Assessment and examination of the respiratory system.

This article aims to outline the fundamental principles of consultations with and clinical assessments of patients with symptoms that may be indicative of respiratory system pathology. The article explores how to perform a respiratory system-focused patient history and physical examination. An evaluation of clinical 'red flags' to reduce the risk of omitting serious illness is also considered, alongside the exploration of features of respiratory pathology and evidence-based clinical decision-making tools that may be used to support clinical diagnosis.

The changing context of advanced practice nursing within the UK community care setting.

Advanced practice nursing (APN) roles have developed partly to address demand and workforce issues. In community care settings and general practice, an advanced nursing practitioner is generally understood to mean a nurse who has undertaken additional education and training in clinical assessment, including history-taking and physical examination, clinical reasoning and independent prescribing, so they can safely manage patients presenting with undifferentiated and undiagnosed conditions. Capabilities in the Skills for Health framework cover everything from communication and consultation skills, practising holistically and personalised care, to working with colleagues and in teams. The framework is intended to ensure advanced nursing practitioners work to an advanced level. It is also designed to support them to demonstrate and evidence their capabilities to service commissioners, employers, people accessing healthcare and the public.

Undertaking consultations and clinical assessments at advanced level.

Once deemed the reserve of doctors, 'the medical interview' has since transitioned across professional boundaries and is now a key part of the advanced clinical practitioner (ACP) role. Much of the literature surrounding this topic focuses on a purely medical model; however, the ACPs' use of consultation and clinical assessment of complex patient caseloads with undifferentiated and undiagnosed diseases is now a regular feature in healthcare practice. This article explores how knowledge of the fundamental principles surrounding ACP-patient communications, along with the use of appropriate consultation frameworks and examination skills, can provide a deeper insight and enhance the existing skills of the ACP. A comprehensive guide to undertaking patient consultations, physical examination and diagnostic reasoning on a body systems basis is explored in future issues of this Advanced Clinical Practice series.

Advanced practice: critical thinking and clinical reasoning.

Clinical reasoning is a multi-faceted and complex construct, the understanding of which has emerged from multiple fields outside of healthcare literature, primarily the psychological and behavioural sciences. The application of clinical reasoning is central to the advanced non-medical practitioner (ANMP) role, as complex patient caseloads with undifferentiated and undiagnosed diseases are now a regular feature in healthcare practice. This article explores some of the key concepts and terminology that have evolved over the last four decades and have led to our modern day understanding of this topic. It also considers how clinical reasoning is vital for improving evidence-based diagnosis and subsequent effective care planning. A comprehensive guide to applying diagnostic reasoning on a body systems basis will be explored later in this series.