Focused assessment
In a
focused assessment
, data are gathered about a specific
problem that has already been identified. A focused assess-
ment may be undertaken during the initial assessment if
health problems surface, but it is routinely part of ongoing
data collection. Another purpose of the focused assessment
is to identify new or overlooked problems. An example of
this may be that during the initial interview it becomes
apparent that the person is expressing feelings of sadness
and despair. The assessment may then focus on this to ascer-
tain if the person is experiencing a reaction to a specific
situation identified in the assessment, such as a bereavement
or a depressive episode that may require further referral.
Emergency assessment
When a physiological or psychological crisis presents,
an
emergency assessment
is performed to identify life-
threatening problems. A nursing home resident who begins
choking in the dining room, a person brought to the emer-
gency department with a stab wound, an unresponsive person
in the rehabilitation unit and a farm worker involved in an
accident with machinery are all candidates for an emergency
assessment.
Time-lapsed assessment
The
time-lapsed assessment
is scheduled to compare a
person’s current status to baseline data obtained earlier.
Most people in residential settings and those receiving care
over longer periods of time, such as people visited by a com-
munity nurse or midwife, may have periodic time-lapsed
assessments to reassess their health status and to make
necessary revisions in the plan of care.
There are times when the features of each type of assess-
ment may be combined.
Consider what you have learnt about focused and
time-lapsed assessment and apply it to the scenario.
Claire and her mother present at the clinic for her three-
monthly appointment with you, the community nurse.
Claire has had several admissions to hospital with
ketoacidosis in the past two years but has been relatively
stable in recent months. You refer to her initial assess-
ment and notice that since that time her entries in her
diabetes record book have become very spasmodic and
her blood glucose levels are fluctuating with increasing
regularity. You ask Claire about the documentation and
notice that her attitude is despondent. She angrily states:
‘I always stick to my diet and it still makes no difference.
My blood glucose levels are always high and I just can’t
do this any more.’ You now need to focus your assess-
ment of Claire in order to collect data that will help you
identify what issues may be arising for her.
1. What questions would you ask Claire and her
mother?
2. What issues might you consider?
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Chapter 15 Assessing
PREPARING FOR DATA
COLLECTION
Establishing health assessment priorities and systematically
structuring data collection are two important considerations
when preparing for data collection.
Establishing assessment priorities
Before beginning data collection, you should have some
idea of the types of data needed to develop a satisfactory
plan of care. Nurses and midwives spend more or less time
on different components of the health history depending on
the reason why assistance is needed. For example, paediatric
nurses are careful to establish the developmental age and
milestones obtained from children admitted to a paediatric
unit so that they can respect and promote these achieve-
ments. A school nurse who suspects child abuse pays careful
attention to the child’s statements about living conditions
at home, and relationships with family members and carers.
A midwife preparing to discharge a first-time mother from
the maternity unit makes sure that the new mother has the
support network needed to provide appropriate assistance
and guidance.
The purpose for which the assessment is being performed
offers the best guideline about what type to use and how
much data to collect. Assessment priorities are influenced by
the individual’s health orientation, developmental stage and
need for care.
Health orientation
Health assessments, such as the ‘A health style self-test’ in
Chapter 2 and the ‘Promoting health’ displays in each
clinical chapter may be used to help people identify poten-
tial and actual health risks, and to explore their habits,
behaviours, beliefs, attitudes and values that influence
levels of wellness. There is a wide body of literature on
specialised assessment tools that focus on relationships;
psychological, environmental and physical self-care;
relaxation; culture and spirituality; humour and play;
movement and exercise; sleep and dreams; nutrition; and
sexuality. All of these specialised assessment tools
provide specific, pertinent information and may be differ-
ent from the assessments of people being hospitalised for
disease-related treatment.
Developmental stage
Assessments are modified according to developmental
needs. For example, when assessing an infant, special atten-
tion is given to weight gain and physical growth, feeding
and elimination problems, sleep–activity cycles, and the
parenting skills of carers. When a child is hospitalised, it is
important to note how independent the child is with basic
care measures (toileting, hygiene, dressing, eating), what
words the child uses to indicate the need to void and defe-
cate, and play preferences.
