1. Kennedy, Maureen Shawn MA, RN, FAAN


The importance of nurses' role in patient assessment.


Article Content

A critical aspect of nursing is patient assessment. Indeed, it's the first step of the nursing process we learn in nursing school and the cornerstone on which nursing interventions are based. Two articles in this month's issue highlight the importance of nurses' role in this process.

Figure. Maureen Shaw... - Click to enlarge in new window Maureen Shawn Kennedy

In the April original research article, "Identifying Hospitalized Patients at Risk for Harm: A Comparison of Nurse Perceptions vs. Electronic Risk Assessment Tool Scores," Stafos and colleagues examined how nurses' perceptions of harm risk compared with risk scores generated by an electronic risk assessment tool. Increasingly, nurses rely on electronic systems to flag when a patient's health parameters are outside the norm. But how accurate are they?


The authors reviewed data from twice-daily safety huddles on three units of a 504-bed metropolitan acute care community hospital and compared nurses' judgments of patients' risk of harm with the risk assessment tool's finding of risk. Nurses' ratings were found to be significantly different from those of the electronic tool. "In situations where the electronic tool cited risk and the nurse perceived no risk, the risks were currently being addressed in the plan of care. In situations where the nurse perceived higher risk than the electronic tool did, the nurse often cited behavioral or psychosocial issues." These issues-which included confusion, delirium, end-of-life issues, and family dynamics, among others-often lacked defined data points in the electronic health record and thus weren't captured by the risk assessment tool. Nurses' keen assessments of these factors can make the difference in enabling nurses to achieve successful outcomes for patients, and this study is a reminder that risk prediction based on algorithms of electronic systems is in its infancy. It also reinforces the need for nurses to have input into designing electronic health systems.


In the spirit of Earth Day, another example of the importance of nurses' role in evaluating those at risk for harm can be found in this month's special feature, "Climate Change and Mental Health," which focuses on people at risk for psychological harm from climate-related events and situations.


Despite the claims of many who discount the evidence, there is global scientific consensus that we are witnessing drastic shifts in our climate. And these effects will only worsen as temperatures continue to increase, resulting in rising sea levels as polar ice caps melt and in more frequent and severe storms, tornados, and floods.


Images and interviews of disaster survivors on news reports all too vividly show the devastation and disbelief of the victims, whose euphoria at surviving with their family intact is quickly replaced by the reality of having their homes obliterated, often with no warning and with little time to gather their belongings. On our cover this month, a young boy surveys the muddy debris that was once his grandmother's home in West Virginia; it had been washed away last summer by floodwaters. (See On the Cover for more.) His is only one of the millions of families that have been uprooted; in some cases, whole communities have been destroyed. While many people choose to rebuild in place or nearby, others move elsewhere, and with the loss of friends and familiar social support systems, the mental health toll can be crippling. Disaster survivors can suffer from posttraumatic stress disorder, anxiety, and depression; the elderly and children are especially vulnerable to postdisaster stress.


The psychological effects of climate change aren't limited to those caused by disasters, as the authors of this article explain. The effects from gradually occurring changes, such as increased temperatures, which have been associated with increases in violence and depression, can also be insidious. Long-term drought can cause anxiety and depression as water sources dwindle and crops fail. And for those who have chronic physical or mental health problems, disaster- or climate-induced factors can exacerbate the psychological stress they may already be experiencing.


As nurses, we will encounter patients at risk for harm, whether physical or psychological, in EDs, clinics, and primary care settings. Whether we are working in an institutional setting or out in the community, our ability to use our knowledge of the physical and psychosocial sciences to ask the right questions and evaluate people and situations with a critical eye can help put our patients on the path to recovery.