Aresearch Investigationinto The Utilizationof Thepqrstnursingcarestrategy Amongnursing Pre-Professionals

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ISSN: 2320-5407 Int. J. Adv. Res.

11(07), 316-326

Journal Homepage: -www.journalijar.com

Article DOI:10.21474/IJAR01/17233
DOI URL: http://dx.doi.org/10.21474/IJAR01/17233

RESEARCH ARTICLE
ARESEARCH INVESTIGATIONINTO THE UTILIZATIONOF THEPQRSTNURSINGCARESTRATEGY
AMONGNURSING PRE-PROFESSIONALS

Dr. Ling-YaoKo
Assistant Professor, English Department, Center for General Education, Chang Gung University of Science and
Technology, Taoyuan, Taiwan, R.O.C.
……………………………………………………………………………………………………....
Manuscript Info Abstract
……………………. ………………………………………………………………
Manuscript History This study implemented the PQRST (Provoking, Quality, Radiation,
Received: 10 May 2023 Severity, Timing) nursing care strategy to assess how effectively junior
Final Accepted: 14 June 2023 nursing students incorporated it into their nursing English
Published: July 2023 conversations. Although all students had been taught the PQRST
strategy during their first and second years, they tended to overlook its
Key words:-
PQRSTmnemonic, Pain Assessment, application in their studies. The research involved two groups: a control
Nursing Care Strategy, Nursing Pre- group and an experimental group comprising a total of one hundred
Professionals, ESP, Nursing English students. The control group was told to utilize the PQRST nursing
Course
strategy while preparing their nursing English scripts, but they did not
receive a review lesson on the strategy itself. On the other hand, the
experimental group received a list of "nursing-patient questions"
categorized into the sections of the PQRST strategy (refer to Appendix
I) and were later guided through a review of the nursing strategy by the
instructor. The findings indicated that a significant majority of the
experimental group's learners were almost familiar with the PQRST
mnemonic, with percentages of 62%, 86%, 60%, 88%, and 94% for the
respective components. Overall, 90% of the experimental group
successfully implemented the PQRST strategy. The study also
identified four scenarios in which the experimental students effectively
utilized the PQRST strategy: prior to admission, after an operation,
during body assessments when patients experienced pain or discomfort
during rehabilitation, and when nurses needed to gather patients'
medical information. In general, the experimental learners appeared to
be confident in their understanding and application of the PQRST
nursing strategy;however, periodic reminders were deemed necessary.
Conversely, the control group did not utilize the PQRST nursing
strategy at all since they neither received information about it nor were
they reviewed on the strategy by the instructor.

Copy Right, IJAR, 2023,. All rights reserved.


……………………………………………………………………………………………………....
Introduction:-
Heradstveit and Heltn (2014) stated that the PQRST mnemonic is employed in the healthcare field to
assisthealthcare professionalsinassessingapatient'spainandothersymptoms.Themnemoniccomprises distinct letters
that correspond to essential elements of the assessment procedure:

Corresponding Author:- Dr. Ling-YaoKo


316
Address:- Assistant Professor, English Department, Center for General Education,
Chang Gung University of Science and Technology, Taoyuan, Taiwan, R.O.C.
ISSN: 2320-5407 Int. J. Adv. Res. 11(07), 316-326

(1)P-
Provokeoralleviate:Whichfactorsaggravateoralleviatethepain?Aretherecertainactivitiesorpositi
onsthat makethe painworseor providerelief?

(2)Q - Quality: What is the nature of pain? Is it sharp, dull, aching, throbbing, orburning?

(3)R - Region or radiation: Where is the pain located? Does it spread to other parts of the body?

(4)S - Severity: On a scale of 0 to 10, how bad is the pain? Does it interfere withdaily activitiesor sleep?

(5)T-Time:Whendidthepainbegin?Isitconstant,intermittent,ordoesitcomeandgo?

The PQRST assessment enables healthcare providers to gain a better understanding of thenature of a patient's pain,
which can inform their diagnosis and treatment planning. Bycomprehending the specific characteristics of a patient's
pain, healthcare providers can select themost appropriateinterventions tomanage the pain andimprovethepatient's
quality of life.

