Essay: Secondary Assessment Tracy Folsom

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[. . .] (Dean & Mulligan, 2009)

In Miss Folsom's case, her neighbor was the primary witness. With the first contact with a health care worker, it would be important to inquire about the scene and the situation in which Miss Folsom was found in. Before considering any rescue measures, it is important to move to the next step of secondary assessment to help analyze the patient's risks. (Dean & Mulligan, 2009)

Analyzing risks are important before attempting to practice any hands-on assistance. This is so that the risk verses benefit debate may be conducted. In Miss Folsom's secondary assessment, it was concluded that her head injury needed to be further investigated immediately, even though her primary complaint was severe epigastric pain. The case of Miss Folsom is a perfect example of the fact that the most obvious complaint may not be the most serious. The secondary assessment tool has been designed to review each system. Information about a secondary complication or more evidence to support a primary diagnosis can be achieved with a systemized approach. (Swash & Glynn, 2007)

Nurses form the largest healthcare workforce. A large part of the demands of patient care is centered on the work of nurses and hence, the care that they provide ultimately determines the quality and safety of the entire healthcare team. Based on different patient needs, nurses integrate their knowledge, skills and experience to care for various patients. Understanding the need for patient centered care, and engaging in strategies to improve its outcome, is paramount to higher-quality and safer care. High-reliability organizations that have cultures of safety and capitalize on evidence-based practice offer favorable working conditions to nurses and are dedicated to improving the safety and quality of care. (Reason, 2000)

Offering a supportive environment for nurses has a great contribution to make in providing quality care to patients. Factors involved in increasing the liability of error can be classified as early or late. Early factors may include missing important points or not understanding the big picture. Late factors include system errors, a heavy workforce, and the working environment. Leadership and staff organizations can create new latent factors through re-scheduling, inadequate training and outdated equipments. When the numbers of risks or hazards are traced down to its root case, it ultimately leads to latent defects in organization and the working environment. (Reason, 2000)

The working environment in a health care facility stems like the branch of a tree. The stem of the tree is the organization that creates protocols. Stemming from the main stem are many branches which comprise of different work groups, for example, technicians, laboratory assistance, radiologists, nurses and physicians. For each group is a leader who supervises workers working under them. For the management of a patient, a collaborative effort of all groups is needed. This urgent need for interaction amongst the various groups creates a gap for iatrogenic injury and management delay. (Lake, 2002) For example, if one technician was responsible for collecting samples for blood sugar and another was responsible for collecting samples for Complete Blood Counts, infections could result from multiple pricks.

Organizational factors have been considered the "blunt end" and represent the majority of errors. Therefore, to prevent such errors from occurring, the environment in which healthcare workers work need to be adapted to their cognitive strengths and weaknesses and should be designed to ameliorate the effects of whatever human error occurs. (Reason, 2000) Junior staff members should be encouraged to seek help and assistance from the main stem employees and should be supervised at all times. In an efficient system, each worker knows what to do and when to do it. For each emergency, first, second and third line respondents need to be assigned before hand. (Lake, 2002)

An ideal model of care should be able to provide nurses with a satisfactory working environment and should consist of a patient centered approach. According to the Institute of Medicine (IOM), safety of patients is dependant upon health care systems and organizations, and patients should be safe from injury caused by interactions within systems and organizations of care. (Institute Of Medicine, 2001)


Canadian Medical Association. (2007, July). Putting patients first ®: patient-centred collaborative care a discussion paper. Retrieved from

Dean, R & Mulligan, J, 2009, 'Initial management of patients in an emergency situation', Nursing Standard, vol. 24, no. 5, pp. 35-41, (Academic Search Complete).

Gilbert, G., Souza, P., & Pletz, B. (2009). Patient assessment routine medical care primary and secondary survey. San Mateo County EMS Agency, 1-5. Retrieved from

Institute of Medicine. (2001) Crossing the quality chasm. Washington, DC: National Academy Press.

Lake E. (2002) Development of the practice environment scale of the nursing work. Index.Res Nurs Health.134(6):264 -- 7.


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