowledge, comprehension, application, analysis, synthesis, and evaluation, to design each lesson gradually ascend from low to high orders and student-centered micro-teaching objectives, teachers focus on diversified teaching activities to help students to learn independently and building knowledge system effectively.

Take the Transient Ischemic Attacks(TIA) section as an example: ① Pre-class self-directed learning stage: mainly the first order of knowledge and comprehension, memorizing the brain’s blood supply, and grasping the disease characteristics of TIA. ② Cooperative learning stage in the class: mainly the middle and high order of application, analysis, and synthesis. Students can observe and make initial evaluations, judge the condition of TIA patients, and cooperate with doctors to actively treat, raise existing nursing problems, implement effective holistic care, and provide health guidance to individuals and families. ③ Consolidation and promotion stage after class. Based on the high-level evaluation, students can use the knowledge to evaluate whether the nursing measures taken for TIA patients are effective. They can find the existing nursing problems and solutions through books, databases, and other resources.

Effective activation to improve students learning interest

Traditional teaching often uses pre-class previews and class tests to activate students, even in some courses that consider the students’ performance an essential part of academic performance. It may have some positive effects, but it also may cause students anxiety and distraction, especially in pure hybrid teaching; students may quickly get answers by intelligent equipment, which not only weakens the students’ interest in learning but can not achieve effective activation. Effective activation requires exciting ways; the activation tools should be closely related to the learning content, and all students participate so that multi-dimensionally activate students’ physical, emotional, and cognition.

This study adopted role-play about clinical reality to activate students’ bodies. Activate students’ emotions by quoting character stories and news reports, such as the diseases that exist in real heroes and ordinary families taking their precious lives, leading to the country and the family loss of talents and relatives to activate students’ empathy; quote positive clinical cases to activate students responsibility, such as healthcare workers save countless patients struggling in disease through solid fundamental knowledge and meticulous clinical work, the teacher praised students’ and created a positive learning atmosphere to activate students’ confidence based on the student’s performance. Presented clinical micro-video and conducted thematic discussions to activate students’ cognition. For example, the leukemia teaching combined with the teaching objectives and content of this chapter, when talking about “acute leukemia,” the teacher through micro-video to initiate a discussion topic, “Does the blood of patients with leukemia turn white?” to motivate student learning interest and enthusiasm, so that students can quickly get into the learning state. The teacher further used brainstorming to guide the students to state whether the blood of leukemia patients will turn white and analyze the causes on the Chaoxing learning platform; the classroom screen will display each student’s ideas to fully mobilize the students to participate actively in the classroom with enthusiasm.

Diversified teaching methods to enhance students’ motivation

Due to the differences between nursing students in personality, learning habits, learning foundation, and learning methods, teachers are required to build new and diversified learning methods to meet the learning needs of most students. This study, based on students’ learning conditions and specific courses, flexibly adopts multiple teaching methods, such as lectured-based learning(LBL), team-based learning(TBL), problem-based learning(PBL), and case-based learning(CBL) etc. A variety of teaching methods are interspersed. At the same time, teachers guided students to experience various learning methods, such as receptive learning, cooperated and explored learning, independent learning, etc. Suppose students must pass the pre-class quizzes to reach the low-order knowledge and comprehension teaching objectives. In that case, the teachers will focus on the class’s LBL and PBL teaching methods, or the teachers will take students as the leading role, application and analysis as the primary teaching objectives, and CBL and TBL as the central teaching methods.

