Respiratory Assessment In Nursing

Respiratory assessment is a significant aspect of nursing practice. According to the National Institute for Health and Care Excellence, respiratory rate is the best indicator of an ill patient and it is the first observation that will demonstrate a problem or deterioration in condition (Philip, Richardson, & Cohen, 2013). When a respiratory assessment performed effectively on a patient, it can result in upholding patient’s comfort and independence in progress of symptom management. Studies have acknowledged that in spite of the importance of the respiratory rate (RR) it is documented rarely than the other vital signs in the hospital settings (Parkes, 2011). This essay will highlight the importance of respiratory assessment and discuss why nurses

often overlooked the respiratory assessment and suggest what can be done to educate nurses about the importance of respiratory assessment.
Respiratory assessment is one of vital components of a patient’s health assessment and it is an essential implement in the management of the patient (Duff, Gardiner, & Barnes, 2007).

Ascertaining the adequacy of gaseous exchange is the major purpose of the respiratory assessment. The components of respiratory assessment comprises of rate, rhythm, quality of breathing, degree of effort, cough, skin colour, deformities and mental status (Moore, 2007). RR is a primary indicator among other components that assists health professionals to record the baseline findings of current ventilatory functions and to identify physiological respiratory deterioration. For instance, increased RR (tachypnoea) and tidal volume indicate the body’s attempt to correct hypoxaemia and hypercapnia (Cretikos, Bellomo, Hillman, Chen, Finfer, & Flabouris, 2008). The inclusive use of a respiratory assessment on a patient could lead to numerous potential benefits. Firstly, initial findings of respiratory assessment reveals baseline data of patient’s respiratory functions. Secondly, if the patient is on respiratory medication such as salbutamol and ipratropium bromide, the respiratory assessment enables nurses to measure the effectiveness of medications and patient’s compliance towards those medications (Cretikos, Bellomo, Hillman, Chen, Finfer, & Flabouris, 2008). Thirdly, it facilitates early identification of respiratory complications and it has the potential to reduce the risk of significant clinical

complications such as atelectasis, pneumonia, pulmonary embolism, pneumothorax, exacerbation of COPD, exacerbation of asthma and respiratory depression (Duff, Gardiner, & Barnes, 2007). Moreover, the tachypnoea is a specific forecaster of severe adverse events such as cardiac arrest and unintended admission to intensive care unit (Parkes, 2011).
According to a research, one of main reasons for nurses to neglect the respiratory assessment is lack of education and lack of emphasis regarding the respiratory assessment and their importance. It also explains the nurses’ attitudes in related to use of stethoscope and integrating respiratory assessment in the daily clinical practice is another obstacle to perform holistic health assessment. A research found that RR was the least recorded variable, while pulse, blood pressure and temperature were recorded more frequently (Parkes, 2011). In a five-year research of nursing observation on ward setting carried out in Kent and Medway, England revealed that in 2002, 72% of patients’ RR was failed to recorded while it was 24% in 2006 (Smith, 2008). Another, cause for nurses to neglect respiratory assessment is their lack of confidence to perform a respiratory assessment competently. The physical assessment is a traditional medical skill that embedded into the current advanced nursing practice; hence it assists to disrupt the confidence of senior nurses in general as it is utilizing the time at the expense of fundamental nursing care (Wheeldon, 2005). Additionally, it also suggests that health care professionals, specifically nurses are generally depending on machinery when assessing vital signs (Parkes, 2011).
According to a research that conducted in UK, senior nurses believe that due to the excessive paperwork and automated assessment respiratory assessment has suffered critically and it has led to deskilled staff in clinical assessment.

Additionally, the clinical staff has shown very low level of confidence in the RR documentation on observation chart. Lack of time, laziness, lack of training and knowledge and unawareness of the importance of the respiratory assessment are main reasons to neglect this important aspect of nursing as stated in this study (Philip, Richardson, & Cohen,

2013).

It is essential to address this overlooked problem and propose solution to eliminate this in hospital settings. Studies and mainly outlined that it is crucial to enhance nurses awareness regarding respiratory assessment and its’ importance. Specifically, nurses should receive a proper training to carry out a comprehensive respiratory assessment competently on a patient. Respectively, the training should be focused on building the ability to identify respiratory changes in acutely ill patients and to implement interventions accordingly (Philip, Richardson, & Cohen, 2013). It is necessary to advise them that measuring pulse oximetry is not an alternative for RR. Hospital system protocols and procedures should be reviewed to emphasise the compliance to documentation of RR. Consequently, it will lead to promote the nurses confidence and accurately maintain the documentation of RR is the clinical environment as per guidelines (Cretikos, Bellomo, Hillman, Chen, Finfer, & Flabouris, 2008).
In conclusion, the RR is the best indicator for early identification of deteriorating condition, thus nurses often neglect to assess respiratory rate. This is mainly due to the nurses’ poor awareness of the respiratory assessment and its importance and it has also lead to lack of confidence among them. However, this problem can be eliminated by enhancing their knowledge regarding respiratory assessment and its’ importance and by providing a competent training.