Physical assssments

[UKPedsRN]

Hi,

I am a UK trained nurse who worked for years in the US, now I am back here in the UK, and have always been struck by the fact that floor nurses here do not complete an assessment of their patients at the start of the shift and Q4 hrs, which I was used to doing in the US.

As part of my course at University, I have to write a reflective essay and also give a presentation. I thought that I might look at why assessments are part of a nurses duties in the US, but not here in the UK.

Personally I feel that we should be doing them here (myself and my family may not have suffered, if nurses had done them here, and complications would have been possibly prevented or reduced) Anyway, I would love to hear from UK nurses who are now working in the US and having to do them. Do you think that completing patient assessments Q4 hrs, or more frequent - is beneficial or not. Do you think that it impacts the quality of care the patient receives, and how does it impact your view of how you nurse and how others view you.

On a personal note, I think that I felt more like a professional, and that it gave me more creadance when discussing patients with the interprofessional team. I would love to hear your views!

Thanks

[Silverdragon102, BSN]

The assessments I did was different but I didn't have time (when there is only 2 RN's for 30 patients not easy) That didn't mean I couldn't see when there was a problem. and act accordingly

[UKPedsRN]

The comments I hear from patients generally indicate that they do not interact much with their nurses. I appreciate that it is difficult to complete an assessment with only 2 RN's to 30 patients, but surely this makes the point. If a nurse spend time with her patients, completing an assessment it gives the patient the impression that they are interacting with the nurse, and the nurse is quick off the mark, when a change occurs with the patient."Seeing or sensing" is the problem, and maybe why we are not always seen as professionals by other discplines. If we took time out to assess each of our patients, then we have concrete information to pass on, and not just "intution"

[Silverdragon102, BSN]

I would find time to talk to the patients as I worked, I would assist in basic hygiene when ever I could, always had a chat with them when doing the medications, but when you have wards working on minimum staffing it is hard to do everything especially when the paperwork is getting out of hand, management moaning because there is a shortage of beds and targets set by the government

[XB9S, BSN, MSN, EdD, RN, APN]

I have to be honest I know nothing about nursing in the US, however from what I have read here we nurse very differently. Just because we don't listen to heart and lung sounds does not mean we are not assessing our patients, we are assessing them differently. For example you don't have to listen to the lungs to recognise changes in the respiratory system, we use other tools and methods of assessment. Even our medics do not do full clinical examinations every day, a complete assessment is done on admission then focused assessments daily, with more detail if the conditions change.

Although our staffing ratios are not brilliant, they are not 2 to 30 patients. We usually have 5 to 30 patients with 3 health care support workers.

I would disagree about us not being seen as professionals by other disciplines, most of the doctors, pharmacists, and physios I work with have a great deal of respect for the nurses on our wards. We work well as multi disciplinary team.

I am not saying it's perfect here but I am not sure that you can compare the 2 as we work so very differently.

[Ginger's Mom, MSN, RN]

I have work with UK trained nurses and their physical assessment skills were all top notch. I know they had to review this from the NCLEX but there assessments were from years of nursing experience. From what I have read UK nurses don't have a formalized nursing assessment but they certainly have the skills.

[karenG]

nurse practitioners spend a lot of time learning how to do physical assessments. the chest physician who taught us how to do chest examinations told us that the history should always give the diagnosis.. laying a stethascope on a patients chest very rarely added anything to your diagnosis! have to say he is right.. at least in the setting i work in. In primary care, we are always being asked to listen to childrens chests just in case they have a chest infection- they never do! most adults with chest infections.. you can usually tell from the history and watching them..

just something to think about..

[cariad]

the nurses in the us do physical assessments, but not always as rigourosly as they make out, i have seem many nurses, who listen to lungs bowels, feel for pulses etc but sometimes not long enough to be actually listening, and as a night nurse follow many instances of incorrect documentation, and although its all tick boxes, its still what each nurse personally thinks the answer is, one nurse may tick that movement is impaired the next nurse doesnt see the patient that way and sees that although the patient has a physical impairement that they can move easily, both nurses use skills and intuition to assess their patients as well as their stethescope, uk nurses do personal care which is also a hands on assessment even although its not documented the same way as in the us. its difficult to make comparisons, we all just have to do what we think is our best practice for our patients whether in the us or the uk.

[Zana2]

I thought that I might look at why assessments are part of a nurses duties in the US, but not here in the UK.

Crickey!

Trusts have physical assessment tools, have a look in their policies.

[RGN1]

As a new nurse in Canada I too had to learn to listen to breath sounds, bowel sounds etc. We do them usually q shift unless otherwise specified. Does it make me a better nurse?? Not really!!

I wouldn't have been able to do them with the pt load I had in the UK anyway! Even if I had done, I don't think that I have picked up anything extra by doing them.

Like others have said - I could hear/see a pt in resp difficulty & didn't need a stethoscope to tell me that!

I religiously do my "vitals" here but it hasn't added to my nursing skills, in my opinion - I had those skills already I just used them differently.