Jarvis: Physical Examination & Health Assessment, 3rd Canadian Edition

Jarvis: Physical Examination & Health Assessment, 3rd Canadian Edition Chapter 01: Critical Thinking and Evidence-Informed Assessment Key Points This section discusses key points about assessment and critical thinking.  Assessment is the collec...

Jarvis: Physical Examination & Health Assessment, 3rd Canadian Edition Chapter 01: Critical Thinking and Evidence-Informed Assessment Key Points This section discusses key points about assessment and critical thinking.  Assessment is the collection of subjective and objective data about a patient’s health. o Subjective data consist of information provided by the affected individual. o Objective data include information obtained by the health care provider through physical assessment, the patient’s record, and laboratory studies.  The database is the totality of information available about the patient. The purpose of assessment is to make a judgement or diagnosis.  Diagnostic reasoning is the process of analyzing health data and drawing conclusions to identify diagnoses. This process has four major components: o Attending to initially available cues, which are pieces of information, signs, symptoms, or laboratory data o Formulating diagnostic hypotheses, which are tentative explanations for a cue or a set of cues and can serve as a basis for further investigation o Gathering data relative to the tentative hypotheses o Evaluating each hypothesis with the new data collected, which leads to a final diagnosis Page 1 of 5 Key Points 1-2 o Validating data, which ensures that the information you have collected is accurate and helps identify missing information; this process is essential to critical thinking  The nursing process has five phases: assessment, nursing diagnosis, planning, implementation, and evaluation. It is a dynamic, interactive process in which practitioners move back and forth among the steps.  Nurses progress from being novice nurses to expert practitioners through the use of critical thinking  Critical thinking is the multidimensional thinking process needed for sound diagnostic reasoning and clinical judgement. Seventeen critical thinking skills that have been identified include the following: o Identify assumptions o Identify an organized and comprehensive approach to assessment o Validate or check the accuracy and reliability of data o Distinguish normal for abnormal when signs and symptoms are identified o Make inferences or hypotheses o Cluster related cures o Distinguish relevant from irrelevant o Recognize inconsistencies o Identify patterns o Identify missing information, gaps in data, or need for more data to make a diagnosis o Promote health by identifying priorities with the patient, assessing risk factors, and considering a patient’s social context o Diagnose actual and potential (risk) problems from the assessment data o Set priorities when a patient has more than one health or illness issue occurring concurrently Page 2 of 5 Key Points 1-3  First-level priority problems are emergent, life-threatening, and immediate, and require urgent measures such as establishing an airway or supporting breathing.  Second-level priority problems are next in urgency. They require prompt intervention to prevent deterioration; these problems may include a mental health change or acute pain.  Third-level priority problems are important to the patient’s health but can be addressed after dealing with more urgent problems. Examples of such problems are lack of knowledge or family coping.  Collaborative problems are physiological complications in which the approach to treatment encompasses multiple disciplines (e.g., alcohol withdrawal, which affects the central nervous system and the cardiovascular system). Nurses have the primary responsibility to diagnose the onset of such problems and monitor changes in status. o Identify patient-centred expected outcomes o Determine specific interventions that will achieve positive outcomes o Evaluate and revise your thinking o Determine a comprehensive plan, or evaluate and update the plan Page 3 of 5 Key Points 1-4 This section presents critical points about evidence-informed assessment and concepts of health.  Evidence-informed practice is a systematic approach to practice and uses the best evidence, the clinician’s experience, and the patient’s preferences and values to make decisions about care and treatment.  Every examiner needs to collect four kinds of databases based on the clinical situation. o A complete (or total health) database includes a complete health history and findings from a full physical examination. o An episodic (or problem-centred) database is used for a limited or short-term problem. It is smaller in scope and more targeted than the complete database. o A follow-up database evaluates the status of any identified problem at regular intervals to follow up on short-term or chronic health problems.  The concept of health has expanded and is based on the practice model used. o The biomedical model of Western medicine views health as the absence of disease. It focuses on collecting data on biophysical signs and symptoms and on curing disease. o The behavioural model extends beyond treating disease to include primary and secondary prevention with emphasis on changing behaviours and lifestyle. o The socioenvironmental model encompasses the biomedical and behavioural models and incorporates sociological and environmental aspects of health.  Social determinants of health are the social, economic, and political conditions that shape the health of individuals, families, and communities.  The concept of health also includes health promotion and disease prevention. Page 4 of 5 Key Points 1-5 o A relational approach to nursing practice considers health and illness and the meaning they hold as being shaped by social, cultural, family, historical, and geographical as well as by the patient’s gender, age, ability, and other individual contexts.  Examiners collect four different types of data, depending on the clinical situation: complete, episodic or problem centred, follow-up, and emergency data.  The frequency of assessment varies according to the patient’s age, gender, social context, and illness and wellness needs.  Each province and territory adapts immunization standards from the Canadian Immunization Guide (Public Health Agency of Canada, 2012) in response to its population’s needs.  Periodic health examinations are designed to prevent morbidity and mortality by identifying modifiable risk factors and early signs of treatable conditions.  Health assessment should consider: o The usual and expected developmental tasks for each age group o The cultural and social background of individuals Page 5 of 5