Introduction to Health Assessment. In today’s rapidly changing healthcare environment, nurses are being expected to do more with less. Patients are coming in sicker and leaving sooner than sometimes we as nurses feel they are ready. While the implementation of the Affordable Care Act has provided 32 million more people with access to healthcare, it has also resulted in changing reimbursement structures and placed greater emphasis on the quality of care being delivered (Nikitas & Feeg, 2011). As bedside nurses and future leaders, our ability to thoroughly and accurately assess our patients, quickly recognize changes in their condition utilize our critical thinking skills to determine the best course of action, and effectively communicate them to other members of the healthcare team can often mean the difference between life and death for our patients. Now more than ever it can also greatly impact the bottom lines of our organizations, which in turn will result in decreased revenue available for staffing and technological advancements which are needed to help ensure that we have all the necessary resources available to provide our patients with the best possible outcomes.
However, in order to be able to accomplish these things we must first know what it means to be healthy. Otherwise, how are we going to recognize when an injury or illness is present, right? While Googling the term health generates a variety of different definitions, the World Health Organization (WHO), defines it as being in a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity (WHO, 2006).
Reflection of introduction to health assessment
How does the WHO definition of health compare to your definition, your family’s definition, and your patient’s definition? Would you guess that each of you have a slightly different idea of what it means to be healthy?
Threats to Wellness
In addition to our genetics, we are being bombarded with talk each day on the nightly news about things that place our health and wellness in jeopardy including such things as global warming, poverty, terrorism, environmental toxins, and foodborne illnesses, second hand smoke, product recalls, lack of healthcare coverage, and a shortage of healthcare providers, and so on. While we unfortunately cannot control all of these things, there are a number of resources available providing recommendations that can be implemented into our own daily lives as well as recommended to our patients that can help contribute to continued wellness. The Healthy People Initiative (DHHS, 2014) is one such resource.
Healthy People 2020
Healthy People is simply a set of health goals used to identify health threats and develop strategies to reduce those health threats. Historically, the Healthy People agenda has defined national health objectives, monitored progress of health goals in health objectives, encouraged collaboration among healthcare organizations, educated the public—individuals, families, and communities—in making wise healthcare decisions, and measured the impact of health prevention. The Healthy People initiative (DHHS, 2014) provides a framework in which healthcare professionals, including nurses, accept the challenge of health promotion and disease prevention in patients, families, and communities. As the initiative has evolved over the years, it has begun to place a stronger focus on major health objectives related to wellness, creating new healthcare policy, and focusing on issues related to creating environments that promote health and prevent disease. The vision of the future focuses on a society in which all people will live long, healthy, and vibrant lives by meeting healthcare goals. The goals include the following: eradication of preventable disease; reducing health disparities through a determinants of health approach by improving the holistic health of all groups of people; creation of environments to promote good health for all; and promotion of health development across all ages (DHHS, 2014).
You can help support the national health objectives of Healthy People 2020 by following these simple steps.
- Share about Healthy People 2020in your practice setting, at health events, and via professional and community publications.
- Use Healthy People 2020in your professional practice. The Healthy People 2020 site has links to http://www.healthfinder.gov (Links to an external site.) a reliable gateway to health information for the public, as well as links to leading health indicators.
Visit the Healthy People website http://www.healthypeople.gov/2020/topicsobjectives2020/default (Links to an external site.) and identify at least one topic that pertains to the patient population that you serve. Read about the topic on the site by clicking on its link. What did you learn that you didn’t know before visiting this site?
It is also important to note that thanks to the Internet, our patients now have the ability to research their symptoms from the comfort of their own homes and often come to us seeking medical attention for a self-diagnosed ailment courtesy of WebMD. While many sites can and do serve as valuable resources to our patients, lacking the ability to distinguish the difference between credible and noncredible sites can prove to be detrimental to one’s health both physically and emotionally.
Go to the Healthfinder.gov (Links to an external site.) website and locate a health topic that pertains to your patient population. There are multiple ways to search the site for information. Try more than one! Consider whether your patients would benefit from visiting this site. Is the information presented in a way that they would understand? How would you educate them about the site? Also, do you ask your patients if they search for health information on the Internet? You may be surprised to learn that many patients turn to the Internet for answers to their healthcare questions.
Definition of Health Assessment in relation to introduction to health assessment
Health assessment is comprised of the health history and the physical examination. These two elements lay the foundation for the entire diagnostic and treatment process.
