Do contemporary patient assessment requirements align with expert nursing practice? a narrative review.

Main Article Content

Paul McLiesh
Philippa Rasmussen
Rick Wiechula

Keywords

Documentation, expert practice, nursing assessment

Abstract

Objective: This paper discusses contemporary patient assessment requirements and how they articulate with expert nursing practice.


Background: Contemporary patient assessment requirements are intended to standardise the conduct, collection and documentation of patient needs and risks. Current assessment requirements are designed to be applied uniformly for both expert and novice nurses’ alike to ensure consistency in the process and documentation of assessment. The requirements for patient assessment have grown in complexity over time but there is a paucity of evidence that considers how those requirements impact the work of expert nurses.


Discussion: This discussion paper reflects on individual aspects of these issues such as how experts develop their practice, the elements of assessment requirements, how and why assessment requirements have changed over time. Expert nurses develop practice over time that is shaped by exposure to a wide range of clinical scenarios and learning experiences. Expert practice is partly defined by an ability to quickly identify key elements of a patient’s condition based on past experiences where the expert has learnt to recognise and predict patterns of care needs. The literature identifies a number of risks inherent with current assessment requirements, many of which are poorly recognised. Disproportionate focus on documentation compliance can reframe nurses’ practice away from assessing patient needs towards the process of assessment documentation instead. A lack of flexibility in assessment practice risks reducing the expert nurses’ ability to respond to the individual needs of a patient and tailor care uniquely designed for their needs. Repetition and duplication of data collection unintentionally embedded within the assessment process, risks impacting the efficiency of practice and serves to increase expert nurses’ frustration with the process. The complexity of assessment documentation was also seen to hinder the process of informing clinical judgement and may cloud the nurse’s ability to recognise risks not specifically included in the mandated assessment tools.


Implications for research, policy and practice: This discussion highlights specific elements of expert practice and compares that to contemporary assessment requirements. Further research is needed to specifically measure the time impact of current assessment requirements on nurses. Feedback from expert nurses regarding the value of current requirements and what changes would positively impact their practice and satisfaction levels is needed. This would assist in refining assessment requirements to ensure that current requirements suit nurse’s practice, ensure the efficiency of expert nursing practice, maximise nursing satisfaction, and limit loss of nurses from the profession while maintaining safety of practice.


What is known about the topic?



  • The purpose and process of patient assessment has been thoroughly investigated over time.

  • There is a significant body of knowledge and evidence that supports the use of standardised patient assessment documents.

  • The value and nature of expert nurse practice has been widely explored in existing literature.


What this paper adds:



  • Recognition that unintended risks in contemporary assessment requirements such as duplication and complexity of data collection has the potential to reduce the efficiency of nursing practice.

  • Acknowledgement that assessment requirements are seen by some expert nurses as impacting safety, are burdensome and have the potential to reduce nursing satisfaction and retention.

  • Recognition that a disproportionate focus on assessment documentation compliance has the potential to shifts nurses’ priorities away from the purpose of assessment onto the process instead.

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