Take acute coronary syndrome and cerebrovascular disease as an example; since students have comprehended the definition and characteristics of the disease, so the teacher took the progressive cases as the main line to present different scenarios of progressive cases gradually. As the disease progresses, it gradually leads to core knowledge points that include the cause of the disease, clinical manifestations, treatment, and nursing measures, etc., and further through teaching strategies such as questioning, enlightening thinking, and group discussion, encourage and guide students to independently explore the implicit knowledge behind the case scenario (such as the causes and inducements of the disease, typical clinical manifestations, and laboratory changes that contribute to identifying the disease, judgment disease of changes, observe treatment efficacy and care adverse reactions), so then guide students to actively participate in the class, more profoundly and systematically understand the internal logical relationship of disease occurrence and development. Finally, according to the feedback from testing, teachers organized students to discuss the frontier or hot topic of clinical nursing. They guided students to track the latest research results and hotspots of nursing. Besides, in the after-class clinical internship, cooperative learning is the primary method; students enter the ward in groups to collect data, and the teachers observe by the bed and give timely guidance and supplements. After the nursing assessment, the students broached the nursing problems and nursing measures according to the case under the teachers’ guidance, evaluated the implementation effect of the nursing measures, and broached the improvement plan. At the end of the internship, the students completed the internship report, which included nursing medical records and experience.

Effective assessment improve teaching effect

The three elements of effective assessment are assessment design, implementation, and feedback. An effective assessment is not a simple score but an effective feedback activity corresponding to the teaching objectives to promote students’ learning effect. This study combines process assessment and final assessment, attaches importance to process assessment and practical ability assessment, continues to assess teaching activities according to teaching objectives, timely adjusts and improves teaching strategies based on students’ feedback, and the assessment runs through the whole online and offline teaching activities. The assessment methods include before and after classroom evaluation, classroom questions and answers, online engagement in the topic discussion, chapter tests, group activities, and clinical internship performance, etc.; the assessment content includes whether the low-order goals (knowledge and comprehension) and the high-order goals (application, analysis, synthesis, and evaluation) can be achieved. The assessment system of internal medicine nursing is presented in Table 1 . For example, this study adopted multiple assessment forms to achieve practical evaluation and feedback, such as group discussion based on clinical progressive cases, topic discussion, and thinking questions. Students can realize how much knowledge they can master in classroom learning and what aspects they need to make up for the deficiencies; it effectively facilitates students to adjust learning objectives timely. Meanwhile, teachers can also analyze the effect of classroom teaching from a multi-dimensional perspective to improve and further promote effective teaching.

Brief summary to promote in-depth learning

This stage is often at the end of a class. After students focus on learning the vital and challenging points of knowledge in class, they tend to become lax at this stage. Therefore, a short and powerful summary is needed to help students connect the key learning content of a class. With students as the main body, teachers guide students in summarizing the classroom content and integrating the learning emphases. Based on the Chaoxing learning platform, it automatically generates summative hot words, or students summarize the teaching content to form mind mapping to help students review what they have learned, further consolidate, reflect, and deepen knowledge.

Statistical data analysis

Entered and analyzed data using the SPSS 23.0 statistical software, measurement information was expressed as mean ± standard deviation ( $\overline {\rm{X}} {\rm{ \pm S}}$ ), and a paired-sample t-test was used to compare students’ self-directed learning ability before and after teaching. The test level is α = 0.05, 1-β = 0.9, p -value<0.05 was considered statistically significant.

Ethical consideration

Informed consent was obtained from the study participants before they were enrolled in the study. Ethical approval was obtained from the Institutional Review Committee of Hunan Normal University School of Medicine before commencing the study. (Ref no 2,023,415, dated 10th February 2023)

Results of final comprehensive grades

In the teaching process, the Chaoxing learning platform, the classroom learning engagement, and the after-class assessment together form the process grades, which combine the final exam score to get the final comprehensive grades. The course passing rate is higher, as recorded in Table 2 .

Results of evaluation of teaching satisfaction

After teaching, using a self-made questionnaire to evaluate the teaching effect, 100% of students gave feedback; more than 90% of students think it is helpful to promote pre-class preview and after-class review and consolidate; more than 80% of students think it helps to stimulate learning interest and enthusiasm, mobilize learning initiative, help adjust learning methods and improve learning efficiency, and teachers can timely feedback; the course satisfaction rate for all students reached 96.1%. The satisfaction results are presented in Table 3 .

