to perfect health history taking and physical examination skills
to explore more continuing education units (CEUs) and attempt to expand networking options in order to gain more allies in the field, that can provide me with new
techniques and more extensive assessment skills as I get closer to graduation. It is important for me to utilize all of the avenues that I can and build a team of
colleagues that I can reach out to that may have more expertise than I do. Nursing is not only a career choice that requires continuous learning of new and improved
practices and techniques, it is also a career that has so many elements to it that a nurse/nurse practitioner is always learning something ‘new’ even if that new thing
has been around for twenty years! The main area that I feel I am going to improve on with advanced practice is connecting the dots between the
assessment/diagnosis/treatment and dosage. I have been a nurse for many years and there are still things that clinicians do that throws me off. Some practitioners
prefer certain medications over others and for the same situation a different clinician may treat the patient with a different medication. I am confident that I will
get into my own flow and my own preferences, but the reason behind those choices is what I need to solidify with my own personal research. As a nurse practitioner I
will be “a member of a team that has certain skills that other people don’t have and other people will have skills that other team members may not have. It’s important
to find a group and fir in as a team.” (Desborough, 2012)
Desborough, Jane L, Dip App ScNurs,Grad Dip Mid,. (2012). How nurse practitioners implement their roles. Australian Health Review, 36(1), 22-6. Retrieved from
http://prx-herzing.lirn.net/login?url=http://search.proquest.com.prx-herzing.lirn.net/docview/1022629676?accountid=167104

Student two
Two ways I will continue to perfect my health history taking and physical examination skills include continuing to: 1. use the best evidenced based resources to
increase my knowledge and 2. gain as much experience as possible interviewing and assessing patients. Continue using the Bate’s and Dain’s textbooks to supplement
knowledge regarding normal vs. abnormal findings you may come across. I feel this will help improve my diagnostic reasoning skills and allow me to reach more accurate
conclusions much quicker (Dains, Baumann, Scheibel, 2012). In addition, I plan to continue searching for evidenced-based practices that will allow me to become a more
competent expert. For example, to become competent Dains et al. (2012) recommends being able to:
• Identify the most important cues (by using techniques such as COLDSPA).
• Understand and perform advanced examination techniques.
• Test differential or competing diagnoses.
• See a pattern in the information gathered.
• Develop clinical judgment.
While Kessenich (2008) also recommends:
• Developing listening and questioning techniques that allow proficiency during the history taking.
• Explaining the role of the NP to patients, so they do not withhold information waiting for the “real” provider to come in.
• Not allowing busy schedules, disorderly work environment, and frequent interruptions to interfere with obtaining an accurate history.
• Not interjecting one’s own experiences to patients as they are sharing components of their health history.
• Keeping the relationship based upon the patient’s needs.
• Become an expert at assisting the patient to provide relevant information needed to formulate a differential diagnosis.
• Encourage patients to bring a list of major issues they would like to address during the visit.
• Summarize perceived issues with the patient before ending the interview.
Second, I also plan to gain as much experience as possible interviewing and assessing patients right away. I feel I will develop my clinical reasoning skills much
faster with practical experience. The knowledge I want to gain (knowing what to ask, becoming a focused listener, and using clinical reasoning skills, etc.) is
acquired only through spending time with patients and gaining experience in recognizing subtle cues (Dains et al. 2012).
Finally, my greatest strength in health history taking is my desire to learn to do things the right way in order to provide the best possible care to my patients.
While my greatest weakness in this areas is my lack of a strong science/A&P foundation, which is something I constantly have to work at overcoming.
References
Dains, J., Baumann, L., &Scheibel, P. (2012). Advanced health assessment & clinical diagnosis in primary care [VitalSource Bookshelf version].
Kessenich, C. (2008). The art and science of history taking. The Journal for Nurse Practitioners, 4(4), 304-305. doi:http://dx.doi.org/10.1016/j.nurpra.2007.11.008
Wolters kluwer health rolls out online video series on physical examination. (2014). Professional Services Close – Up, Retrieved from
http://search.proquest.com/docview/1509230813?accountid=159007