@Arjuna,
Arjuna;94708 wrote:Well you may say we don't assess consciousness
I NEVER said that. All I said is that A+Ox3 is not an assessment of consciousness at all. It's not even an assessment at all of alertness. It's an assessment of a response to three questions, that are asked in uncontrolled, heterogeneous, and often leading ways, have no diagnostic value at all for dementia and yet less for delirium, and distract people from doing actually meaningful assessments. It's only useful if it's reassuring (i.e. x3) -- but if someone is not able to answer those questions, it's meaningless except to initiate further assessment.
You want to know if someone is delirious? Do attentional testing, like counting the months of the year backwards, at least to start (and get a timeline of their ups and downs in level of consciousness). You want to know if someone has dementia? Take a history, and do a full Folstein mini-mental state exam to start. You want to assess someone who is unresponsive? A Glasgow Coma Scale can help. You want to convince yourself that you've done an assessment but not actually have done anything? Ask A+Ox3 -- and believe me, I tell my students / interns / residents the same thing I've typed here.
Nurses DO assess level of consciousness. And the ones with good practice and complete documentation do more comprehensive assessments.
Arjuna;94708 wrote:A healthcare worker may use this format to quickly convey what the situation is, and what it's not.
People say all kinds of things, I could give you
plenty of examples from physician documentation ("vital signs stable", also meaningless -- someone can be dead and have stable vital signs); and this is one of those common practices that are bereft of clinical meaning. They quickly convey the patient's ability to answer those questions. They do not convey alertness, they do not convey consciousness, and they are limited even for orientation depending on the patient.
Arjuna;94708 wrote:The same person who does this kind of assessment may later be seen talking to a patient who appears to be completely unconscious... there are states of consciousness in which a person has awareness but can't respond.
That is true -- but tell me how A+Ox3 differentiates that kind of patient from someone in a true coma, someone cortically dead, or someone with true brain death.