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Course: Health Assessment�Unit Title: Performing an assessment:

Environmental considerations

Sara Culling, RN, MSN, CPN

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Learner Outcome:

At the completion of these modules the learner will demonstrate knowledge and skills to perform a complete health assessment of an individual.

Module Objectives:

List environmental considerations
Describe how to prepare the environment for collecting a health assessment
Explain how the environment can influence the quality of the data collected during the health assessment

Module Goals

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Environmental Considerations-Privacy

Privacy:

Respects the dignity of the patient.
Reduces infection
Can have legal implications
HIPAA

Consider:

Age and development of patient
Cultural backgrounds

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Providing a private environment will help establish trust with your patient, thus allowing them to feel more comfortable with your assessment. Giving your patient privacy is important for maintaining patient dignity as well as reducing infection. In the US, patient information must be kept private under the Health Insurance Portability and Accountability Act. Age considerations with privacy are important, especially with teenagers, who may be embarrassed or unwilling to share certain information in front of their parents. Patients who are developmentally delayed may need a family member or representative present to feel comfortable and help give an adequate history. Cultural backgrounds of patients must also be taken into account. For example,, in some cultures, a female is not allowed to be alone with a male.

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Environmental Considerations--Lighting

Lighting is important for safety

Allows nurse to accurately observe patient
Helps patients maintain sleep-wake cycle and circadian rhythm

Safety issues related to lighting:

Falls
Eye strain
Assessment mistakes
Task related mistakes

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Environmental Considerations--Room temperature

Affects patient comfort

Too cold

Shivering
Increased demands on body
Falsely lowered body temperature

Too hot

Sweating and spread of germs
Falsely elevated body temperature
Bacteria growth (if too humid)

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Environmental Considerations--Safety

Organized equipment

Emergency set up
Medication safety
Monitor alarm limits

Fall prevention

Consider age and developmental status of patient

Infection prevention

Clean environment

Patient identification

Always use 2 patient identifier
Do not use room number as a patient identifier

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Equipment should be organized and easily accessible by staff. If appropriate, emergency equipment, such as oxygen, ambu bags, and suction, should be readily available and easy to access in the event of an emergency. If medications are required, the nurse should be able to administer them safely, following the rights of medication administration. IV tubing or feeding tubes should be labeled to prevent errors. If a patient is being monitored on an electronic monitor, the nurse is responsible for ensuring that the limits are set correctly. Another safety consideration is fall prevention. Falls in an assessment environment should be prevented by lowering the exam table, ensuring the area is free of tripping hazards. Small children may need to be held and confused adults may need supervision. Assessment environments should be clean to help prevent infection. There should also be a system in place to correctly identify patients.

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Environmental Considerations-Noise

Can be distracting

Calming sounds promote patient comfort

Quiet environment enhances communication, allows nurse to accurately hear patient

Age considerations:

Neonatal development
Older adults

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What would the nurse do?

You are getting a room ready to assess patients. List five environmental factors you will consider. What things can you do to modify factors that may be out of your control?

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Preparing the environment

Goal is to provide a safe environment to assess patients.

Establish privacy

Space free from interruptions, unable to be overheard
Area for patients to change into a gown, if necessary

Ensure good lighting

Open blinds if able to provide natural light
Ensure lights in the room work
If working at night or in low light areas, carry a flashlight

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Preparing the environment

Control the temperature

Fans can be used if it is too warm
Provide blankets if it is too cold
Consider opening a window if able

Control noise

Turn off tv or radio during assessment
Assess patients in an area away from loud talking

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Preparing the environment-Safety

Emergency equipment is organized and easy for staff to reach and use

Set up rooms in a similar fashion
Check monitor alarms

IV lines are organized to prevent confusion and medication errors

Label tubing and/or pumps

Patients are easily identified

Name bands on patient

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Preparing the Environment

Ensure environment is safe from fall risks and tripping hazards

Children are held or have cribs/beds with side rails up
Older adults or confused patients are supervised
Tripping hazards such as cords are eliminated and organized
Educate patients about safety risks to involve them in care

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What would the nurse do?

You are tasked with designing a room in which to assess patients. Sketch the room, label potential safety hazards and how you would address/limit them.

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Environment influence on patient assessment data

Privacy-affects patient history and willingness to share.

Lighting-affects nurse’s visual assessment of the patient & patient’s visual acuity

Temperature-room temperature can influence temperature of patient

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Factors such as privacy, lighting, noise, and temperature affect patient status and influence nurses’ judgement. If the area is not private, patients may be embarrassed to share their concerns or information about their lifestyles due to an unwillingness to be overheard. Good lighting is required so the nurse can adequately assess the patient’s skin for color, integrity, rashes, etc. Lighting is also important when testing patient’s eyesight. The temperature of the room can affect the patient’s temperature. If the room is cold, the patient’s temperature may also be on the cool side. They may also develop goosebumps. Cold temperatures will also make the body expend extra energy. Conversely, if it is too warm, the body temperature may be falsely elevated. A patient may be sweaty and it would be unknown if this was due to the environment or the actual patient condition.

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Environmental influence on patient assessment data

Organized equipment

Easily accessible in an emergency
Prevents medication errors
Prevents mis-identification

Clean environment

Infection prevention
Fall prevention
Promotes patient trust and comfort

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Environmental influence on patient assessment data

Noise-loud environments make it hard to communicate

Have a negative effect on infant development

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What would the nurse do?

Consider this picture of a temporary hospital that has been set up to provide care to injured children in Haiti.

Describe how the environment will affect the children’s health and well being.

Make a list of supplies that the nurse will need to maintain a health environment for the children

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Additional learning resources

Gimenez, M, et al. (2016). Patient room lighting influences on sleep, appraisal and mood in hospitalized people. Journal of Sleep Research. 26(2), 236-246. Online at

https://onlinelibrary.wiley.com/doi/full/10.1111/jsr.12470

Henneman, E.A. (2017). Recognizing the ordinary as extraordinary: Insight into the “Way We Work” to improve patient safety outcomes. American Journal of Critical Care, 26(4), 272-277. doi:10.4037/ajcc2017812

Contact info: info@nursesinternational.org

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Additional learning resources

Martin, S (2018). Safe Environment (Pediatric). Elsevier Clinical Skills. Retrieved online at https://lms.elsevierperformancemanager.com/ContentArea/NursingSkills/GetNursingSkillsDetails?skillid=CCP_201&skillkeyid=946&searchTerm=environment&searchContext=home

Seifort, P., & Hickman, D. (2005). Enhancing Patient Safety in a Healing Environment. Topics in Advanced Practice Nursing 5(1). Retrieved online at https://www.medscape.com/viewarticle/499690_6

Contact info: info@nursesinternational.org