Results of comparison of SDL ability before and after teaching

The after-teaching was superior to the before-teaching in the total score of nursing students’ SDL ability ( P < 0.05). The scores of nursing students’ SDL ability were improved in four dimensions, especially in learning motivation, planning and implementation, and self-management ( P < 0.05). The SDL ability scores before and after teaching are presented in Table 4 .

Existing research results show that the students’ SDL ability is positively associated with health education ability, clinical practice behavior, and learning motivation [ 17 , 32 , 33 , 34 ] and negatively associated with study burnout and academic stress [ 35 ], so improving the nursing students’ SDL ability is beneficial to promote the nursing students’ better master theoretical knowledge and operation skills, integrate into the clinical work, promote professional identity, cultivate consciousness and ability of lifelong learning, improve clinical nursing quality in all aspects, meet the growing social health needs [ 36 ]. The O-AMAS effective teaching model emphasizes the educational philosophy of “student-centered and result-oriented development” in all teaching activities [ 20 ]. This study is based on the digital educational trend, combined with the national Massive Open Online Courses(MOOC), the school Small Private Online Course (SPOC) teaching resources, the Chaoxing learning platform, and the Wisdom Tree Platform teaching tools, which scientifically cover pre-class preview, class teaching, and post-class improve three teaching link, designed and practiced blended teaching of internal medicine nursing teaching based on O-AMAS effective teaching model. Establishing a multi-level oriented multi-dimensional goal in line with Bloom’s Taxonomy of educational objectives; Quickly activating the learning interest and behavior from the three aspects of students’ physical, emotional, and cognitive; adopting multiple teaching methods to guide nursing students learning autonomously based on the needs of diagnostic theory and experimental manipulation; combined with the Chaoxing online learning platform for effective measurement and assessment, multi-dimensional analysis, process evaluation and dynamic feedback on the teaching and learning behaviors generated during the course teaching process, to promote the timely improvement of teaching and learning; finally, teachers take the students as the main body and guide students to generate summarizing hot words or mind mappings, help students review what they have learned, explore the relevant scientific research frontiers, and further consolidate and deepen their reflections, improve the coherence and efficiency of nursing students both in and out of class, reduce the learning burden of nursing students, so as to promote the improvement of learning enthusiasm and independent learning ability.

Blended teaching based on the O-AMAS effective teaching model is beneficial to improve the academic performance of nursing students. After teaching, the student’s average academic score was 78.38 ± 7.12 points, which was higher than the academic score of the previous students. More than 96% of students are generally satisfied with this course, and more than 80% believe it can stimulate their interest in learning, mobilize their learning initiative, and increase their learning investment. Moreover, the SDL ability of nursing students was higher than before class, with statistically significant differences ( p < 0.001). These results show that the O-AMAS effective teaching model helps to analyze and grasp students’ learning characteristics and cognitive mode, clarify multi-dimensional learning objectives, effectively and quickly activate the students’ learning behaviors and interests, and significantly improve students’ participation in class. The application of the online curriculum platform for teachers and students to communicate has provided more opportunities and diverse methods; while improving feedback efficiency, it can effectively promote the adjustment and improvement of teaching and learning methods. In this process, teachers’ pedagogy improved, and students effectively realized the enhancement of knowledge level and clinical ability. Both sides progress to complete the overall goal of the course and develop a harmonious relationship. Therefore, students achieved excellent academic performance and were given a higher teaching evaluation. In the post-epidemic era, Shen Bingzheng et al. based on the O-AMAS teaching model and flipped classroom, developed an online continuing training program, effectively improved community pharmacists’ SDL ability, professional competence online, and received a high evaluation of teaching satisfaction [ 23 ]; Luo PeiPei et al. adopted the results-oriented effective teaching mode (O-AMAS) to guide the clinical nursing teaching of undergraduates in cardiovascular internal medicine and improved the nursing students of theoretical scores, comprehensive skills test score, and evaluation of clinical teaching effect [ 37 ]. Wang Xiaojun et al. applied the O-AMAS effective teaching model in the health assessment course, which effectively improved the teaching effect, improved the teaching evaluation of teachers and students, and cultivated students’ independent learning ability [ 38 ]. Therefore, the O-AMAS effective teaching model is helpful in improving students’ self-learning ability, academic performance, and teaching satisfaction and is also suitable for nursing teaching in different settings.

