HLTH6121 Principles of History Taking and Physical Assessment
This module is designed to prepare nurses, midwives and allied healthcare practitioners with the additional skills in History Taking and Physical Examination (specifically the skills of inspection palpation and auscultation) across all major body systems. The module is appropriate for anyone who seeks to practice enhanced patient/client assessments with a higher level of autonomy. These skills are the foundation for Advanced Practitioner education for those undertaking roles such as Advanced Practitioner, Specialist Practitioner, Consultant Practitioner or Emergency Care Practitioner. They are also essential skills for anyone undertaking Non Medical Prescribing. The skills are also of value to many ward and community based nurses seeking to enhance the quality of the assessments that they undertake on patients in their care as part of their regular nursing, midwifery or allied health professional roles.
Aims and Objectives
To equip you with a) a deeper level of knowledge, ability and critical awareness in relation to patient/client history taking and recording, and the ability to differentiate normal vs abnormal findings. b) a foundation level of skills and critical awareness in relation to the systematic physical assessment of patients/clients across the lifespan, and the ability to differentiate normal vs abnormal findings. This will be underpinned by a deeper knowledge base in relation to relevant/applied anatomy and physiology.
Having successfully completed this module you will be able to:
- Demonstrate knowledge, skill and judgement in patient/client consultation, including data gathering, data processing and communication, and be able to critically appraise the place of these skills and underpinning knowledge within the context of an holistic health assessment.
- Demonstrate knowledge, skill and judgement in the physical assessment skills of inspection, palpation, percussion and auscultation across major body systems, and critically consider the application of these skills and their underpinning knowledge in the context of care delivery across the lifespan
- Distinguish, articulate and justify findings of ‘normality’ and ‘deviations from normality’ in the assessment process, including those influenced by genetic, ethnic, physiologic, anatomic and developmental/lifespan differences, and demonstrate the ability to seek advice and/or make and justify credible referrals as appropriate.
- Demonstrate self awareness regarding the importance of maintaining respect for privacy, dignity and confidentiality when undertaking health assessment.
- Debate the contribution of the evidence base underpinning the implementation of history taking and physical assessment skills within the context of professional practice
- Critically consider the place of the skills of history taking and physical examination within the context of advanced clinical practice
This module's content is a key component of advanced practice programmes and pre-requisite for the Diagnostic Assessment and Decision Making and non-medical prescribing modules. Syllabus content is underpinned by extensive insights and feedback that has been gained during the 12 years over which this module has been run at academic levels 5, 6 and 7. It has also been informed by the considerable experience of the team which delivers the programme, which includes consultant practitioners, lecturer/practitioners and seconded practitioners alongside academic staff. The level 7 module lead has extensive experience of undertaking research in the field of advanced health assessment and advanced clinical practice, with her doctorate studies centred on the utilisation of these skills by nurses in the context of paediatric pre-operative assessment. A subsequent scholarship/study tour enabled her to explore how these skills are taught and assessed across a number of centres in the UK, Republic of Ireland, Canada and the United States. The level 7 deputy module leader is a Consultant Practitioner with considerable experience within nurse led health assessment within the UK health service. The level 6 module lead is currently undertaking her doctoral studies exploring how history taking and physical assessment skills are used in practice within an acute care environment. Extensive literature searching has further underpinned programme development, and use of core texts from both the US and UK (texts widely used across the UK and many other countries) ensures national and international transferability of the skills taught. A textbook adapted for UK use by the level 7 module lead is also a core text for the programme. Extensive consultation with purchasers and former students has also very helpfully informed the development of this most recent iteration of the module, with an extremely strong advocacy that in large part the content and format of the 2007 module be retained. The syllabus content is as follows: • Methods of undertaking a systematic, comprehensive health history across all major body systems and with people of all ages, using a range of different assessment tools and formats. Includes mental health screening. • Relevant anatomy and physiology, particularly ‘surface anatomy’, pertaining to all major body systems, including variations across the lifespan, and variations occurring as a result of gender or ethnicity. • The role of the ‘general survey’, including inspection of hands, nails, hair, skin and face, as a core assessment process which underpins and integrates the physical examination. • Utilisation of the physical examination skills of inspection, palpation, percussion and auscultation across the lifespan and to assess all major body systems (including respiratory, cardiac, gastro-intestinal, genitor-urinary, neurological and musculo-skeletal systems, as well as inspection of eyes, ears, nose and throat) • Interpretation of assessment findings to enable the distinction between ‘normal’ and ‘abnormal’ findings, including variations of normality. • Making credible referrals in cases of proven or suspected abnormality. • Documentation of findings from all history taking and physical assessment processes • Contextualising of history taking and physical examination skills by critical analysis of different models and frameworks of health assessment. • Exploration of the place of history taking and physical assessment skills within the context of care delivery/advanced clinical practice • Exploration of legal, professional and ethical issues pertaining to the changing/blurring of role boundaries between and within different health care professions. • Critical consideration of the evidence base underpinning health assessment, role expansion and advanced practice. • Consideration of issues relating to privacy, dignity and confidentiality in the context of health assessment.