The health history review assesses the patient’s overall health. The purpose is to collect both subjective (what the patient says) and objective (what is observed) data. Furthermore, it compares the patient’s view of his or her body with what is considered normal in health. The health history interview consists of
- determining the reason for the patient visiting the healthcare provider;
- recording the patient’s family history;
- reviewing the patient’s experience of health and illness in all systems; and
- consideration of the developmental stage of the patient.
Cultural Awareness in Healthcare
Cultural awareness encompasses knowledge of biocultural, psychological, sociological, and linguistic differences among people. Misunderstandings due to cultural differences lead to workplace stress and poor healthcare outcomes.
Today’s healthcare organizations are multicultural microcosms of today’s society. Cultural competency is vital to effective healthcare staff relationships, as well as to healthcare delivery.
Nurses must adapt health assessment strategies to meet the needs of patients of different cultural groups. Cultural differences must be carefully considered to obtain an accurate health assessment and provide optimal cultural care.
Cultures develop values, behaviors, and traditions that are considered the norm for individuals, families, groups, communities, and populations. Patients should not be expected to adapt to the foreign customs or speak the language of a different culture. Illness is a stressful time when patients rely on traditions and cultural beliefs. Those beliefs help the patient adapt to the physical and environmental stressors encountered when health is not optimal. For example, it is important to understand cultural beliefs in obtaining patient information. Patients within some Asian cultures may not request pain medication because they believe that illness is due to some wrongdoing on their part. On the other hand, it is relatively common for individuals from Mediterranean cultures to request pain medication for only slight discomfort.
The United States is a multicultural society and nurses will frequently encounter patients from diverse cultural backgrounds. It is important to develop insight and appreciation for patients of different cultures and to respect and uphold the rights of culturally diverse patients, families, and communities.
Cultural Health Assessment Strategies
It is also important to gather cultural data in order to understand the environment in which the patient exists. There are six cultural indicators that a nurse must understand when conducting a health assessment (Giger & Davidhizer, 2008).
- Communicationis often viewed as only encompassing language barriers in health assessment. But language barriers are not just present when there is a different language spoken—language barriers can occur within the same language. Some commonly used words or phrases in one group may have a derogatory meaning to others who speak the same language. In addition, communication addresses nonverbal language. For example, patients from certain cultural groups consider direct eye contact disrespectful. Lack of eye contact in other cultural groups is considered a sign of lying.
- Spacerelates to the level of personal space in the health assessment process. It is important to understand cultural practices of proximity during communication. It is also important to note varying cultural beliefs of body movement, eye contact, and use of touch.
- Social organizationsaddress the patterns of cultural behavior. For instance, health-related authority may rest with either the eldest male or eldest female within the family or community. It is also necessary to understand the roles of various family members. Last, ethnicity is not the only factor when considering culture. Geography, age, religion, gender, sexual orientation, and socioeconomic factors in patients, families, and communities are integral to an accurate patient health assessment and history.
- The perception and importance of timeis another cultural consideration that is sometimes not taken into consideration in the health assessment process. Some cultures are past orientated, and patients from those cultures may be reluctant to institute new healthcare practices. On the other hand, some cultures are more present oriented. In those cultures, the patient may not be concerned about the future or the consequences of poor health practices.
- Environmental controlin health assessment refers to the control of the nature of the surroundings. The environment may encompass health practices, values, and understanding of health and illness.
- Biological variationin the assessment process is described as understanding differing body structures among racial or ethnic groups, including color of skin, texture of hair, and other physical characteristics. In addition, it is important to consider biologic susceptibility to disease, nutritional preferences and deficiencies, and psychological characteristics.
It is imperative that the nurse consider cultural phenomena in the health assessment process. When considering cultures in health assessment, a checklist would include the following.
- Normal standards of behavior belief system
- Belief system about time, money, education, beauty, and change
- Relationships, including roles within family and community
- Communication beliefs
- Economic values, political systems, and educational beliefs
- Nutrition and diet beliefs
- Religion and healing beliefs
- Health and illness beliefs
Summary of introduction to health assessment
This week, we discussed definitions of health and how those are defined by each individual. We reviewed the goals of Healthy People 2020 and how that influences our nursing practice. Over the next few weeks, you will learn how to improve your health assessment skills and complete a more thorough and accurate health history that encompasses not only the physical aspects but also the psychosocial, cultural, and socioeconomic needs of the patient. Enjoy your journey!
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