This study further found that the self-directed learning instrument for nursing students of the three dimensions’ total scores (learning motivation, planning and implementation, self-management) were higher than before teaching, with statistically significant differences ( p < 0.05), which can be attributed to that the teaching model expand the cognition of learning from the starting point of teaching, let students get rid of the idea of learning for the sake of examination, and realize that the course of internal medicine nursing can help them master knowledge, improve their ability, and establish good professional ethics, to correct, activate and maintain the learning motivation of learners [ 39 ]; adhere to the student-centered from beginning to end, online and offline, and provides external learning conditions and resources that suitable for students’ learning paths, starting from the activation of existence, then using self-improvement as the intermediary, students to formulate and implement learning plans according to their own situation in the support of rich teaching resources and various teaching methods, finally promote individual self planning and implementation ability [ 40 ]. Besides, combining the online learning platforms of MOOC and the Chaoxing Learning platform to multi-dimensionally analyze, dynamically evaluate, and provide feedback improves students’ ability to actively think, explore, and build knowledge systems. Supervise and manage students’ online learning situations and include usual performances as process assessment data, which improves students’ self-management ability to a certain extent [ 41 , 42 , 43 , 44 ]. Compared with traditional face-to-face teaching and simple online teaching, the blended teaching mode that integrate online resources and clinical case has more positive effects on student’s academic performance [ 45 , 46 ], self-directed learning ability [ 47 , 48 ], learning interest [ 49 ], motivation [ 50 ], and satisfaction [ 51 , 52 ]. It is also worth noting that the interpersonal communication skills of nursing students improved compared with before teaching, but the result did not have statistical significance. In terms of interpersonal communication, when applying the O-AMAS effective teaching model in this course, the teaching process takes students as the main line and teachers as the guidance, but online learning mainly focuses on students’ independent learning, with fewer chapters on peer learning, team-based learning, and learning feedback between peers. Therefore, there is no noticeable improvement in students’ SDL ability in interpersonal communication. In the future, education must focus on cultivating students’ confidence to improve interpersonal communication.

The results of this study show that the design of blended teaching of internal medicine nursing based on the O-AMAS effective teaching model has an explicit level, rich content, a wide range of applications, more than 100 effective interactive methods, and a variety of teaching methods, teaching techniques, teaching organization and management complements each other, which can effectively improve students’ academic performance and SDL ability, further stimulating students’ enthusiasm for learning to encourage students to learn more actively and effectively. Students’ high satisfaction with the course also promotes the establishment of harmonious relationships between teachers and students and the realization of course objectives; the course objectives and teaching objectives are successfully realized and deeply penetrate the teaching process, the teaching objects are deeply involved, the teaching methods have rules to follow, and the teaching effect is visible and controllable. This study has limitations in the number of courses applied, class hours, and sample size, which need to be improved in future studies. Therefore, nursing teaching needs to innovate the classroom teaching mode and optimize the teaching process constantly to promote the development of students’ self-directed learning ability, improve students’ innovation capacity, and lay a talent foundation for the sustainable development of China’s health cause.

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. The data are not available publicly due to privacy.

Abbreviations

Self-directed learning

Transient Ischemic Attacks

Lectured-based learning

Team-based learning

Problem-based learning

Case-based learning

Massive Open Online Courses

Small Private Online Course

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Acknowledgements

We acknowledge all the students who participated in the study.

This work was supported by grants from the Teaching Reform research project of the Hunan Normal University School of Medicine.