Moreover, the PQRST assessment facilitates more effective communication between patients and healthcare
providers. Patients can employ the PQRST framework to describe their pain in a structured and detailed manner,
assisting healthcare providers in comprehending their needs anddeliveringmoretailored treatment.

In conclusion, the PQRST assessment serves as a valuable tool in healthcare for evaluatingpain and other symptoms.
By providing a structured framework for the assessment process,healthcare providers can gather comprehensive and
accurate information about a patient's symptoms, aiding in diagnosis and treatment decision-making.

Literature Review:-
WhenCommunicativeLanguageTeaching(CLT)emergedasasignificanttrendinthelate1980s, language teaching, and
learning theories started emphasizing the needs of learners and thelanguage used in authentic work settings. Various
teaching and learning principles, such as Content-Based Teaching, Competence-Based Language Teaching, and Task-
Based Language Teaching, highlighted the importance of meeting learners' needs and engaging in meaningful
learning activities. ESP (English for Specific Purpose) was a subfield of Language for Specific Purposes(LSP), which
grew out of the same theoretical background of Content-Based Teaching. LSP(Language for Specific Purpose) was
said to target the language requirements of learners who needed language to carry out specific roles (e.g., student,
engineer, technician, nurse). Such learners needed to acquire content and real-world skills through the medium of a
second language rather than master the language for its own sake (Douglas & Frazier, 2001). In this sense, ESP
referred to the teaching and learning of English for content and real-world skills in the specific work contexts where
English was a foreign language.

Within ESP, the concept of "need" held significant importance in the field of professional nursing and had become a
core concept in nursing studies. According to American Nurses Association (2009), they emphasized the crucial role
of nurses in assessing and addressing the diverse needs of patients to promote their health and well-being. Potter et al.
(2021) further emphasized that nursing activities should align with human basic needs, as this alignment played a
critical role in nursing care by directly contributing to the overall well-being and health outcomes of patients.
Carpenito-Moyet (2006) highlighted the essential relationship between assessment and needs in healthcare and
nursing. Effective and patient-centered care relied on assessment to identify and understand the specific needs of
individuals, enabling healthcare professionals todevelop tailoredcareplansand interventions.

In the clinical nursing domain, patients were admitted to hospitals for the purpose of disease treatment andrecovery of
their health.Thehealthcareteam provided medical care toassist patients in improving or recovering from their illnesses
and managing pain. In the nursing assessment process,the nursing staff employed the PQRST
(Palliative/Provoking,Quality,Radiation,Severity,Timing) strategy to inquire about the patient’s experience of
pain.Initiating such nursinginteractions requireda combination of medical knowledge and communicative proficiency.
Frank (2000) argued thatnursing learners needed to enhance their medical knowledge and understanding, grasp the
pragmaticsofmedicalencounters, becomefamiliarwith theworkenvironment, andpractice cooperative problem-
solvingratherthanengagein one-waycommunication.

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Using pain assessment as an example, it was evident that ineffective and inadequate communication could lead to
unnecessarysufferingforpatients,resultinginprolongedtreatmentandcare. Appropriate pain assessment was crucial for
effective pain management, and it was not necessary to be ill oneself to understand its importance. If healthcare
professionals couldn’t accurately evaluate pain, patients might endure unnecessary suffering for longer periods. It
wasunacceptable for the pain to be incorrectly assessed and reported due to a lack of knowledge among nursing staff
regarding howtoaskpatientsabouttheirpainorcommunicateittothedoctor.

Therefore, effective communication plays a pivotal role in successfully managing pain, as thedescription of a patient's
pain serves as a valuable tool for healthcare professionals involved in their care. Consequently, we have concerns
regarding our learners' ability to integrate the PQRSTapproach into their caregiving practices and assess pain using
this method. Our primary inquiries revolve around the nursing pre-professionals' proficiency in applying the
evaluation, particularly when communicating with patients in English, which may not be their native language. Based
on the above statements, this study aims to address the following issues:

(1)To what extent do nursing pre-professionals possess knowledge of the PQRST mnemonic?
(2)How effectivelydo theyimplement the PQRSTmnemonic duringnursingassessment
communication?
(3)InwhatspecificsituationsdonursingprofessionalsemploythePQRSTassessmentstrategy?

