Volume 13, Issue 10, November–December 2017, Pages 681-686  https://doi.org/10.1016/j.nurpra.2017.08.012Get rights and content Assessment is considered the basis, or foundation, of health care. The act of gathering information about a patient is the first step in the nursing process. Adequate information from the patient drives the plan of care. The goal is to attain a comprehensive history and review of systems (ROS), if possible, on the first encounter with the patient. The evidence-based recommendations presented herein are informed by unpublished data from real-life experiences using a detailed ROS during an ongoing medical surveillance program of former nuclear weapons workers from a United States Department of Energy (DOE) site. Primary care (PC) is an essential element within the health care system. Nurse practitioners (NPs) are skillful at providing PC and acute care, and are often the first contact with patients. This initial contact may include discovering an undiagnosed sign, symptom, or health concern. Specific case causes can be difficult to determine. Therefore, we understand that medical screening is important in PC. Medical screening includes an ROS. Within the PC setting, patients seeking care are often There is growing attention in the scientific literature on the health care of a population, not just on individual patients. According to Kindig, population health is defined as “the health outcomes of a group of individuals, including the distribution of such outcomes within the group.”2(p1) Public health is the science involved in protecting and improving the health of families and communities.3 Medical screening often plays an important role in prevention of serious illnesses. It is also an The ROS is an integral part of an evidence-based nursing assessment practice. The use of some type of a ROS is widely accepted and recognized throughout health care.5 A ROS is a systematic list of questions arranged by organ systems that is useful in aiding clinicians to uncover clinical problems that may be at the root cause of a disease process and that may otherwise go unnoticed. The ROS serves as a guide to help identify potential or underlying illnesses or disease states subjectively, thus As a meaningful example to illustrate these concepts, the National Defense Authorization Act for Fiscal Year 1993 called for the DOE to provide ongoing medical evaluations, at no cost, to all former DOE federal, contractor, and subcontractor workers. The Former Worker Medical Screening Program is conducted within the DOE Office of Environment, Health, Safety and Security and has provided over 128,000 exams.9 This DOE program provides ongoing medical screening examinations for all former DOE This example of occupation and environmental issues that may be linked to patient problems underlines and illustrates clearly the importance that the PCP must place on completion of an accurate medical history. A detailed ROS should be included as this may be the only chance a patient has to have unsuspected problems properly detected/identified.12 The foundational part of PC has been described as resting on several essential components: the longitudinal, trusted relationship with the patient; A patient history and ROS are elements of the Evaluation and Management (E&M) history component. The US Centers for Medicare and Medicaid Services defines the ROS as “an inventory of body systems obtained by asking a series of questions in order to identify signs and/or symptoms that the patient may be experiencing or has experienced.”16(p7) There are 14 recognized systems making up the ROS. The provider asks pointed questions to coax additional and potentially important pieces of medical Electronic health records (EHRs) were mandated as part of the American Recovery and Reinvestment Act of 2009. We know that PC practices that did not implement EHR systems by 2015 had a 1% reduction in Medicare reimbursements.18 The benefits underlining the switch to an EHR system may be reflected in improved provider decisions and patient outcomes and better population and public health.19, 20 There has been some debate regarding the reality of EHR use within PC.21 When used correctly, EHRs may When viewed from an occupational and environmental perspective, it is clear that workplace exposures encompass a wide range of human disability and death in American society.22 When learning basic assessment formats or orientation in a practice that has patients who have high occupational or environmental risks, clinicians should be taught that abnormal complaints may arise from work-related asbestos-related diseases, silicosis, pneumoconiosis, lung nodules, obstructive airway dysfunction, There are many types of health care personnel involved in assessing and treating patients. As a result of a focus on identifying the importance of a thorough ROS, an increased emphasis may be built into didactic experiences regarding the ROS. Taking a detailed ROS should be included in objective structured clinical examination case studies. Through the experience of objective structured clinical examination, NP students can be involved in using the ROS as a key tool in driving decision-making Angela Phillips, DNP, APRN is an assistant professor at West Texas A&M University in Canyon, TX. She can be reached at [email protected].
Over the years, nursing instructors have utilized multiple active learning activities to assist students in developing competence in physical assessments. Supportive peer evaluation, use of video technology as well as the use of standardized patients have been recognized as important instructional strategies for assessing and evaluating student performance promoting deeper learning, improved self-assessment, stronger critical thinking skills, and better accountability. Teaching nursing students physical assessment is often done with the use of a structured ‘head to toe’ approach. But in addition to learning ‘head to toe assessments’, there is a need for nurses to complete a focused assessment of the systems that are presenting health challenges for the patient. There are several tools or cheat sheets available to guide both the comprehensive ‘head to toe' assessment and systems focused assessments but there are no tools outlining the process of doing focused assessments within a head-to-toe assessment. To address this need, one nursing teacher in a baccalaureate nursing program at a university in Western Canada decided to create a clinical support tool to guide learning of this critical clinical reasoning skill. Listeriosis is a rare but potentially deadly foodborne infection. Listeria monocytogenes is a common contaminant of food, and may cause severe disease in pregnant women, fetuses, neonates, the elderly, and those who are immunocompromised by medical conditions or treatments. Delay in treatment is an independent risk factor for neurologic sequela of L monocytogenes infection. A review of the literature, pathophysiology, epidemiology, clinical presentation, prevention, diagnosis, and treatment options is presented. The role of the primary care provider in prevention, patient education, and clinical management is reviewed. Academic program curricula have historically been mapped. It is proposed that a map can also be utilized to provide a visual overview for individual courses to meet professional and best practice standards. A course map serves as a visual representation to link course learning objectives to course assignment expectations and how the student can assess achievement. This article is specific to an online course, but the framework could be applied to any course. Chronic obstructive pulmonary disease (COPD) impacts 24 million Americans with annual treatment costs expected to exceed $50 billion by 2020. Effective treatment uses inhalers to deliver medications to the airways and lungs, preventing exacerbations associated with progression of COPD and accounting for much of the associated cost. Studies show up to 90% of COPD patients do not adhere to treatment plans or use their inhalers correctly. In this pilot study we looked at the feasibility of using an assessment tool to identify the habits and skills of COPD patients to tailor their patient education needs. An audiovisual approach was used to enhance COPD patient education. Angela Phillips, DNP, APRN is an assistant professor at West Texas A&M University in Canyon, TX. She can be reached at [email protected]. Arthur L.Frank, MD, PhD, at Drexel University in Philadelphia, PA. Collette Loftin, PhD, RN, is an assistant professor in the Department of Nursing at West Texas A&M University. Sara Shepherd, MAMS, is a database coordinator at the University of Texas Health Science Center in Tyler, TX. View full text |
Which is a component of the review of systems?
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