Creighton Abrams said: When eating an elephant, take one bite at a time. When I first started nursing, I was told to assess all my patients in one hour and then start my medication pass. However, I learned very early that it is impossible to assess all my patients before I start a medication pass.
One of the best pieces of advice I ever received from a fellow nurse was, “You have twelve hours to assess your patients.” That helped me realize that I don’t have to do it all at once. I do my assessments over time. If I know I have to take the patient to the bathroom, I will check the sacrum and the legs then. If I know that I have to clean the patient, I will assess them then. I listen to their lungs when they sit down or roll over.
There are two types of assessments. There is the full body assessment and a focused assessment. When meeting the patient for the first time, I assess what the patient came to the hospital for first, and then assess the full body afterward.
For example, Wilson came to the hospital for shortness of breath and was admitted for pneumonia. When first meeting Wilson, I will assess his lung sounds and respiration. While I have my stethoscope out, I will listen to his bowel sounds and heart. After seeing all my patients, I will come back and complete his head-to-toe assessment. However, for new patients that I am admitting, I try to do a head-to-toe assessment as soon as I can.
For new admission patients that are ambulatory, I offer to help them put on a gown and do their skin assessment at that time. After they change into their gown, I ask them to sit down so I can listen to their lungs before they lay in bed. After getting the patient comfortable in bed, I listen to their heart and lungs.
If the patient is non-ambulatory and I must slide them from a stretcher to the bed, the process is different. Usually, when sliding a patient over, the sheets must slide over with the patient. First, I roll the patient over to remove excess sheets. While rolling the patient, I assess their skin and listen to lung sounds while they are still on their side. After placing the patient in a gown, I finish my assessment.
Some nurses are very quick and chart their assessments while they are in the room. Of course, this only works if you are a fast charter. There are always tricks to get the assessment in without having to do it all at one time. As that wise nurse told me, we have twelve hours to do so.
Tip: Assess the patients as you go through your shift. Not every assessment must be done right away.
