Guide to Taking a Patient's History

538 Words3 Pages

Chamberlain College of Nursing

NR294: Health Assessment

A Guide to Taking a Patient’s History The article, A Guide to Taking a Patient’s History, was written by Hillary Lloyd and Stephen Craig (2007) and published in the Art & Science Journal Vol 22 No 13 in December 2007. The focus of the article was to present a practical guide to history taking using a structured systemic approach with the rationale of preventing incomplete patient assessments which may result in inadequate care and adverse outcomes. The article did not specify a population but was geared mainly towards taking the history of an adult patient. Some of the steps are general and could be used for anyone but would require alteration and incorporation of other skills when dealing with pediatric patients. Lloyd & Craig (2007) presented several strategies and tools that would be beneficial in improving the abilities of the nurse as a history taker, if they are learned early and incorporated and used in regular practice. The tools include examples of non-verbal and verbal communication skills, history taking sequence, examples of unhelpful interview techniques, cardinal symptoms, equivalent units of alcohol, the CAGE system and approximate calculation of tobacco. Structure, using a systemic approach and the practitioner’s proficiency in assessing and communicating were some of the strategies suggested. In evaluation, this article is very basic but can be very useful to nursing students or used as a refresher for nurses who are returning to work after a long period of inactivity. The article sparked very little interest in me, except for its British base because I was trained under the British system in the West Indies.

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