Assessment, a requisite skill of nurses at all levels of academic preparation, is the collection of “comprehensive data pertinent to the healthcare consumer’s health and/or the situation” (ANA, 2010, p. 9). Typical data include but are
not limited to the following domains: age, cognitive, cultural, economic, emotional, environmental, functional, organizational, physical, psychosocial, sexual, spiritual, and transpersonal.

Assessment is contextual. The type and amount of emergent data collected on a patient with a life-threatening gunshot wound in a fast-paced Level 1 trauma center will differ from that collected from an elderly patient who underwent a hip replacement and is being considered for discharge to home or a long-term care facility. The latter will additionally necessitate assessment of financial, family, and community resources, as well as the need for environmental accommodations in the home.

The relevance of context extends to role. For example, following transition from one shift to the next, an oncoming staff nurse will typically make patient rounds to conduct a brief assessment of patient status and to update the plan of care. This type of repetitive physical assessment provides the opportunity to anticipate or identify evolving changes in status. For the nurse manager, recurring errors drive the need to analyze outcome data for contributing factors and to review the literature for relevant interventions to change practice and improve quality of care. Nurse educators must assess not only how but also what staff nurses teach. Relevant data include the following:

Assessment is a continuous and iterative process driven by responses. The types and frequency of data collected from a patient with second-degree burns over 25% of his or her body changes over time and are analyzed differently. For example, an immediate goal may be pain relief requiring frequent assessments for adequate and sustained pain management. Over time, concerns about body image, physical function, and discharge to home will take on new urgency and will require the collection of broader types of information to secure appropriate interventions for those evolving issues.

Assessment varies according to the education and expertise of each nurse. Whereas new nurse graduates tend to think more linearly and to conduct
assessments that are driven by tools with standardized parameters (e.g., instruments that measure fatigue, cognitive status, performance status, etc.), the graduate-level prepared specialty nurse and advanced practice registered nurse (APRN) are expected to critique the reliability and validity of assessment tools and to recognize gaps necessitating the addition, adaptation, or development of more contextually relevant tools that may be better suited to existing patient conditions, co-morbidities, or culture, as well as the changing demands of an organization for more technologically relevant assessment options.

Finally, assessment knowledge and skill requirements will change in relation to the demands of society, the need to translate new research into practice, and the changes in the dynamics of the healthcare system. One example concerns the rapid growth in society’s understanding the relevance of cancer genetics and genomics for individualized risk assessment and the use of this information to guide decision-making around genetic testing and the use of targeted biologic treatments. In this instance, the cutting-edge nurse of today is expected to collect sufficient data to elicit a three-generation family health history and to construct a pedigree from this information using standardized symbols. The information can then be used to identify individuals at increased risk for disease and possible candidates for referral for genetic counseling. The graduate-level prepared specialty nurse and APRN would be expected to collaborate with genetic counselors and other specialists to develop and implement a plan of care that incorporates the genetic and genomic assessment information (Consensus Panel on Genetic/Genomic Nursing Competencies, 2009, p. 12).

A second example concerns the more contemporary focus on patient-and family-centered care. Whereas all nurses must ensure that patient and family values, preferences, expressed needs, and knowledge of the healthcare situation are considered in treatment planning, the graduate-level prepared specialty nurse and APRN may additionally examine the appropriateness of existing models of patient-centered care for selective use in particular units, departments, or organizations.

In the nursing process, assessment includes not only data collection but also synthesis of that data. Synthesis combines data elements to construct a coherent whole. All nurses are expected to synthesize complex information and to identify and prioritize problems and trends. Then nurses are expected to use the information to plan, provide, and direct care that maximizes health outcomes for patients and families; to improve knowledge and skills among staff
members; and to enhance organizational capacity to provide safe, high-quality, and cost-effective care. At the heart of synthesis is a foundation of formal theoretical and scientific knowledge that is informed by experiential knowledge garnered from exposure to many particular clinical situations (Benner, Sutphen, Leonard, & Day, 2009). One’s background frames what is attended to and how data are prioritized. Hence, nurses with greater experience and advanced education are expected to be able to recognize and efficiently correct gaps in information, to recognize salient data and trends, and to apply theoretical models in ways that enhance their ability to enable rapid and highly targeted responses to patient, practice, and organizational problems.

Nursing students should receive structured and systematic teaching and evaluation of clinical assessment skills. Current nursing education programs facilitate this process in both academic and clinical environments. The use of laboratory options for student-to-student interviewing and physical assessment, the use of simulation technology, and the use of volunteer patients or “standardized patients” (often for intimate physical examinations) allow learners to practice, make mistakes, and learn from their mistakes without patients suffering adverse clinical consequences. The use of laboratory options, simulation technology, and volunteer patients also offers more control over the learning experience. However, transferring this learning to real patients requires that educators attend to such factors as similarity of physical characteristics between the learning and the practice settings, approximation of sensory stimuli, and ability to maximize students’ perception that the simulation is a surrogate for the real experience (Teteris, Fraser, Wright, & McLaughlin, 2011). The use of standardized patients, though expensive, can smooth the bridge between simulation and clinical practice settings, as well as offer invaluable real-time guidance and feedback on student skills (Jha, Setna, Al-Hity, Quinton, & Roberts, 2010).