Methodology:-
Participants
Two nursing student classes, comprising 50 students each, were divided into two groups: anexperimental group
consisting of 50 students, and a control group with the remaining 50 students.Given that all the students had
completed more than two-thirds of their medical terminology courses,they were expected to be acquainted with
medical terms and capable of handling general nursingtreatments. Subsequently, the 100 students were divided into
small groups of eight individuals, and they were instructed to incorporate the PQRST nursing strategy into their
nursing English conversations, using the textbook "Nursing English for Pre-professionals" as a reference. In thisstudy,
the control group was reminded to utilize the PQRST nursing strategy in their scripts but received no additional
information aboutthePQRSTframework.Conversely,theexperimentalgroupreceived a list of "nursing-patient
questions" categorized according to the PQRST sections (refer to Appendix I) and would later have their
understanding of the nursing strategy reviewed by the instructor.

Instruments
This study employed three instruments for data collection. The first instrument was a set ofPQRST questions (refer to
Appendix I). The second instrument was an evaluation form designed fornursing and English teachers to assess and
score the application of the PQRST mnemonic. The thirdinstrument was a questionnaire consisting of six sections.
Each section contained specific questionsrelated to various aspects, including (1) the participant's familiarity with
PQRST (questions 1-2), (2) the participant's understanding of the meaning of PQRST (question 3), (3) the
participant's grasp of how to apply the PQRST assessment strategy (question 4-5), and (4) the situations learners
would employ the PQRSTnursingstrategyduring their nursing clinical practice (question 6).

Procedure
At the beginning of the school semester, nursing students were asked to adapt a nursing English conversation based
on the textbook “Nursing English for Pre-professionals.” The experimental group received instruction with PQRST
skillsandwereprovidedwithacategorizedlistof "nursing-patient questions" aligned with the PQRST framework and
would later be reviewed onthe PQRST nursing strategy by the instructor. In contrast, the control group did not receive
anyinformation regarding PQRST but were reminded to incorporate the PQRST nursing strategy into their scripts. All
the students were assigned topics through a random drawing, and they developedand revised their own conversations
accordingly. Subsequently, both a nursing teacher and an English teacher evaluated the extent to which the control
group and the experimental group effectively utilized the PQRST nursing strategy in their scripts (refer to Appendix
II). Each smallgroup earnedonepointif theycorrectlyemployedonemnemonicnursingstrategy.

DataAnalysis
The evaluation of the written scripts was conducted by an English teacher and a nursing teacher. The scripts were
assessedbased on the following categories: headfirst, eye to eye, an earful,by a nose, into the mouth and down the
throat, up to your neck, breath by breath, the heart of the matter, breasts in women...and men, stomach-turning, going

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with the flow, reproduction review,bones and muscles, emotional function, endocrine glands, and blood and
emotional status. For eachcorrectimplementationofa mnemonic nursingstrategy, onepointwas awarded.

Results:-
Regarding the initial research question, which aimed to assess the level of familiarity of nursing pre-professionals
with the mnemonic PQRST, Table 1 displayed the results. It indicated that a majority of learners in the experimental
group were acquainted with the PQRST mnemonic to varying degrees, with percentages ranging from 60% to 94%.

However,the scoresforthePandRmnemonic nursing strategies were relatively lower, suggesting that learners would
benefit from additional training on these two specific strategies. The instructor could further support
theirunderstandingbyprovidingmore casestudiesor clinicalexamples related tothesetwomnemonicnursingstrategies.

Table1:- KnowledgeofPQRST.
KnowledgeofPQRST(N=50) Correct
Whatis the meaningof P? 62%
Whatis the meaningofQ? 86 %
Whatisthe meaningof R? 60%
Whatis the meaningof S? 88%
Whatis the meaningofT? 94%

Concerning the second research question, which focused on the application of the PQRSTmnemonic in nursing
assessment communication, Table 2 presented the findings. It revealed that the control group, who had only received
a reminder to use the PQRST strategy in their adaptedconversation without any further information, utilized the
strategy to a lesser extent. Conversely, theexperimental groups, who were equipped with a list outlining the PQRST
nursing strategy and received a subsequent review from the instructor, demonstrated superior and more proficient
utilization of the strategy in their assessments. Notably, 90% of the experimental groups effectively
employedthePQRSTstrategy.Thefollowingarea few examples oftheirsuccessfulimplementation:

