Book Review: A Guide to Taking a Patient's History

Introduction

While practical nursing contributes a great deal toward gaining an understanding of how the job is done, investigating the scientific literature surrounding the profession can also be a valuable tool. Lloyd and Craig's (2007) article "A Guide to Taking a Patient's History" is a highly informative and useful collection of ideas important to the subject of patient history taking as it pertains to a key task of nursing. The purpose of this essay is to review the aforementioned article in order to gain insight and understanding by explaining the authors' argument. The essay will first summarize the article in an objective fashion to present the facts and the authors' position. The next portion, before concluding, will evaluate the article through a subjective critique of both content and presentation.

Lloyd and Craig's article presents a simple and systematic approach to history taking. The article suggests that nurses should model their approach to this subject by using a framework similar to the one presented in the article. This framework includes three key points that should generally govern any medical history inquiry: preparing the environment, developing communication skills, and following a proper order of inquiry.

Summary of the Article

In addition to these three key points, the article makes secondary suggestions for efficiently maximizing resources when conducting patient interviews. Validated training is recommended as a more reliable way of ensuring that this important nursing practice is maintained at a high level. The article also recommends that the standards presented in the NMC Code of Professional Conduct be used to ensure high quality in practice.

The article begins with important and succinct comments regarding the importance of preparing the environment before beginning any history-taking procedures. The authors suggest that "the environment should be private, quiet and ideally, there should be no interruptions. When this is not possible the nurse should do everything possible to ensure that patient confidentiality is maintained" (p. 42). The key point of communication is also addressed early in the article to establish what the authors consider foundational principles around which the history-taking framework should revolve.

Besides developing their argument, the authors present several helpful charts to guide the reader. Box 2 of the article outlines a history-taking sequence that can serve as a practical reference. The authors also incorporate the Calgary Cambridge Observation Guide's (CCOG) suggested models for constructing a consultation, recommending it as a useful tool to help nurses formulate a system suited to their individual needs.

The article continues to break down each step of the sequence, giving the reader the opportunity to understand what each piece of information might look like in a real-world situation. Each step is accompanied by important data and useful guidance relevant to that part of the framework. For instance, the description of the social history segment introduces key conversion factors to help quantify units of alcohol, and similar guidance is provided for tobacco use.

Box 2 of the article outlines the following eleven-step history-taking sequence as an approved system to support the authors' framework:

The History-Taking Sequence

1. The presenting complaint.
2. Past medical history.
3. Mental health.
4. Medication history.
5. Family history.
6. Social history.
7. Sexual history.
8. Occupational history.
9. Systemic enquiry.
10. Further information from a third party.
11. Summary.

The article concludes with a brief summary that reinforces its core argument — that it has presented a practical guide to an important task in the nursing profession. Key recommendations are reemphasized, and a list of references is provided for readers who wish to continue research on the topic. The Calgary–Cambridge Observation Guide is among the resources highlighted as particularly useful for nurses developing their own consultation framework.

Conclusion

This article is one of the more valuable pieces of writing I have encountered regarding nursing theory and practice. Its combination of sound theory and practical examples makes it useful on several levels. The article is long enough to explain its key points thoroughly, yet short enough to encourage the reader to conduct further investigation on the subject. This balanced approach is evident throughout the article and is representative of the authors' overall argument.

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