What is the nurse’s primary source of information when obtaining a patient history?

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What is a primary source?

A primary source in science is a document or record that reports on a study, experiment, trial or research project. Primary sources are usually written by the person(s) who did the research, conducted the study, or ran the experiment, and include hypothesis, methodology, and results.

Primary Sources include:

  • Pilot/prospective studies
  • Cohort studies
  • Survey research
  • Case studies
  • Lab notebooks
  • Clinical trials and randomized clinical trials/RCTs
  • Dissertations

  • PubMed This link opens in a new window

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    Major index to articles covering all aspects of medicine.
    Finding Primary Sources: After conducting your search, check the boxes for Clinical Trial, Controlled Clinical Trial, and/or Randomized Clinical Trial under Article Type in the left sidebar.

  • CINAHL Complete This link opens in a new window

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    Literature in nursing and allied health disciplines, 1937 to present.
    Finding Primary Sources: Under Publication Type, select Clinical Trial and Randomized Clinical Trial. (Hold down the CTRL key to select multiple items in the list)

  • MEDLINE This link opens in a new window

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    Provides authoritative medical information on medicine, nursing, dentistry, veterinary medicine, the health care system, pre-clinical sciences, and more.
    Finding Primary Sources: Under Publication Type, select Clinical Trial, Controlled Clinical Trial, and Randomized Clinical Trial. (Hold down the CTRL key to select multiple items in the list)

What is a secondary source?

Secondary sources list, summarize, compare, and evaluate primary information and studies so as to draw conclusions on or present current state of knowledge in a discipline or subject. Sources may include a bibliography which may direct you back to the primary research reported in the article.

Secondary Sources include:

  • Reviews, systematic reviews, meta-analysis
  • Newsletters and professional news sources
  • Practice guidelines & standards
  • Clinical care notes
  • Patient education Information
  • Government & legal Information
  • Monographs
  • Entries in nursing or medical encyclopedias

Secondary Sources

  • PubMed This link opens in a new window

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    Finding Secondary Sources: After conducting your search, select the Systematic Review filter in the left sidebar on the results page.

  • Cochrane Library This link opens in a new window

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    A collection of regularly updated, systematic reviews of the effects of health care.
    Search Tip: Keep the search simple. If your topic is "Should women be given hormone replacement therapy" - search for Hormone Replacement Therapy.

What is your primary source of information when obtaining a patient history?

Primary sources of information are attained from the patient themselves (i.e., physical assessment and patient report of symptoms). Secondary sources include family members and the health record.

Which primary source of information would the nurse use when completing a patient's assessment?

The primary source of data collection during the nursing assessment is the patient. Other sources include family, friends, caregivers, and other members of the healthcare team. Data are also collected from laboratory or diagnostic reports, the patient's medical records, and the nurse's observations.

What is the nurse's primary source for data collection?

What is the nurse's primary source for data collection? The nurse's primary source of data is the patient; however, there may be times when it is necessary to supplement or rely completely on another for the assessment information.

What is the primary method of obtaining patient data?

The main methods used to collect data are health interviews, physical examination, and observation.