Table2:- EvidenceofUsingorNotUsingPQRSTStrategy.
Scriptswithout PQRST Scriptswith PQRST
(TheControlGroup) (TheExperimental Group)
P: Howis myson,doctor? N:WhatbroughtyoutotheERyesterday?(P)
D : He has an open fracture on therightlegand P: I had a lot of urine in my blood
lastnight.IfeelpainwheneverIurinate.
abrasionsalloverhisbody. We will arrange N:Whereelsedoyoufeelpain? (R)
anoperationforhimtomorrow. P:In mylowerabdomen.
P:Willhebeallright? N: If we define pain from 1 to 10,
howmuchpaindoyoufeel?(S)
D:Hewillrecoversoon.Don’tworry.
Bytheway,Ineedyoutosignaconsent form. P:Ithinkit’sfive.
N:Whatkindofpainisit?(Q)
P: It’s astabbingpain.
N:Howlonghave youbeenexperiencingthis?(T)
P:Iam notsure.
Regarding the third question, which explored the situations in which experimental nursing pre-professionals applied
the PQRST assessment strategy, Table 3 provided insights into four specific scenarios. These scenarios encompassed
the following instances: prior to admission, after an operation, during body assessment when the patient experienced
pain or discomfort during rehabilitation, and when the nurse aimed to collect the patient’s medical information. In the
pre-admission script, the nurse employed the PQRST strategy to comprehend the patient’s discomfort triggers (P), the
nature of the pain experienced (Q), additional symptoms besides angina (R), the severity of the pain (S), and the
duration of the pain (T). In the post-operation script, the studentnurse utilized the PQRST strategy to assess the
patient's condition and identify any post-operativeside effects. The lines below exemplified the application of the
PQRST strategy: the nurse inquiredabout the intensity of the patient's suffering (S), the areas where the patient
experienced pain (R), thecharacteristics of the pain (Q), the factors that alleviated or exacerbated the pain (P), and the
duration of the pain (T). During the body assessment script, the nurse employed the PQRST strategy toevaluate the

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patient's rehabilitation progress, observing their physical rehabilitation performance andidentifying any encountered
challenges. The lines below represented the use of the PQRST strategy:the nurse asked the patient about pain-
alleviating factors (P), the type of pain experienced (Q), other areas where the pain was felt besides the leg (R), the
severity of the pain (S), and the duration of the pain(T). Lastly, in the pain assessment script, the nurse utilized the
PQRST strategy to identify the pain and assess its quality, severity, and impact. The lines below exemplified the
implementation of thePQRST strategy: the nurse inquired about the factors that caused the patient significant pain (P),
the type of pain experienced (Q), additional symptoms alongside lower abdominal pain (R), the intensity of the pain
(S), and the duration of the symptoms(T).

Table3:TheSituationsNursingPre-professionalsAppliedthe PQRSTAssessmentStrategy

BeforeAdmission
Nurse : What brought youtotheERyesterday?Whatmakes you feeluncomfortable?(P)
Mary :Ihaveangina, and I forgot to bringmymedication.
Nurse : Under what kinds of conditions do you feel angina?
George :Shewill feel angina ifsheis tooexcited.
Nurse : What kind of pain do you feel? Is it a burning pain or a dull pain? (Q)
Mary :It’saburningpain.IthinkIamgoingto beshortofbreath.
Nurse : Besides the angina, where else do you feel pain? (R)
Mary :In myleftshoulder.
Nurse :Howmuchpaindoyou feel?(S)
Mary : I feel short of breath and dizzy.
Nurse : How long does the pain last? (T)
Mary : It’saboutafewminutes.

After an Operation
(AfterCRIF,thepatientisintherecoverywardandastudentnurse(SN)enters.)
SN :You look uncomfortable.
Patient : Mywound feelsvery painful.
SN : If we score pain from 0 to 10, with 10 being the most painful and zero the least painful,what is your
level of painright now?(S)
Patient :Oh,it’s about 7 to8.
SN :Whereelsedoyoufeelpain?(R)
Patient : I feel pain in myright calf and right thigh.
SN : How is the pain? Is it a stabbing pain or a pulling pain? (Q)
Patient :It’sa pullingpain.
SN : What makes the pain decrease? (P)
Patient :IfI don’t move, thepaindecreases.
SN :Whatmakesthe painworse?(P)
Patient :WhenImove,Ifeel lotsofpain.Actually,Ican’tdoanythingatall.
SN :How longhas thepain lasted?(T)
Patient :Abouthalfanhour.

