Introduction to Nursing and Allied Health ServicesCHAPTER 1

In earlier days of medical practice, the physician alone used to manage the patient care services by recording the patient identification demographic data, taking history and physical examination, dressing the patients for wounds and injuries, taking blood for testing, giving injection and dispensing medicines. And also used to give counseling the patient when to take the medicine, dose, when to see doctor and so on. In simple terms the doctor was doing the services of medical records, nurse, laboratory technician, pharmacist, social worker and so on. By this method, a physician can see only limited patients, while the number of patients who needed medical services was more. In order to meet the patient care services swiftly and efficiently, the need for some assistants arose. This need has created the allied healthcare professionals, one after one, emanated to assist the busy physician and allow him/her to deal with medical and complicated cases, which need medical background, while other allied professionals can contribute greatly to patient care service directly or indirectly with their area of expertise.

Nursing is a discipline, profession and an area of practice. As a discipline, nursing is centered around knowledge development. As a profession, nursing has a social mandate to be responsible and accountable to the public it serves.2

The explosion of scientific knowledge that followed World War II brought increasingly sophisticated and complex medical diagnostic and treatment procedures. In addition, increasing medical and healthcare costs provoked a trend away from treating patients in hospitals toward the provision of care in physician's private and group practices, and ambulatory medical and emergency clinics. What followed was an increase in the need for expertly trained healthcare delivery personnel lied professionals have taken the rest.

Allied healthcare workers are those specialized persons distinct from medicine, dentistry and nursing. They work in an environment of health care team to make the healthcare system function uninterruptedly and effectively. Evidently, these professionals, who will be associated with medical, nursing and other allied medical professionals in rendering 3patient care services directly or indirectly, need to have the fundamentals of medical related field's knowledge to enable to contribute effectively. This has become imperative to have a fundamental knowledge and skills of certain subjects, e.g. anatomy and physiology, medical terminology, pathology, laboratory, radiology, radiation therapy, pharmacology, pharmacy, oncology, psychiatry, medical psychology medical social work, medical records, and so on.

Are clinical healthcare professions distinct from medicine, dentistry and nursing. They work in an environment of healthcare team to make the healthcare system function effectively and efficiently uninterruptedly.

Depending on the country and local healthcare system, a limited subset of the following professions may be represented and may be regulated. All professionals/professional areas ascribed before belong to the ever growing group of allied health professionals and their subspecialties. The precise titles and roles in the allied health professions may vary considerably from country to country.

As a part of allied health profession, which is also know paramedical services, the paramedics generally learn besides their own selected specialty field, also learn subjects such as anatomy, physiology, medical terminology, medical records, fundamentals of diseases and diagnostic procedure. These are pharmacology, pharmacy, physical therapy, occupational therapy, optometry, nutrition (dietetics), and oncology, psychiatry, medical psychology and many more. Medical social 4work, public relations and medical secretary have besides condensed combination of the above stipulated subjects such as hospital management program to deal with the day-to-day administrative and patient care issues.

Medicine being dynamic and with advent of technology, the medical healthcare services are growing much faster and the patients and public expectation from the health institutions have also equally increased. Thus, the need for appropriate allied healthcare services has become essential. These services have been playing a vital role in taking away most of nonprofessional and administrative types of wok from the highly qualified medical professionals, helping them and allowing them to contribute in their specialized field not wasting time for nonmedical and for trivial jobs. Yet, in many ways the paramedics service cost much less than the highly paid specialists. This is not only cost effective, but much more than that, it contributes in swift and improved patient care resulting great service to general public.

The author has taken care to incorporate this chapter especially for the benefit of users of this Handbook. Which talk of general and special investigations that includes testing of laboratories such as pathology, microbiology, serology, biochemistry, radiology, diagnostic therapies, electrocardiography (ECG), electroencephalogram (EEG), ultrasound, computed tomography (CT) scan and magnetic resonance imaging (MRI). Investigations as such are vital part of dynamic medicine. Without these tests detecting, proper diagnoses would not have happened and without established diagnoses, there would not be in any remedial treatment. Precisely, appropriate investigation carried out in patient on time would reveal the health problem of the patient that will help the doctors and medical care providers to plan and treat the disease/injury promptly that remedies the sick and injured not only saves live, but also prevents further aggravation and complications. It is hard to measure dimension and role of investigation.

Pharmacology is the science that deals with the origin, nature, chemistry, effects and use of drugs. Pharmacist is the one who is licensed to prepare and sell or dispense drugs, and compounds and make up prescriptions. Pharmacopeia is an authoritative treatise on drugs and their preparations; a book containing a list of the products, used in medicines with descriptions, chemical tests for determining identity, purity and formulae for certain mixtures of these substances with statement of average dosage. Pharmacy is the place where the drugs are stored and dispensed by the pharmacists.

Drugs are chemical substances used in medicine, in the treatment of disease. A drug can have three different names:

Pharmacy is the health profession that links the health sciences with the chemical sciences, and it is charged with ensuring the safe and effective use of pharmaceutical drugs.

A physical examination including medical history helps in finding out the correct diagnosis. The information obtained help in interpreting to know whether the patient is normal or something wrong with his/her general health. The most important aspect of examination is to cautiously notice all the symptoms existed when something is wrong, e.g., blood pressure, pulse and respiration are high or low, etc. The history taking and physical examination to be brief or detailed depends upon the patient's condition and severity of his/her illness. One of the most important ingredients of a physician is how good in taking the history of sick and injured patient. Similarly a comprehensive physical examination involves evaluating from the patient's appearance, his/her way of walking, talking, and vital signs organs systems.

