How Nursing Assessments Supplement Clinical Intuition
How do mothers know when their child will be sick before they show any classic symptoms? It’s all based on a “mother’s intuition” which comes from mothers being able to pick up the most subtle changes in their child’s behavior. Maybe they aren’t eating normally or something just seems a little off, but this maternal instinct is rarely wrong.
Nurses carry this same intuition regarding the health of their patients. Spending hours of a clinical shift at the patient’s bedside enables the nurse to pick up on subtle observations that can go unnoticed by other practitioners who spend significantly less amount of time at the bedside. Nurses are educated to document their clinical findings through head-to-toe nursing assessments which include information about a patient’s physiological, physical, psychological and sociological status. These assessments are performed upon admission or transfer, and once each shift, at minimum, during a patient’s hospital stay, and then documented in the patient’s medical record.
Given the depth of content in nursing assessments, one might think these findings serve as a foundation when reviewing the overall health of patient outside of nursing hand offs. However, these insights are infrequently incorporated into patient evaluation despite the amount of data and insights they contain. Physicians tend to look at vital signs, lab results and physician progress notes when making clinical decisions. Unintentionally, health care providers overlook the value of clinical data contained within nursing assessments.
What if the data in nursing assessments could be mined to paint an accurate patient clinical status for the care team? Here’s why I think healthcare should start placing more emphasis on the value of nursing assessments and how they can benefit both providers and patients in a number of ways:
- Detect patient deterioration earlier – Nursing assessments are proven to be important leading indicators of deterioration, providing powerful insight before the patient’s physiological decline becomes apparent through altered vital signs. Researchers have found a direct correlation between the first nursing assessment taken upon admission with in-hospital mortality, as well as a correlation between the last nursing assessment taken prior to discharge with post-discharge mortality. These findings suggest that nursing assessments gathered throughout the patient’s stay contain significant and valuable clinical information.
- Provides a holistic view of the patient’s condition – Vital signs are still important in evaluating a patient’s condition, but the key is to align that information with the qualitative assessment findings from the nurses who provide bedside care during the patient’s stay. The benefit of utilizing nursing assessments in addition to vital signs is the enhanced ability to understand the patient’s overall condition, thereby allowing clinicians to identify changes in clinical status before a significant, untoward event occurs.
- Improves early warning system effectiveness – The majority of early warning systems utilize roughly five to seven measures, most of which are vital signs, to predict patient deterioration. Clinicians using these systems to flag at-risk patients are intervening on patients at a point when they have already clinically decompensated proving that there is a limit to how effective a scoring system can be when it is based on vital signs and neurological status alone. By incorporating nursing assessments, the clinician can visualize clinical changes from integumentary to cardiac function to respiratory status, among other body systems, providing a holistic snapshot of the patient’s current condition. Including the assessment findings found in these body systems outside of vital signs help improve the effectiveness of early warning systems.
With nurses spending an average 35% of their time on documentation, during a 10-hour shift, and healthcare systems continuously searching for ways to improve quality, it is apparent that using nursing assessment findings is the perfect solution to bring awareness of a patient’s clinical status to all healthcare providers. Deploying an early warning system that leverages nursing findings and allows for the identification of at-risk patients can help us all reach the patient outcome goals we’re working toward.
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