BodyAssessment
(The patient has been following the instructions of the physical therapist and doing rehabilitationexercisesfor5 days.)
Nurse : Good morning. I am going to assess your rehabilitation condition. Please lift your left leg and push
against me.
Patient :OK.
Nurse : Please liftyour right leg.
Patient :Hmm… ....... (The patient seems uncomfortable).
Nurse :Youshouldmakeaneffort.I believe youcandoit.
Patient : I really can’t, and it really hurts me.
Nurse : Besides the leg, where else do you feel pain? (R)
Patient : On my right foot.
Nurse : How long does the pain last? (T)

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Patient :About 30 minutes.


Nurse : Can you describe the pain? Is it like a dull pain or a stabbing pain?(Q)
Patient : I feel a kind of dull pain.
Nurse : OK. If I score the pain from 0 to 10, where 0 means you have no pain at all, but 10 means you feelthe
most pain, howmuch pain do you feel?(S)
Patient :It’sabout8.Iamreallyinseriouspain.
Nurse :What eases thepain?(P)
Patient :Afterdoingtherehabilitation, mypainwill go awaywhenIrestfor30 minutes.

When the Patient Feels Pain or Is Uncomfortable


Patient : Help me!I’min seriouspain.
Nurse : What’s wrong? Please sit down.Whatmakesyoufeelsopainful? (P)
Patient : I have serious pain in my lower abdomen.
Nurse : Do you have any other symptoms besides lower abdominal pain? (R)
Patient :Well,I’m uncomfortable when I urinate.
Nurse : How bad is the pain from one to ten? (S)
Patient :Eight.
Nurse : Can you describe the pain? (Q)
Patient :Stabbing.
Nurse : How long have you been like this? (T)
Patient : I have felt pain sincelastnight.

Discussion:-
Based on the analysis of the data presented above, it was evident that most of the learners from the experimental
group were well acquainted with the PQRST mnemonic nursing strategy, with the exception of the provocative
strategy (62%) and radiation strategy (60%). As shown, the PQRSTnursing strategy offered a systematic approach to
collecting patient data and assisted healthcare providers in identifying potential causes of the patient’s symptoms. To
enhance students’ effective learning of the PQRST nursing strategy, the following approaches could be employed.

(1) Introduce to the PQRST nursing strategy: Based on Frank (2000), the instructor could begin by introducing the
PQRST nursing strategy as a systematic approach to evaluate pain in patients and then explain that PQRST
represented different aspects: Provocation/Palliation, Quality, Region/Radiation, Severity, and Timing. The
instructor could emphasize the importance of this strategy in obtaining comprehensive information about the
patient’s pain experience.
(2) Explain each component of PQRST: The instructor should ensure a thorough explanation of each component of
the PQRST nursing strategy. For example, learners needed to understand that “P” referred to factors that
worsened or alleviated pain, and instructors should teach how to identify them (Pasero& McCaffery, 2010).
According to Lacasse & Beck (2007), asking the patient about what made their symptoms worse or better could
provide important clues about the underlying cause of their symptoms.

Similarly, learners needed to grasp that “Q” represented the quality or nature of pain, and instructors should
describe how to assess it using appropriate pain descriptors (IASP, 2017). As noted by Toney-Butler & Unison-
Pace (2018), the quality of the symptoms could help healthcare providers identify the potential cause of the
patient’s symptoms.

Moving on, learners should understand that "R" stood for radiation, and they should be taught how to determine
the specific region where the patient experienced pain and whether it radiated to other areas (Cooper& Cooper,
1991). According to Bates et al. (2002), identifying the region and radiation of the patient's symptoms could
assist healthcare providers in narrowing down potential causes.