History taking is an art and this is done, in a general talk and in winning the confidence of patient; when patient realizes that giving the facts of his/her problem will help in quick recovery, the patient will be willingly divulge the facts. There is no hard and fast rule what to ask and what not to ask, the whole exercise is to get the right and pertinent information for arriving at an accurate diagnosis. This is done most often with patient himself/herself, in certain cases, where the patient is either unable to talk or not in a position to divulge due to his/her health, in pediatric patients, the patient attendant or accompanied person reveals the information. All these information is documented in a patient medical record that could be manual or electronic.7

A physical examination is an evaluation of the body and its functions using inspection, palpation (feeling with the hands), percussion (tapping with the fingers) and auscultation (listening). A complete health assessment also includes gathering information about a person's medical history and lifestyle, conducting laboratory and radiological tests and screening for disease that has to be recorded in a prescribed patient medical record or especially designed computer formats (screens).

A comprehensive medical history and physical examination provides an opportunity for the healthcare professional to obtain baseline information to arrive a diagnosis, if not final, at least tentative, which is a must for initiating appropriate treatment and about the patient for future use, and to establish a relationship before problems happen. It provides an opportunity to answer questions and teach good health practices. Early detecting a problem can help in achieving better and long-term good results.

There are several techniques which are used while taking patient's medical history, or during the physical examination. As a rule, the physician compiles the history by questioning the patient himself/herself. A physician should not invite specific answers. The volume and validity of information obtained through history taking are limited by the informants’ memory, intelligence and ability and willingness to communicate. The answer to a multiple questions may be consolidated into a single telling phrase. These techniques, which are used during the physical examination, such as palpation involves feeling the body using hands in order to assess size, shape, location and level of pain, etc. to visually assess parts of the body using the hands in order to assess color, shape, size, texture, etc. Percussion produces a sound by tapping or scraping a part of the body, which helps in determining the organ size and density. Auscultation involves listening to sounds produced by organs such as the lungs, heart or stomach. Carefully taken patient's history and detailed physical examination to be recorded manually or entered in the computer.8

While taking medical history or performing physical examination, the patient should be taken into confidence to feel free and provide factual information in the best interest of his/her health. The patient should be made comfortable and treated with respect throughout the examination. As the examination proceeds, the examiner should explain what he/she is doing and share any relevant findings. In certain instances, it is necessary to verify patient's statements by questioning a relative or friend.

The term diagnosis (from Greek ‘diagignosko’ to judge, discriminate) has several closely related meanings in medicine, which few of us take the trouble to distinguish in practice. Diagnosis means, first, the intellectual process of analyzing, identifying or explaining a disease. Diagnosis forms the subject matter of the branch of medicine called physical diagnosis. Secondly, in a somewhat more concrete sense, diagnosis means the explanation proposed for a given patient's problems. Thus, one speaks of ‘arriving at a diagnosis’ or of ‘making a tentative diagnosis of pancreatitis’. Thirdly, diagnosis is often used synonymously with disease or the name of a particular disease. ‘The diagnosis is multiple sclerosis.’ ‘Patients with this diagnosis often progress to renal failure.’

The method of the medical diagnostics is an empirical one based upon a few elementary techniques and a ‘memory bank’ of diseases and symptoms. A healthcare provider or medical student learns not only the characteristic features of hundreds of diseases, but also possible causes for each of the hundreds of diseases and causes for each of the hundreds of symptoms. By combining these two bodies of information into one, so to speak, vertical and the other horizontal—he/she learns to determine the most likely cause or causes for a given set of complaints 9or abnormalities. Starting with a specific problem such as chest pain/fever/loss of appetite/inability to urinate, the physician considers the full range of diagnostic possibilities (called, in professional jargon, the ‘different diagnosis’) raised by the problem.

The techniques used by the physician to group data for a diagnosis are embodied in the two procedures known history and physical examination. The history is the patient's own account of his/her experiences and observations of the illness—patient symptoms—elicited by careful, methodical questioning. Physical examination is the process whereby the physician seeks and observes objective changes and abnormalities the signs of illness. It is not generally appreciated by laypersons that in a typical case, a skillfully obtained history supplies both a larger number of diagnostic clues and more useful and specific ones that of the physical examination.

The scope and nature of the history and physical examination depend on several variables. The patient's complaints give direction and focus to both history taking and examination. The physician's field of specialization often determines the type and extent of diagnostic maneuvers the employs. The setting of the examination spot-doctor's office or clinic, hospital emergency room, intensive care unit or the patient's home will 10have a bearing on what is done and not done. The patient's condition whether alert, confused, belligerent or unconscious will influence the type of history that can be obtained and the degree of cooperation that can be enlisted during examination. Much may depend on formally established, quasi-legal requirements—forms to be filled out for a prospective employer or insurer or hospital staff bylaws to be compiled with. The standard outline of history and physical examination is as detailed below:

In earlier days of medical practice, the physician alone used to manage the patient care services. In order to meet the patient care services swiftly and efficiently, the need for some assistants arose. This need has created the allied healthcare professionals, one after one, emanated to assist the busy physician and allow him/her to deal with medical and complicated cases, which need medical background, while other allied professionals can contribute greatly to patient care service directly or indirectly with their area of expertise. Nursing is the integral part of the healthcare system and as such encompasses the promotion of health, prevention of illness and care.