Chamberlain College of Nursing
NR 305: Health Assessment
Journal Article Review
Taking a patient’s history is an essential part of the caring process that a nurse performs. In a 2012 article entitled: Taking a patient’s history: the role of the nurse, Fawcett & Rhynas (2012) highlight the importance of a once described function, history taking, as a “remir of medical colleagues” (p.42). This function, history taking, has become a major part of a nurse’s role since the advent of the nursing process in the 1970’s. The aim of the article is to promote and enhance the necessary skills in obtaining comprehensive patient history, via both the patient-centered approach and effective communication, over time. The authors suggest that this approach fosters the patient-nurse relationship, allows for the nurse to gain better insight into the patient for the patient’s perspective, and ultimately develops into the best collaborative identification of the problem, formulation of a plan of care that produces the best possible outcome for the patient.
Summary of Article According to Fawcett & Rhynas (2012), in order for nurses to get to know their patients better, they must employ a patient-centered approach(p.42), a position, advocated by the Victorian State (Australia) Department of Health in 2001 & 2009, as well as the Scottish Department of Health in 2010(p.42). The authors subscribe to the thought that nurses must master the skills necessary for effective history taking. These skills include the encompassing and acknowledgement of the patient’s medical, social, physiological, and biographical realm. The biographical data, according to Fawcett & Rhynas (2012), assist the data collector, “to fill in the gaps about a patient and his or her family, allowing interactions to be person-centered” (p. 44). Valuable data collection is achieved via effective communication and casual interviewing skills, coupled with the nurse’s understanding of cultural competence as he or she incorporates “the social, cultural, and psychological factors that may play a role in the illness”. The authors consider these points to be of immeasurable value as this is how a patient is brought to ease of mind as his or her fears are allayed (p. 44 - 45). The authors argue Fischer Pearls journal article(1995), that explains the difference between medical model and the nursing model as it relates to history gathering as doctors “make a history”, and nurses “take a history”. The suggestion is that doctors collect data that is heard and recorded and leads to their formulation of a diagnosis and plan, whereas nurses hear the information, makes observations, employs measures of intuition, over time, in periods of “short exchanges” (p.43), incrementally and cumulatively, to identify “the problem and it’s causes from the patient’s perspective”(p. 42). Data may be gathered from the patient, the family, the care giver and also from review of medical records. The authors cite Kale (2001) in the expression of history taking as “a performing art learned at the bedside” (p.42). They also cite Gask and Usherwood (2002), who suggest that the center of efficacious history taking is “skilled and patient-centered communication through which rapport is established between the nurse and the patient” (p.42).
Calgary-Cambridge framework for effective communication is:
I- Initiating the session by: establish the initial rapport, and identify the reasons for the consultation.
II- Gathering information by: Exploring the patient’s problem, understanding the patient’s perspective, and providing structure to the consultation.
III- Building the relationship by: Developing a rapport, and by involving the patient.
IV- Providing structure to the interview by: Summarizing, signposting, sequencing, and timing.
V- Explanation and planning by: providing the correct amount and type