Additionally,learnersneededtocomprehendthat"S"referredtoseverity,andinstructorsshould teach students how to


assess pain severity using appropriate pain scales (Herr & Coyne, 2011).As noted by Munroe et al.(2013),
severity played a significant role in providing valuable information about the urgency of the patient's condition.

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Finally, learners had grasped that “T” represented timing, and instructors should explain the importance of
understanding the timing of pain episodes, including onset, duration, frequency, and patterns (Hjermstad et al.,
2011). According to Hagmann et al. (2018), the timing could help healthcare providers identify potential
triggers or underlying causes of the patient’s symptoms.

(3) Involve students in case studies or practical scenarios that allowed them to apply the PQRST nursing strategy.
The instructor could provide fictional patient profiles or real-life instances to demonstrate the application of this
strategy in a clinical environment, specifically for evaluating various types of pain (Hockenberry & Wilson,
2018).

(4) Facilitate role-play and practice sessions: The instructor could arrange interactive activities and practice sessions
wherein students could take on the roles of nurses and patients. Learners could be encouraged to employ the
PQRST nursing strategy to evaluate and document pain. Additionally, the instructor should provide constructive
feedback and guidance throughout the practice sessions to support learners’ learning process.

(5) Review and consolidation: To wrap up the learning session, the instructor could conduct a review of the essential
elements of the PQRST nursing strategy. The instructor could summarize the significance of each component and
highlight how they collectively contribute to a thorough pain assessment.

By adhering to these procedures, students could enhance their comprehension of the PQRST nursing strategy and its
practical implementation in healthcare settings. Furthermore, employing the PQRST strategy helped empower
learners to gather patient data and identify potential causes of symptoms more efficiently.

Conclusion and Suggestion:-


The PQRST nursing strategy is highly significant in nursing as it offers a systematic and comprehensive approachto
assessing and understanding patient symptoms. By utilizingthisstrategy,healthcare providers can obtain crucial
information about a patient's condition and utilize it to guidetheir care. Research indicates that the PQRST nursing
strategy is an effective tool for patientassessment among healthcare providers. For instance, a study conducted by
Lacasse & Beck (2007) revealed that nurses who received training in the PQRST nursing strategy reported enhanced
confidence and competence in evaluating patient symptoms.

Additionally, the PQRST nursing strategy aligns with the nursing process and promotes communication and
collaboration among healthcare providers. According to Lacasse & Beck (2007), employing a systematic approach to
patient assessment ensured that all members of the healthcare team had a clear understanding of the patient’s
condition, facilitating their ability to work together and deliver optimal care.

Overall, the PQRST nursing strategy is an important tool for healthcare providers in evaluatingand managing patient
symptoms. By adopting a systematic and comprehensive approach, healthcareproviders can gather critical
information about a patient's condition and provide appropriateinterventions to improve patient outcomes. Therefore,
it is highly recommended for instructors to incorporate the PQRST nursing strategy into their courses, enabling
learners to improve theirhealthcare assessment skills in clinical practice and prepare them to provide high-quality care
to theirpatients.

References:-
1. Association, A. N. (2009). Nursing administration: Scope and standards of practice: Nursesbooks. org.
2. Bates, B. P., Bates, B. R., & Northway, D. I. (2002). PQRST: A mnemonic to communicate a change in
condition. Journal of the American Medical Directors Association, 3(1), 23-25.
3. Carpenito-Moyet, L. J. (2006). Nursing diagnosis: Application to clinical practice: Lippincott Williams &
Wilkins.
4. Cooper, B. C., & Cooper, D. L. (1991). Multidisciplinary approach to the differential diagnosis of facial, head,
and neck pain. The Journal of Prosthetic Dentistry, 66(1), 72-78.
5. Douglas, D., & Frazier, S. (2001). Teaching by Principles: An Interactive Approach to Language Pedagogy .: H.
Douglas Brown. In: Wiley Online Library.
6. Frank, R. A. (2000). Medical communication: non-native English speaking patients and native English speaking
professionals. English for Specific Purposes, 19(1), 31-62.

