The nursing assessment is a process of collecting, organizing, and interpreting data about the patient’s health status in order to assess their needs for nursing care. The nurse gathers information from multiple sources to determine how well the patient’s physical, emotional, social, and spiritual needs are being met. This information is used by the nurse to plan care that will meet these needs and promote holistic healing.

The content of the nursing assessment will vary depending on the purpose of the assessment and the type of patient being assessed. For example, a psychiatric patient may be assessed using different tools than a post-operative surgical patient would be. A nursing assessment typically includes:

• History of present illness
• Health history (family history)
• Past medical history (including surgical history)
• Review of systems (ROS)