David Stanley, BSc, MSc, RN, RM, Dip HS; Helen Jones, BA (Hons), MA, RN, PGDE
David-Senior Lecturer in Nursing and Midwifery; Helen-Senior Lecturer in Nursing and Midwifery, University College Worcester, WorcesterThe ability to assess clients and patients appropriately and accurately has always been a key part of nurses' responsibilities. Nurses now face meeting the requirements of the Making a Difference (DoH, 1999) agenda. They will have to cope with the roles extended to them by the decrease in junior doctors' hours - one of which is that nurses will be involved in patient assessment to a greater level than in the past.
In terms of 'health assessment', this can be a problem, as different stages of the process become muddled together. Terms such as 'holistic assessment', 'physical assessment', 'nursing assessment', 'health screening' and so on, are often used interchangeably, to explain a range of approaches. But that can lead to confusion.
This paper's lead author, David Stanley, a senior lecturer on health assessment to pre- and post-registration nurses at University College Worcester, felt it was necessary to find a way of regrouping and organising the terms around health assessment. He developed the health assessment pyramid (Figure 1) to enable this to happen. A clearer understanding of assessment activities allows for judicious curriculum planning and places the principles of assessment within an appropriate and tiered context. The pyramid graphically displays the inter-relationship between various elements of health assessment.
- Holistic assessment At the pyramid's base are the factors that contribute towards holistic assessment. Higgleton et al (1999) define holism as a consideration of a whole, taking into account social, physical and psychological factors that impact on and relate to the person's health and well-being, such as their living environment, family history, general appearance, and psychosocial history. The holistic assessment represents factors that will inform other aspects of the patient's assessment. It is relevant to all levels of the pyramid.
The health assessment pyramid provides a framework for educators and students of health assessment to conceptualise aspects of health assessment relating to individuals and the community. It can highlight the relationships between holistic, physical and specific or specialist types of assessment and draw them together.
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