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W.C. and A.Y.D. conceived the original idea and wrote the proposal. A.Y.D., W.C., and F.J. designed and applied the study. A.Y.D., F.J., L.L., Q.L., and W.C. organized the data collection and analyzed the data. All the authors contributed to revising the draft of the manuscript, and all the authors read and approved the final draft of the manuscript.

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Duan, A., Jiang, F., Li, L. et al. Design and practice of blended teaching of internal medicine nursing based on O-AMAS effective teaching model. BMC Med Educ 24 , 580 (2024). https://doi.org/10.1186/s12909-024-05588-8

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Health Promotion Models in Nursing Practice
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The impact of whole of patient nursing assessment frameworks on
Papers were included where they focused on a nursing tool or framework designed for the general assessment of patients and where they reported on patient or health service outcomes, for example, patient deterioration, re-admission rates, representation, discharge pathway, staff satisfaction, communication and/or adverse events.
Nursing Admission Assessment and Examination
The initial nursing assessment, the first step in the five steps of the nursing process, involves the systematic and continuous collection of data; sorting, analyzing, and organizing that data; and the documentation and communication of the data collected. Critical thinking skills applied during the nursing process provide a decision-making framework to develop and guide a plan of care for the ...
Assessing the patient's needs and planning effective care
Planning care is essential in the delivery of appropriate nursing care. Following assessment of a patient's needs, the next stage is to 'plan care' to address the actual and potential problems that have been identified. This helps to prioritise the client's needs and assists in setting person-centred goals. Planned care will change as a patient's needs change and as the nurse and/or other ...
Defining Assessment And The Importance Of Assessment Nursing Essay
Assessment is the first stage of the nursing process and enables the nurse to undertake a holistic assessment of the patient considering all of the individuals needs in order to identify their problems. Planning is the second stage and is the process that the nurse and patient set achievable goals and plan how they can be achieved.
Nursing care assessment
This page of the essay has 2,087 words. Download the full version above. This assignment will discuss and analyse the nursing care given to an 85 year old female patient, during a four week hospital practice placement. In order to fully comply with the Nursing and Midwifery Council (NMC) Code of Conduct (2008), full consent has been verbally ...
The Importance Of Nursing Assessment
Nursing assessment has a significant role in providing effective, accurate and safe nursing care in clinical practice. Nursing assessment is the first stage of the Nursing Process. It is used to explore the physical, psychological, spiritual and social aspect of the patient's life. It is therefore a holistic and systematic guide for nurses to ...
Completing A Health Assessment In Nursing
A complete nursing health assessment requires a health professional to examine a patient in a systematic fashion, from head to toe. Nurses rely on self-reported symptoms, visual observation, reported health histories, and a physical medical examination to make a health assessment. This data then informs the nursing care plan.
PDF Critical Thinking and Writing for Nursing Students
nursing and making a case regarding how the nurse might proceed. At the end of the essay we offer notes that explain the critical thinking and writing features of Stewart's work. N.B. Remember, copying essays such as this, submitting them as a whole or in part for assessment
How to Write a Nursing Essay
Here's your quick guide from our nursing essay writing service: Choosing Your Topic: Select a topic that sparks your interest and relates to real-world nursing challenges. Consider areas like patient care, ethical dilemmas, or the impact of technology on healthcare. Outline Your Route: Plan your essay's journey.
The nursing of patient assessments
Essay Writing Service. The nurse should assess the patient by using effective communication skills. Communication can be measured in different ways, these are verbal and non verbal, written, and body language. This can be from the nurse to the patient or the patient to the nurse. Verbal communication can be misunderstood if the non verbal ...
Comprehensive Assessment Of A Chosen Patient Nursing Essay
This essay will give a critical account of a patient summary given below. It will incorporate the pathophysiology of COPD, linking the signs and symptoms that the patient presented on admission. It will also explore the detailed process of respiratory assessment of a patient experiencing exacerbation of COPD in hospital.
