Assessment is the mainstay of nursing, it is the basis of all ongoing plans. It informs, and if robustly undertaken with the patient at the centre, can be facilitative in many ways. It relies on the holistic overview of the individual at a point where they are at now, prior to current touchpoint with healthcare services, as well as where they are anticipating that the they will will be going forward.
It is possible to slip into siloed thinking with some frameworks, as although often holistic completing does not necessarily facilitate a consideration of how they interlink, one aspect impacting on the other - that comes with practice and skill. Whilst models are helpful, they are not to be undertaken in isolation, without fully understanding how systems are linked. This informs the questions to be asked and being mindful of the matrix of enquiry creates the holistic overview.
What is being assessed, and guiding the assessment process is paramount, as without self-awareness, it is possible to limit the assessment with assumption and misguided focus. If for example someone is coming into the healthcare with a physical issue, the focus for the individual may be the psychological impact that is most disruptive, whilst being resilient to a condition that may have been an aspect of their lives for some time, or not deemed as consequential.
With all nursing, the assessment is so crucial in fully understanding what is going on for the individual. How their current presenting issues impact on the day to day functioning in their lives, it is essential to fully understand, and also to explore ability is an appropriate element.
The assessment is a powerful multi facetted tool requiring skill and knowledge - embrace it from the first day of nursing and all the rest will fall into place in all paths that open up to you.
I read recently an advisory, suggesting that looking back over achievements and adversity whilst considering the key benefits and challenges can support forward planning. This is in understanding better what the elements were that brought you to be where you are today and how these may take you forward. When it referred to looking back, it meant with a lens of self evaluation, not pointing fingers of blame or crediting others, but really seeing what the internal response was and how this affected the outcome. Look out for patterns that may emerge and what you might have done differently for taking forward, and again, whether there is a pattern to that too. Are there new skills needed? Elements of emotional intelligence that need work? Are there common situations that bring out the best/worst in you? All questions that support positive change, but also define recognition to flag any potential repetition in the future.
Reflection can be really positive, but it is essential, to glean benefit from it to do so with a self-awareness hat on, to derive emotional intelligence and learning.
I have been reflecting very much on systems and aspects that we have as well as the part we all believe we have to play within it. Everyone has a varying viewpoint and may not realise, positively or negatively, the impact that they have. Is the bit that we do needed anymore, or is it time to evolve? Have we evolved and we hadn’t seen this until we are reviewed at some point?
I have been fascinated also about the thought of systems being circles within circles, all interconnected and having a shared goal, however responding in a unique way. This unique response is indeed a pebble in a pond and the ripples, even those subtle ones are felt. There are many theorists who interlink systems, sociology and psychology, which is to be expected as we are holistic beings. With this is mind we need to consider our actions carefully, and plan for what may be an improvement in one area, but detrimental to another. This is why organisations need to recognise that targets are sometimes misleading in identifying progress. Thinking big, looking outward, finding your links in the system, allow for a collaboration in a shared understanding, where change is inevitable and actions fluid.
There is also something about how we are viewing this system - is it viewed as the earth once was, as a flat disc? Or is it more of a global view that we understand now, rounded and deep, equality all round? Take the first scenario here, if we are working horizontally then we are only seeing one level, this is not inclusive, and may involve a group of people that could potentially be a far cry from the interface of provider and user interaction. All could be excellent work but not connected at all levels. The global concept provides depth, equality, an understanding that if something happens underneath the surface there is a reaction at the top - like a volcano. Because of observations and communications globally we are able to understand, plan and make provision with a better shared knowledge and ability to respond. Also, as with the natural world, the fluidity of change can at times be predictable, but this is invariably abundant in unpredictability also.
So whichever part of a system you are in, consider who is in the global circle around you and keep moving outwards, communicating, identifying, building, trusting...