Adapted from my report on : The role of the Registered nurse in general practice

The role of the Registered nurse in general practice varies in some general practices
 the Registered Nurse conducts clinics, health assessments, chronic disease management
 programs, collaborates with Doctors and other health professionals. The Registered nurse also works on health promotion /prevention (ANF, 2005).
It is part of the competency standards for the RN in General Practice to conduct a comprehensive and systematic nursing assessment (competency standards, 2012). 
The Scope of practice in General Practice nursing is that in which nurses are educated, competent and authorised to perform (competency Standards, 2012)

The Registered nurse role in some practices conducts 
 health assessments
Aboriginal and Torres strait islander health checks
Health kids checks – 4 years immunisations
Well baby checks 
Health checks for medical examinations
Drug screening for mining and corrections examinations
Drivers licenses examinations
Support and counselling 

A key role for a General Practice is the maintaince of wellness as a positive state as well as incorporating the prevention of illness injury and disease, rehabilitation of those with chronic illness and reductions in the burden of illness in the community (RACGP, 2012)







Holistic nursing care looks at the psychological, environmental and spiritual needs of the patient as well as the physical (nursing standard, promoting excellence in nursing care).  Holistic nursing ensures the patient is treated as a whole human being and the impact of their illness on their quality of life and life style too (nursing standard, promoting excellence in nursing care).

Assessment is an integral part of nursing (Broome,2007).  Using the holistic approach the patients health would be considers in terms of his/her total function g (Potter & Perry)

Comprehensive nursing is care that is provided to the patient according to his needs in an appropriate continues dynamic pattern (Potter &Prerry ) 

A comprehensive holistic screening tool would include but not limited to  questions on 

Medical history
Age
Level of mobility
Nutritional status
Medication
Compliance with medication
Reasons for not taking medication
Mental state
Degree of dependence
Attitude towards health and illness
Lifestyle changes



Psychological
Problems and perceptions of quality of life

Continence status

Dental status
Immunisation status
Hearing
Health promotion
Social and family support
Environemtn – including but not limited too, heating, cooling, lighting, acsess to bathroom, falls risk
Home security
Financial status and benefit advise
Ability to access shops and social events 

Benefits to introducing a formalised comprehensive holistic assessment are effective preventative care that enhances quality of life, reduces unnecessary morbidity and mortality and improves health outcomes (RACGP, 2012).  Other benefits of introducing a more holistic approach include: offering a more comprehensive service, there are limited resources in Tennant Creek due to the remoteness counselling, spirituality, and overall wellness services are quite limited. Offering this service could be beneficial for people who need or want some help with their overall lifestyle and health.  Due to the overall limited services available for example a dietician, patients may benefit from talking to a PN about their overall diet and how it may be effecting there health, or looking at issues such as being able to mobilise around the house.  The PN may be able to make simple suggestions such as putting a hand rail in the toilet or help the person with a referral to a visiting Aged Care Assessment Team      (ACAT) team.  A comprehensive holistic screening tool would include but not limited to questions on

Medical history	Mental State
Age	Degree of dependence
Level of mobility	Attitude towards health and illness
Nutritional status	Life style changes
Medication	Psychological
Compliance with medication	Problems and perceptions of quality of life
Reasons for not taking medication	Continence status
Dental status	Immunisation status
Hearing	Health promotion
Social and family support Environment – including but not limited to, heating, cooling, lighting, access to bathroom, falls risk	Home security Financial status and benefit advise
Ability to access shops and social events

(Barry, 1996; Broome, 2007; Jenkins, Baker & White, 2009)

That a comprehensive holistic assessment would look at all aspects of her health and life

 Comprehensive nursing is care that is provided to you according to your needs (Potter &Perry, 2011) and the holistic component is an approach that considers the patients health in terms of their total function (potter & Perry, 2011).

In other words we wouldn’t just be looking at the wound but the whole picture The assessment would include objective measures such as height, weight, BP wound swab, general blood test, age, level of mobility As well as information on nutritional status, medications,  a medical history, history of the wound, mental state degree of dependence and attitude toward wound healing. (Benbow, 2011).

The assessment will also look at how the wound is impacting on your life, such as socially – does the wound cause embarrassment, does it have an offensive odour, is it painful? Does the wound effect your work for the same reasons? Is it difficult to get time off for dressing changes?

The assessment will also look at the wound itself, the location, size, depth, exudates, infections, pain, clinical appreance, as well as an assessment on the surrounding skin and weather it has been affected by trauma or irritations from repeated dressing changes and effects of exudates. And an assessment of pain, is it painful all the time does this affect the way you live your life, is it painful at dressing times does this affect the compliance with dressings?

The Comprehensive Holistic Assessment process would also provide some education on the process

of the wound, and wound healing and factors effecting the healing.  The assessment would be ongoing.  Once a full assessment is done, then treatment options can be discussed, if it was too painful at dressing time for example the pain relief can be provided 30 minutes before change of dressing or It may mean going on light duties at work to allow the leg to be elevated more often

The more information obtained during the Comprehensive holistic approach would be beneficial in providing an overall picture and treatment solution.  The assessment would be ongoing and change to reflect the needs of the patient.