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7. Heradstveit, B. E., & Heltne, J.-K. (2014). PQRST–A unique aide-memoire for capnography
8. interpretation during cardiac arrest. Resuscitation, 85(11), 1619-1620.
9. Herr, K., Coyne, P. J., McCaffery, M., Manworren, R., & Merkel, S. (2011). Pain assessment in the patient
unable to self-report: position statement with clinical practice recommendations. Pain Management Nursing,
12(4), 230-250.
10. Hjermstad,M.J.,Fayers,P.M.,Haugen,D.F.,Caraceni,A.,Hanks,G.W.,Loge,J.H.,...&Kaasa,
S. (2011). Studies comparing Numerical Rating Scales, Verbal Rating Scales, and
VisualAnalogueScalesforassessmentof pain intensityin adults:Asystematic literaturereview.Journalof Pain and
Symptom Management, 41(6), 1073-1093.
11. Hockenberry, M. J., & Wilson, D. (2018). Wong's nursing care of infants and children-E-book: Elsevier Health
Sciences.
12. International Association for the Study of Pain (IASP).(2017) IASP taxonomy. Retrieved from
https://www.iasp-pain.org/Taxonomy
13. Lacasse, C., & Beck, S. L. (2007). Clinical assessment of symptom clusters. Paper presented at the
Seminars in oncology nursing.
14. Munroe, B., Curtis, K., Considine, J., & Buckley, T. (2013). The impact structured patient assessment
frameworks have on patient care: an integrative review. Journal of Clinical Nursing, 22(21-22), 2991-3005.
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Health Sciences.
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AppendixI: Nursing-Patient Questions


Headfirst Eyeto eye
1.Doyou getheadaches? 1.Whenwasourlasteye examination?
2.If so, where are they and howpainfulare 2.Doyouwearglasses?

they? 3.Doyouhaveglaucoma,cataracts,orcolor
3.Howoftendotheyoccur,andhowlong do blindness?
they last? 4.Doeslightbotheryoureyes?
4.Does anything trigger your headaches, and 1. 5.Do you have excessive tearing;blurred vision;
how do you relieve them? 2. double vision; ordry, itchy, burning, inflamed,
5.Haveyoueverhadaheadinjury? 3. or swollen eyes?
1. 6.Do you have lumps or bumps onyour head? 4.
Anearful Bya nose
1.Do you have loss of balance,ringingin your 1.Haveyoueverhadnasalsurgery?If so, whyand
ears,deafness,orpoorhearing? when?
2.Haveyoueverhadearsurgery?If so, whyand 2.Have you ever had sinusitis or nose bleeds?
when? 3. 3.Do you have nasal problems that
3.Do youwearahearingaid? causebreathingdifficulties,frequentsneezing,or
4.Areyouhavingpainswelling,ordischarge from discharge?
your ears? If
so,hasthisproblemoccurredbeforeandhowfrequen
tly?
Intothemouthanddown thethroat Uptoyourneck
1.Do you have mouth sores, a drymouth,lossof 1.Do you have swelling, soreness,lackofmovement,
taste,atoothache,or bleeding gums? stiffness, orpaininyourneck?If so, didsomething
2.Doyouweardenturesand,ifso,do theyfit? specific cause if tohappensuchastoomuchexercise?
3.Doyouhaveasorethroat,fever,orchills? 2.How long have you had thissymptom?
4.Howoftendoyougetasorethroat,andhave 1. 3.Doesanythingrelieveitoraggravateit?
youseenadoctorforthis?
5.Do you have difficultyswallowing? Ifso,isthe

