The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [38]
Memorial Symptom Assessment Scale (MSAS) (Portenoy et al. 1994)
Concerns Checklist in Oncology Outpatient Setting (Dennison and Shute 2000)
Therapy Related Symptom Checklist (TRSC) (Williams et al. 2001)
Social Problems Inventory (SPI) (Wright et al. 2001)
Symptoms and Concerns Checklist (Lidstone et al. 2003)
The methods used to facilitate patient assessment are important adjuncts to assessing patients in clinical practice. There is a danger that too much focus can be placed on the framework, system or tool that prevents nurses thinking about the significance of the information that they are gathering from the patient (Harris et al. 1998). Rather than following assessment structures and prompts rigidly, it is essential that nurses utilize their critical thinking and clinical judgement throughout the process in order to continually develop their skills in eliciting information about patients’ concerns and using this to inform care planning (Edwards and Miller 2001).
Principles of an effective nursing assessment
The admitting nurse is responsible for ensuring that an initial assessment is completed when the patient is admitted. The patient’s needs identified following this process then need to be documented in their care plan.
The following box (Box 2.7) discusses each area of assessment indicating points for consideration and suggesting questions that may be helpful to ask the patient as part of the assessment process.
Box 2.7 Points for consideration and suggested questions for use during the assessment process
1 Cognitive and perceptual ability
Communication
The nurse needs to assess the level of sensory functioning with or without aids/support such as hearing aid(s), speech aid(s), glasses/contact lenses, and the patient’s capacity to use and maintain aids/support correctly. Furthermore, it is important to assess whether there are or might be any potential language or cultural barriers during this part of the assessment. Knowing what the norm within the culture will facilitate understanding and lessen miscommunication problems (Galanti 2000).
How good are the patient’s hearing and eyesight?
Is the patient able to express their views and wishes using appropriate verbal and non-verbal methods of communication in a manner that is understandable by most people?
Are there any potential language or cultural barriers to communicating with the patient?
Information
During this part of the assessment the nurse will assess the patient’s ability to comprehend the present environment without showing levels of distress. This will help to establish whether there are any barriers to the patient understanding their condition and treatment. It may help them to be in a position to give informed consent.
Is the patient able and ready to understand any information about their forthcoming treatment and care? Are there any barriers to learning?
Is the patient able to communicate an understanding of their condition, plan of care and potential outcomes/responses?
Will he or she be able to give informed consent?
Neurological
It important to assess the patient’s ability to reason logically and decisively, and determine that he or she is able to communicate in a contextually, coherent manner.
Is the patient alert and orientated to time, place and person?
Pain
To provide optimal patient care, the assessor needs to have appropriate knowledge of the patient’s pain (Wilson 2007) and an ability to identify the pain type and location. Assessment of a patient’s experience of pain is a crucial component in providing effective pain management. Dimond 2002 asserts that it is unacceptable for patients to experience unmanaged pain or for nurses to have inadequate knowledge about pain. Pain should be measured using an assessment tool that identifies the quantity and/or quality of one or more of the dimensions of the patient’s experience of pain.
Assessment should also observe for signs of neuropathic pain including descriptions such as shooting, burning, stabbing, allodynia (pain associated with gentle