Nursing Assessment Essay
Decent Essays. 709 Words. 3 Pages. Open Document. High-quality nursing is a right way to patient's correct diagnostics, treatment and recovery. The role of a patient's assessment is one of basic steps in the process of a patient's care and treatment. Subjective and objective assessment skills define in the process of interaction of a ...
Reflective Account of a Nursing Assessment of a New Admission
This essay is going to reflect upon the care that was provided to Patient A, a 16-year-old with a diagnosis of self-harm and psychosis. A care assessment was carried out, with the use of various questions. The Gibbs (1988) reflective model will be utilised to reflect on the care provided. Reflection is key, to identify strengths and weaknesses ...
Nursing Assessment and Patient Care Essay
Nursing Assessment and Patient Care Essay. Best Essays. 1181 Words. 5 Pages. 40 Works Cited. Open Document. Lily was a 65 year old lady with stage 5 CKD, she had recently begun hemodialysis treatment three times a week as an inpatient and had been responding well to treatment. During dialysis treatment on the morning of the first day, Lily's ...
Nursing Assessment And Care Planning For A Patient
Nursing Assessment and Patient Care Essay. Lily was a 65 year old lady with stage 5 CKD, she had recently begun hemodialysis treatment three times a week as an inpatient and had been responding well to treatment. During dialysis treatment on the morning of the first day, Lily's observations showed that she was: tachycardic, hypotensive ...
Nursing Assessment Essay Examples
Nursing Assessment Essays. Changing View of the Client and the Role of Nursing Assessment. Introduction As a student progressing through the nursing program, my view of who constitutes a "client" has expanded greatly from initial classroom teachings. Where I once saw clients as solely individuals receiving direct care in isolated clinical ...
Describing The Assessment Process For Hospital Ward Patient Nursing Essay
The purpose of this assignment is to describe how a nurse assesses a patient admitted to a hospital ward. It will discuss the history of the patient, any pre-existing medical conditions and the reason they were admitted to the ward. It will also describe the hospital setting, the nursing model used, the risk assessment tools and the information ...
Academic Guides: Common Assignments: Writing in Nursing
Like other APA style papers, research papers in nursing should follow the following format: title, abstract, introduction, literature review, method, results, discussion, references, and appendices (see APA 7, Sections 2.16-2.25).
Defining Assessment And The Importance Of Assessment Nursing Essay
The importance of assessment in nursing. As found in the work of Barrett et al assessment is a procedure in which the nurse will need to gather information from questions that are asked during the assessment process and on-going observations. This gathered information provides a comprehensive description of the patient.
Nursing Essay: Patient Assessment
Nursing Essay: Patient Assessment. Better Essays. 2473 Words. 10 Pages. Open Document. This piece of work will be based on the pre-assessment process that patients go through on arrival to an endoscopy unit in which I was placed in during my second year studying Adult diploma Nursing. I will explore one patient's holistic needs, identifying ...
Design and practice of blended teaching of internal medicine nursing
Self-directed learning (SDL) ability is the basis for cultivating nursing students' ability to find and solve problems, lifelong learning, and providing high-quality nursing talents for healthcare. The O-AMAS (Objective, Activation, Multi-learning, Assessment, Summary) model adheres to the teaching philosophy of student-centered, result-oriented, combines the advantages of online and offline ...
AI firms mustn't govern themselves, say ex-members of OpenAI's board
Last November, in an effort to salvage this self-regulatory structure, the OpenAI board dismissed its CEO, Sam Altman.The board's ability to uphold the company's mission had become ...
PDF Learning and Assessment of First Nations Languages: Overview and
assessment through oral performance and a written essay in a posttest. For example, students needed to interview an elderly person to show their oral performance. Bellin also talked about security in assessment to guarantee students do the tasks by themselves. Furthermore, he shared the results of a survey of the pre-and post-assessment of seniors
Nursing Essays
Strategies of Patient Assessment in Nursing. Example essay. Last modified: 12th Aug 2021. The purpose of this assignment is to describe how a nurse assesses a patient admitted to a hospital ward. It will discuss the history of the patient, any pre-existing medical conditions and the reason they were admitted to the ward.