THE NURSE AND THE NURSING ASSESSMENT
The nurse on the Interdisciplinary Team must rely heavily on both community health and primary care skills. One's idea of the "scope of nursing practice" must be very broad, as is evident from the following discussion. This perspective allows for numerous areas of collaboration with other Team members. Skill in acute care of the medically ill is sometimes useful here, but knowledge of more general health promotion is essential.
This chapter will describe a nursing assessment process taking place in the context of an Interdisciplinary Team evaluation. Some information can be included in written, pre-appointment questionnaires; some is easily obtained in Team discussion after the intake interview; and some may require direct investigation by the nurse.
The first area to be considered is the client's general level of wellness. Is the person healthy? This includes assessment of mental alertness, mood, level of comfort or distress, presence or absence of fatigue, and degree of physical endurance. These may or may not be independent of specific medical problems. Some people with long lists of medical problems appear and feel well; others have fatigue and malaise in the absence of disease. One must consider the perceptions of client, family, staff, and one's own direct impression (even if based on a brief observation). These may be contradictory, in which case the varying impressions should be noted.
Next, evaluate the person's gait and any physical limitations or adaptive equipment, such as a walker. Is there a history of repeated falls? A recent increase in falls? How and where do falls occur? What does this person want to do, physically, that he or she cannot do now? Direct observation of gait--walking down the hall with the client--can be invaluable when a gait problem is suspected. The physical therapist,