Nursing is a game of multitasking.
During your shift, you constantly have something to do. Admissions, discharges, taking handovers, giving handovers, medications, taking blood and other samples, participating in ward rounds, teaching students, taking vital observations, bathing patients and other ADLs, talking to relatives and then dealing with a deteriorating patient.
As a rookie nurse, you will find yourself feeling overwhelmed with all these on several occasions. Previously I shared a few tips on how to cope with large patients ratios.
Today I want to focus on assessment of patients. More specifically opportunities to assess patients and what to look out for.
Assessment is the first step in any Nursing Process; whether you are using the ANA version or the UK version known as APIE. Assessment determines all your actions moving forward, making it the most fundamental step in The Nursing Process.
On patient admission, you will have a chance to conduct a thorough head-to-toe assessment. However, after this you may not have the luxury of spending a lot of time with each patient, owing to the large nurse to patient ratios in many parts of the world.
You must therefore look out for opportunities to assess patients even as you continue with other tasks. Here are some of those:
During Handover
This is your first contact with patients when you come in for your shift. If your handover involves going round the ward, glance at the patient. Assess their general condition and demeanor at this point. Are they sleeping or awake? Are they calm or Agitated? Do they have oxygen or fluids or medication going on? Are they clean?
Listen carefully to what the nurse is reporting. Listen to the diagnosis of the patient and what they are currently being treated for. This will save you time since you don’t have to start looking for this information later on. The handover of the patients’ vitals and observations is also a good way to tell you who is more sick and will need more of your attention. Don’t forget to ask questions on points that are not clear.
During your Drug Round.
For most medical-surgical units, administration of medication is the next procedure of the day after handover. Use this time to have a closer look at your patients.
Immediately you come to the bedside, greet the patient and introduce yourself. Obtain consent. Ask the patient how they are feeling. It could be fatigue or pain or nausea. Allow them to express their worries and concerns. Assess the patient’s orientation as you converse. You can also obtain some insight on patient’s history and health behavior. Be sure not to get carried away, especially with chatty patients.
When giving oral medication, you can assess the patients swallowing and drinking. Sometimes you may find them having breakfast and can assess their eating as well.
When Bathing/Washing
This is particularly important for patients who are bed bound. You need to assess their skin and look out for pressure sores or risk of pressure sore. You can also assess their ability to move in bed, which forms a key part of your care plan. Patients who are totally bed bound will need regular repositioning and pressure area care. Others may just need to be prompted to change their position.
Nursing Desk Assessments
These are the assessment you do when you are seated at the nurse’s station. Maybe you are about to write in the cardex or fill your charts, depends with where you are. Take this time to look at the patient’s history. Get an in depth understanding of their current diagnosis and medical management plan. You can also use this opportunity to look at lab reports and escalate deranged findings as appropriate.
Conversations with Patient’s Family
While most conversations with patients families revolve around you updating them on the patients condition, the family can sometime give you useful information on the patient’s baseline. For instance family may mention that the patient’s blood pressure is usually low or that they are a poor feeder. They may even give you suggestions on the preferred meals. This can help you formulate some of your interventions for different patient needs.
The bottom line is to use every opportunity you get to find out what the patients condition is and intervene using The Nursing Process. I have not exhausted the opportunities to conduct quick bedside assessments. What are yours? Share them with me in the comments section.
Like I mentioned above, Nurses are king when it comes to multitasking.