The evidence base for individual patient and client assessment by community nurses

Abstract

There is wide recognition that patient and client assessment by community nurses is central to the provision of high quality care. It is also acknowledged that assessment in the home setting is a complex process requiring a wide range of knowledge and skills. This article identifies two distinct approaches to assessment that have emerged in different contexts around the world. These approaches comprise the formal, structured questionnaire-based assessment that has been developed particularly in response to the requirement to determine service eligibility and the informal, conversation-based assessment that draws on nursing concepts and theories.The article briefly traces the professional and policy influences that have shaped the development of these two approaches before turning to a critical analysis of selected empirical work that has examined their effectiveness. Research undertaken on the structured form of assessment has focused largely on issues of reliability. While the majority of studies indicate that this form of assessment is reliable in identifying patient need, some research highlights its failure to take account of patient and client perspectives.This raises questions about the appropriateness of the nursing interventions that are planned in response to a structured assessment. Less research attention has been devoted to exploring the conversation-based approach to assessment, but this body of work has drawn attention to the potential for practitioners to adopt a controlling influence over the assessment process. Reference is made to research in which the author has collaborated that illuminates the way in which two styles of conversation-based assessment impact differently on patients and clients.The article concludes by identifying the need for further research and argues that a key focus should be the ways in which assessment contributes to care planning and patient outcomes. © 2006, Cambridge University Press. All rights reserved.