History

A Review of lloyd and Craig 2007

The following review examines Lloyd and Craig’s (2007) framework and provides an evaluation of its proposed benefits. Summary of Article According to Lloyd and Craig (2007), taking a patient history is arguably the most important aspect of patient assessment. Because of the continually expanding role of nurses, the need exists to expand their assessment skills as well. In this article, Lloyd and Craig provide a detailed framework for conducting a patient history assessment. First, Lloyd and Craig believe it is important to prepare the environment so that it is properly equipped, safe, free of distractions, and allows the patient to feel comfortable. Second, nurses must practice effective communication in order to enhance trust and obtain the most accurate information from the patient. Nurses can use both verbal and non-verbal cues to signify interest and empathy for the patient. Finally, consent is essential and nurses must obtain some form of informed consent by the patient or patient’s surrogates before proceeding with the assessment. Lloyd and Craig then outline the history-taking process and illustrate the importance of maintaining some form of order when asking questions. Questions should begin in an open-ended format in order to generate conversation and obtain a large amount of information. Nurses can then follow up with closed questions to receive more detail about a particular point of concern. Lloyd and Craig draw on the Calgary Cambridge framework for structuring the consultation. This model proposes five stages of history taking, including: (a) explanation and planning. (b) aiding accurate recall and understanding. (c) achieving a shared understanding. (d) planning through shared decision making. and (e) closing the consultation. This model provides a systematic order to guide nurses’ assessment-taking. While Lloyd and Craig advocate following an order, these authors also highlight the importance of following the natural flow of conversation. Simply reading off a checklist of questions seems mechanical and impersonal, and can prevent the patient from wanting to reveal personal information. Therefore, Lloyd and Craig suggest using their framework as a practical reference, and not a step-by-step operations manual. Lloyd and Craig also provide examples of behaviors to avoid while conducting a patient history assessment. Examples of such behaviors include giving advice, interrupting, using defensive responses, jumping to conclusions, and several more. Improper interview techniques can disrupt communication and trust, and ultimately hinder the nurse’s ability to treat the patient. Respect for each patient’s individuality and rights as a human being is a critical component of most nursing associations’ codes of ethics. Finally, Lloyd and Craig include examples of key points to remember in the history assessment, including family and occupation history, drug and alcohol use, sexual history, and family and social history. These can be difficult questions to ask and patients may not always feel comfortable answering them. Therefore, effective communication and establishing a positive rapport with the patient is vital to the consultation. At the same time, these difficult questions reflect the importance o

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