“A Guide to Taking a Patient’s Health History”: Article Summary and Evaluation

Introduction

Hillary Lloyd and Stephen Craig (2007) wrote the article “A guide to taking a patient’s health history” to delineate the process and rationale through which a patient’s health history should be taken in a clinical setting. The article was published in ‘The Nursing Standard Journal’ in August 2007. Apart from providing readers with this outline, the article describes several different methods that nurses should use when taking and developing a comprehensive history of the patient’s health. The author’s focus is mainly based on the process of preparing the appropriate environment for taking a patient’s health history. It emphasizes issues like communication skills and the order of taking information from patients. Noteworthy, the article suggests that the rationale and methods therein can be applied in any healthcare setting.

Article Summary

The article states that the process of obtaining accurate and comprehensive information about a patient is a difficult task in the fields of healthcare and nursing. Nevertheless, the process is one of the most important tasks for nurses and clinicians seeking to understand the degree, cause, and nature of the disease they are managing¹ (Crumbie, 2006). The authors argue that lack of a comprehensive history of the patient’s health may hinder the provision of the most appropriate care and medication required to manage the disease in question.

The aspect of the environment in which a patient’s health history is taken is an important point of focus in the article. According to the authors, the environment must be practical in nature. As stated by Crouch and Meurier (2005) and cited in the article, the environment should be characterized with a number of features such as accessibility, freedom from interruptions, a high degree of safety for nurses and patients, and availability of the proper equipment or facilities². In addition, the environment should include a private setting in which the nurse or clinician takes information from the patient in order to ensure that patient’s confidentiality is provided.

According to the article, nurses and clinicians should consider cultural factors when creating a good environment for history taking. It ensures that a good client-nurse relationship is developed where the nurses are required to involve a non-judgmental way of extracting information from their patients. Cultural factors such as beliefs on health and practices, handshakes, eye contact, and body posture should be considered because they have different meanings in various cultural groups within the society.

Thirdly, patients should be given adequate time to give their stories in their way. The article emphasizes that nurses or clinicians involve active listening, which maintains a good communication process. In fact, the authors indicate that listening is the most critical part of the interaction because it provides the nurses with the appropriate way of extracting the most relevant and correct information from their clients.

Evaluation

The article has provided nurses and clinicians with a good and summarized source of knowledge on how to draw information from patients. It takes into consideration a number of factors that present problems and opportunities in a clinical setup. For example, the nature of the environment in which information is collected is an important issue in real health settings. Since most settings lack information on how to conduct the process, the article summarizes the right conditions that need to be considered.

Secondly, the article indicates that the information obtained from the patients should be relevant to the disease or condition in question. As the patients narrate their story, nurses should capture the information that relates to the past medical history, which includes diagnosis, dates, processes of management, sequence of the condition and outcomes of the management processes.

As a nursing student, I find this article interesting because it has discussed some of the most critical problems I expect to encounter in my profession. For instance, it emphasizes the collection of information on health history, social history, family history, work, and education history as well as marriage history in order to develop a good understanding of the condition, which determines the appropriate action³.

The issue of mental health is also cited in the article because some patients may be unable to provide the relevant information about their conditions. According to the article, about one in four patients is likely to have mental health problems. In this case, the article requires nurses to apply their professional knowledge and experience to deal with such patients.

Therefore, this health assessment strategy is beneficial to professionals and students in clinical medicine and nursing. As a nurse, I expect to adopt this assessment process in most of my work. Nevertheless, I expect more research to be done in this area to define the process that nurses should follow in the future rather than reading the whole article to extract information.

Conclusion

This article shows that the collection of information about the history of the disease from patients presents one of the most important but difficult processes in diagnostic and management procedures. It argues that obtaining the right and proper health history from the patient depends on the professionalism applied, such as the ability to develop a proper environment, obtain the rightful and relevant information and apply diligence and knowledge.

References

Crouch, A., & Meurier, C. (2005). Vital notes for nurses: Health assessment. Oxford: Blackwell Publishing.

Crumbie, A. (2006). Taking history. In M. Walsh (Ed.), Nurse Practitioners: Clinical Skill and Professional Issues (pp. 14-27). Edinburg: Butterworth Heinemann.

Lloyd, H., & Craig, S. (2007). A guide to taking a patient’s history. Nursing Standard, 22(13), 42-48.

Footnotes

1. As it is also stated in Walsh’s Nurse Practitioners: Clinical Skill and Professional Issues (pp. 14-27).
2. Crouch and Meurier agree with the information provided in the article written by Lloyd and Craig.
3. Check page 43 in the article by Lloyd and Craig for more information.