TYPES OF ASSESSMENT

The type and scope of information needed for assessment are usually determined by the health care setting and needs of the client. Three types of assessment are comprehensive, focused, and ongoing. Although a comprehensive assessment is most desirable in initially determining a client’s need for nursing care, time limitations or special circumstances may dictate the need for abbreviated data collection, as represented by the focused assessment. The assessment database can then be expanded after the initial focused assessment, and data should be updated through the ongoing assessment process.
Comprehensive Assessment
A comprehensive assessment is usually completed upon admission to a health care agency and includes a complete health history to determine current needs of the client. This database provides a baseline against which changes in the client’s health status can be measured and should include assessment of physical and psychosocial aspects of the client’s health, the client’s perception of health, the presence of health risk factors, and the client’s coping patterns.
Focused Assessment
A focused assessment is an assessment that is limited in scope in order to focus on a particular need or health care problem or potential health care risks. Focused assessments are not as detailed as comprehensive assessments and are often used in health care agencies in which short stays are anticipated (e.g., outpatient surgery centers and emergency departments), in specialty areas such as labor and delivery, and in mental health settings or for purposes of screening for specific problems or risk factors (e.g., well-child clinics). See the accompanying display for sample questions used to assess a client experiencing labor.
Ongoing Assessment
Systematic follow-up is required when problems are identified during a comprehensive or focused assessment. An ongoing assessment is an assessment that includes systematic monitoring and observation related to specific problems. This type of assessment allows the nurse to broaden the database or to confirm the validity of the data obtained during the initial assessment. Ongoing assessment is particularly important when problems have been identified and a plan of care has been implemented to address these problems. Systematic monitoring and observations allow the nurse to determine the response to nursing interventions and to identify any emerging problems. The nurse delivering care to a client at home uses ongoing assessment. In the home, the nurse often has to direct the client to provide information relevant to the current problem, as the client may have a tendency to spend a lot of time telling stories of past medical problems and treatment, as opposed to providing information relevant to the situation at hand (Humphrey, 1994). Use of specific questions will be most helpful in eliciting specific information.