In order to learn and practice the skills taught on this module, you have the opportunity to work in small groups of three to five with an instructor, and practice the examination skills on each other. With consent, you can therefore expect colleagues to examine your neck, head, back, chest (females upper chest only) abdomen and limbs. Guidance re appropriate clothing (e.g. swim/sportswear) will be given. Underwear is never removed and small group practice is screened. Every effort is made to ensure privacy and dignity, and ground rules are set on day one. Participation in the ‘patient role’ is not compulsory, and if you have individual concerns you are invited to discuss these with the module leader.
Learning and Teaching
Teaching and learning methods
The module uses a wide variety of teaching and learning methods. The emphasis is very much on the importance of self directed learning, accompanied by a considerable emphasis on skills rehearsal. Atypically, you are encouraged to identify a core text as the basis of your learning, and to supplement this by accessing other texts, relevant journal publications and on line resources. You are also encouraged to explore and critically consider the evidence base underpinning the utilisation of these skills. Learning is also supported by your access to the on line blackboard learning environment, which includes core and supporting learning materials, and video demonstrations of the skills being taught. You are strongly encouraged to read relevant hand outs and book chapters before each session, and to revisit these materials after each session, to maximise effective learning and consolidation. You are also strongly encouraged to identify mechanisms by which you can practice the skills taught, both within your professional working environment and informally. Much of the study time allocated to the programme needs to be used for skills rehearsal to ensure effective learning and execution of the skills taught. Importantly, although skills and knowledge are examined at the end of the programme, and a required standard must be reached, successful completion of the course does not confer confirmation of competence. Rather, it is acknowledged that competence is context specific, and also normally takes considerably longer to achieve than the total length of the programme. You are therefore given guidance regarding how competency can be achieved within your own practice setting after the course is completed. A wide range of teaching and learning methods will be used, and are likely to include: • Lectures • Demonstrations • Supervised skills practice on peers • Audio-visual presentations • Quizzes • Self directed learning (including books, journals, audio-visual resources etc.) • E-learning (including use of Blackboard and other on-line resources.) • Supervised skills rehearsal within the practice setting. (The module is not formally assessed in practice but you are encouraged to develop informal arrangements to enable you to undertake supervised skills rehearsal/development within your particular clinical practice domain.)
|Wider reading or practice||72|
|Preparation for scheduled sessions||20|
|Practical classes and workshops||27|
|Total study time||250|
Resources & Reading list
Tortora,G. and Derrickson,B. (2011). Principles of Anatomy and Physiology.
You will need to have access to a copy of at least one of these core texts, or an equivalent text, for the duration of the course..
Lumley,J. (2008). Surface Anatomy: The Anatomical Basis of Clinical Examination.
McGee,S. (2012). Evidence Based Physical Diagnosis.
Jarvis, C., (2011). Physical Examination and Health Assessment.
Rawles,Z., Griffiths,B. and Alexander,T. (2010). Physical Examination Procedures for Advanced Nurses and Independent Prescribers.
Marieb, E. and Hoehn,K (2012). Human Anatomy and Physiology.
Henderson, M., Tierney,L., Smetana,G. (2012). The Patient History: Evidence Based Approach.
Jevon,P (2009). Clinical Examination Skills.
Fergusson,D. (2008). Clinical Assessment and Monitoring in Children.
Epstein,O., Perkin G., Cookson, J., & Watt, I. (2008). Clinical Examination.
These texts are particularly helpful in enabling you to explore the underpinning evidence base for some of the skills being taught..
Seidel,H., Ball,J., Dains,J.,Flynn,J, Solomon,B, Stewart,R. (2010). Mosby’s Guide to Physical Examination.
Rushforth, H (2009). (UK adapter) Assessment Made Incredibly Easy.
Hogan-Quigley,B; Palm,M and Bickley,L (2011). Bates Nursing Guide to Physical Examination and History Taking.
Bickley,L.S., Szilaygi,P.G. (2012). Bates’ Guide to Physical Examination and History Taking.
Multiple choice Test
|Objective Structured Clinical Examination||100%|
|Multiple choice Test||%|
|Objective Structured Clinical Examination||100%|
Repeat type: Internal & External