COMPLEX HISTORY TAKING AND PHYSICAL EXAMINATION IN NURSING PRACTICE
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Introduction Identification of factors determining nurse’s performance of a comprehensive history taking and physical examination. Material and methodsThe material was collected in a group of 828 nurses and nursing students. Inclusion criteria were: practicing as a nurse or studying in the field of Nursing, passing training in Physical examination and voluntary compliance for participation in the study. The authors used the diagnostic survey method, with the application of their own questionnaire. Obtained results were statistically analysed. Results In practice, only 42.8% of nurses declared that a comprehensive interview and physical examination of a patient had been carried out. Respondents pointed out difficulties in the implementation of history taking and physical examination in nursing practice, i.e. low support from doctors, nurses, management and lack of time/excess of responsibilities, lack of knowledge and skills, lack of acceptance by patients, lack of appropriate equipment/rooms. Training of nurses, doctors, management staff, increasing the nursing staff, reducing and their duties, the possibility of cooperation/consultation with a doctor, adaptation of premises along with their appropriate equipment, and patient education may contribute to the liquidation of the above mentioned difficulties. Conclusions Little support from doctors, nurses and lack of time due to an excess of responsibilities are a major factors in the failure of nurses comprehensive history taking and physical examination. Training of nurses, doctors, and management staff in the scope of nurse’s competence, increasing the number of nurses, adapting the rooms and their appropriate equipment are elements that can motivate nurses to conduct independently history taking and physical examination of patients.
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