Head to toe assessment....how long does it take you?

[CareBayer]

Be honest!!! I am a new grad and care for six patients. My first assessment is always a head to toe.....I can't spend more than 5-7 minutes per patient or I get too behind. But, at times, I feel as though I am not being thorough.

[CareBayer]

gardenmum-I've gotten into the habit of popping in on all of my patients first thing as well. That way I can at least chart safety and pain. I have tried to chart as I go, but on days like today....three of my patients were leaving the floor for tests first thing, so I wanted to get their assessments done.

[jjjoy, LPN]

I realize nursing schools want to teach the most comprehensive and thorough assessments and that's fine. However, once they teach that, the schools could then teach focused and integrated assessments - in other words, examples of 'real-world' assessments. I had one, just one, instructor that had us 'round' on each other's patients. It was a good experience because we got exposure to many more patients and focused on the most pertinent issues... as opposed to the four page, minimun 20 minute assessment that we were required to do on our patients that covered EVERYTHING from patient financial status to bowel habits. While I understand the intention of teaching students to not take anything for granted or overlook any possible problem area, it did seem a bit strange to both student and patient to ask a patient in for bowel obstruction or MVA how often they see a dentist and what their usual sleep patterns are. We had to go through all the neuro checks on without neuro risks and check bowel sounds on patients without any risk for bowel issues. And were supposed to check elbow and knee reflexes as well! As if that's something most bedside nurses have time for!! There's a difference between the type of head-to-toe assessment you would do in primary care for yearly physical versus a fresh post-op patient. My school never formally addressed that difference. It was up to any one individual instructor to pass on any of their own tips or tricks and personal judgement. So of course, one instructor would chastise you for NOT assessing this or that and another would accuse you of not being judicious in what you took the time to assess. Poor instructors, though, who perhaps had to demand these long assessment forms be complete & pages of care plans if they disagreed with the utility of such exercises.

[Spatialized]

I should make a caveat: I usually don't end up charting assessments until much later. I write plenty of notes, more stuff to jog the memory than anything else, and come back to it. I think this allows me time to assess, pass meds, do change dressing, other nursing tasks until everyone is asleep. Sometimes I end up charting my first assessment and vitals at the same time as my second, others it's done early. It just depends.

I work nights too, so yes, we don't always have the luxury of baths, but usually we're in the room multiple times before the patient goes to sleep. I will prioritize my patients, who needs the most in-depth, and who needs a quick once over. This allows me to focus on who needs the most attention vs. those who don't.

Cheers,

Tom

[time4meRN]

Use critical thinking skills, focus on the general appearance of the pt first, do they appear well then go from there. What appears to be the no. 1 threat to the pt at that time. In ER, ICU you learn quick to do a rapid once over assessment, then move to less critical areas of the pt. Go into a pt's room knowing the DX and potential problems from the shift before. Do a quick once over, document and go back to the less problematic areas later. If you take too much time assessing everything , there many be a pt in the next room that has more immediant needs that you'll miss.... if your asking a 20 year old appy with no complications to squeez your hands and tell you what day it is.