PAST

As the previous passage indicates, physical assessment has

been an integral part of nursing since the days of Florence
Nightingale. Nurses relied on their natural senses. Palpation
was used to measure pulse rate and quality and to locate the
fundus of the puerperal woman. Examples of independent
nursing practice using inspection, palpation, and auscultation
have been recorded in nursing journals since 1901. Some
examples reported in the American Journal of Nursing (1901-
1938). Despite of historical documentation of the use of
assessment skills by nurses, it is generally recognized that the
depth and scope of nursing assessment have expanded
significantly over the past several decades because of rapid
advances in biomedical knowledge and technology and through the promotion of primary
health care. The early 1970s prompted nurses to develop an active role in the provision of
primary health services and expanded the professional nurse role in conducting health
histories and physical and psychological assessments. Joint statements of the American
Nurses Association and the American Academy of Pediatrics agreed that in depth client
assessments and on the spot diagnostic judgements would enhance the productivity of
nurses and the health care of clients. Acute care nurses in the 1980s employed the
“primary care” method of delivery care. Each nurse was autonomous in making
comprehensive initial assessments from which individualized plans of care were
established. In the 1990s, critical pathways or care maps guided the clients progression,
with each stage based on specific protocols that the nurse was responsible for assessing
and validating. Over the last 20 years, the movement of health care from the acute care
setting to the community and the proliferation of baccalaureate and graduate education
solidified the nurses role in holistic assessment. Advanced practice nurses have been
increasingly used in the hospital as clinical nurse specialists and in the community as
nurse practitioners. In turn, there was a demand for documentation of client assessments
by all health care providers to justify health care services.
 PRESENT
The role of the nurse in assessment and diagnoses is
more prevalent today than ever before in the history of
nursing. Nurses from numerous international countries are
expanding their assessment and nursing diagnosis skills.
The rapidly evolving roles of nursing require extensive
focused assessment of related nursing diagnoses. Current
focus on managed care and internal case management has
a dramatic impact on the assessment role of the nurse. The
acute care nurse performs a focused assessment then
incorporates assessment findings with a multidisciplinary team to develop a
comprehensive plan of care. Critical care outreach nurses need enhanced assessment
skills to safely assess critically ill clients who are outside the structured intensive care
environment. Ambulatory care nurses assess and screen clients to determine the need
for physician referrals. Home health nurses make independent diagnostic judgments.
Public health nurses assess the needs of communities, school nurses monitor the
growth and health of children and hospice nurses assess the needs of the terminally ill
clients and their families. In all settings, the nurse increasingly documents and
retrieves assessment data through sophisticated computerized information systems.
Nursing health assessment courses with informatics content are becoming the norm in
baccalaureate programs. As the scope and environment for nursing assessment
diversify, nurses must be prepared to assess populations of clients not only across the
continuum of health but also by way of telecommunication systems with online data
retrieval and documentations capabilities.

FUTURE
 The future will see increased specialization and diversity of assessment skills
for nurses. The nurse can discuss and demonstrate assessments with other health care
professionals as clearly and quickly as if they were in the same room. Assessment
data and findings can be documented over the internet or in computerized medical
records some small enough to fit into a laboratory coat pocket and many activated by
the nurses voice. While client acuity increases and technology advances, bedside
nurses are challenged to make in-depth physiologic and psychosocial assessments
while correlating clinical data from multiple technical monitoring devices. The
communication health assessment and clinical data will span a myriad of electronic
interactivities and research possibilities. These structures provide diverse settings and
levels of care in which nurses assess clients and facilitate their progress. New deliver
systems such as “integrated clinical practice” for surgical car may require the nurse to
assess and follow a client from the preoperative visit to a multidisciplinary outpatient
clinic and even into the home by way of remote technology. Nursing leaders envision
tremendous growth of the nursing role in the managed care environment. The most
marketable nurses will continue to be those with strong assessment and client teaching
abilities and also those who are technologically savvy. Extensive research has resulted
in several nursing languages to describe what nurses diagnose. This future
development of nursing languages relies on the ability of practicing nurses to collect
and analyze relevant client data to develop valid nursing diagnoses. Nurses will
continue to be challenged to form client information and to move this information to
knowledge through nursing informatics in order to improve health care.

The role of the nurse in health assessment has expanded drastically from the
days of Florence Nightingale, when the nurse used the senses of sight, touch,
and hearing to assess clients. Today communication and physical assessment
techniques are used independently by nurses to arrive at professional clinical
judgments concerning the clients health. In addition, advances in technology
have expanded the role of assessment and the development of managed care
has increased the necessity of assessment skills. Expert clinical assessment
and informatics skills are absolute necessities for the future as nurses from
all countries continue to expand their roles in all health care settings.
Unfortunately, querying “nurses and technology” or “nursing leadership and
technology” produced few results. Substituting “Physician” for “nurse”
produced significantly more results. In light of this, the search terms “nurses
and computers” and “nurses attitudes and computers” were substituted
successfully. Future research may require a fine-tuning of search terms to
produce the desired results. But it does seem likely that there is a dearth of
both anecdotal information and research related to use of these technologies
by nurses, whereas literature about physician use is readily available. The
research studies ultimately chosen cover several aspects of interest: attitudes
and anxieties towards computers and computer use, factors related to
adoption of innovations, nurse’s use of email, and use of handheld
technology. These studies were representative of the literature, had
predictive value about nurses and/or use of technology, with obvious
implications for future study.

ASSIGNMENT
IN
 HEALTH
ASSESSMENT
LECTURE

Submitted by:
Karen G. Delgado
BSN II-A
Submitted to:
Mrs. Jasmin Freal

EVOLUTI
ON OF
 THE
NURSE’S
ROLE IN
HEALTH
ASSESSM
ENT