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problemwithsolidsorliquids?Isita constant
problem or does it accompany a sore throat or
another problem?
Breath bybreath Theheart ofthe matter
1.Do you have shortness of breathonexertionor 1.Do you have chest pain,palpitations,irregular
whilelyinginbed? heartbeat,fastheartbeat, shortness of breath, or
2.Howmanypillowsdoyouuseatnight? apersistentcough?
3.Doesbreathingcausepainor wheezing? 2.Haveyou everhad anelectrocardiogram?Ifso,
4.Doyouhaveaproductivecough?Ifso,do you when?
coughupblood-tingedsputum? 1. 3.Do you have high blood pressure,peripheral vascular
5.Doyouhavenightsweats? 2. disease,swelling of the ankles and hands,varicose veins,
6.Have you ever been treated forpneumonia, 3. cold extremities, orintermittentpaininyour legs?
asthma,emphysema,or frequent respiratory
tractinfections?
7.Haveyouever hadachestX-rayortuberculinskin
test?Ifso,whenandwhat weretheresults?
Breastsinwomen…andmen
Women Men
1.Doyouperformmonthlybreastself- 1.Doyouhavepainin yourbreast tissue?
examinations? 1. 2.Haveyounoticedlumpsorachangeincontour?
2.Haveyounoticedalump, achangeinbreast
contour,breastpain,ordischargefromyournipples?
3.Haveyoueverhadbreastcancer?If not, has
anyone else in yourfamilyhad it?
4.Haveyoueverhadamammogram?Whenand
what were the results?
Stomachturning Goingwith theflow
1.Haveyouhadnausea,vomiting,loss of appetite, 1.Doyouhaveurinaryproblems,such as burning during
heartburn,abdominalpain,frequentbelching, orpassingof urination,incontinence,urgency,retention, reduced
gas? urinary flow, anddribbling?
2.Haveyoulostorgainedweightrecently? 2.Doyougetupduringthenightto urinate? If so,
3,How often do you have a bowelmovement,and how many times? What color is your urine?
whatcolor,odor,andconsistencyareyour 3.Haveyouevernoticedbloodinyoururine?
stools? 4.Have you been treated for kidneystones?
4.Have you noticed a change inyourregular
eliminationpattern?
5.Doyouuselaxativesfrequently?
6.Have you had hemorrhoids,rectalbleeding,
hernias,gallbladderdisease,orliverdisease?
Reproductionreview
Women Men
1.Howoldwereyouwhenyou started 1.Do you perform monthlytesticularself-
menstruating? examinations?
2.Howoftendoyougetyourperiods, and how 2.Have you ever had a
long do theyusuallylast? prostateexaminationand,ifso,when?
3.Do you have pain or pass clots inyourperiods? 3.Have you noticed penile pain,discharge,or
4.Ifyou’repostmenopausal,at what age did lesionsortesticular lumps?
you stop menstruating? 4.Whichformofbirthcontroldoyouuse?
5.If you’re in the transitional stage,what 5.Have youhadavasectomy?
perimenopausalsymptomsareyouexperiencing?

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6.Haveyoueverbeenpregnant?If so, how many 6.Are you involved in a long-term,monogamous


times?
7.What was the method ofdelivery? relationship?
8.How many pregnancies resultedinlive births? 7.Have you ever had a sexuallytransmitteddisease?
9.Howmanyresultedinmiscarriages?
10.Have youhad anabortion?
11.Whatisyourmethodof birth control?
12.Are you involved in a long-term,monogamous
relationship?
13.Haveyouhadfrequentvaginal infections or
a sexually transmitted disease?
14.Whenwasyourlastgynecologic
examinationandPapanicolaoutest?Whatwere
theresults?
Bonesandmuscles Brainfunction
1.Doyouhavedifficultywalking,sitting,or 1.Haveyoueverhadseizures?
standing? 2.Do you ever experience tremors,twitching,
2.Areyousteadyonyourfeetordoyouloseyour
numbness, tingling, orloss of sensation in a part
balanceeasily?
3.Doyouhavearthritis,gout,abackinjury,muscle of your body?
weakness,orparalysis? 3.Areyouless abletoget aroundthanyouthinkyou
shouldbe?
Endocrineglands Blood
1.Haveyoubeenunusuallytired lately? 1.Haveyoueverbeendiagnosedwith anemia or blood
2.Doyou feelhungryorthirstymoreoftenthan usually? abnormalities?
3.Haveyoulostweightfor unexplained 2.Doyoubruiseeasilyorbecomefatiguedquickly?
reasons? 3.Have you ever had a bloodtransfusion?
4.Howwellcan youtolerateheatorcold?
5.Haveyounoticedchangesinyourhairtexture
or color?
6.Haveyoubeenlosinghair?
7.Doyoutakehormonemedications?
Emotionalstatus
1.Doyouever experiencemoodswingsormemoryloss?
2.Doyou everfeel anxious,depressed,orunabletoconcentrate?
3.Areyoufeelingunusuallystressed?
4.Doyouever feelunabletocope?

Appendix II:Grading
TotalScore

Group NursingTeachers EnglishTeachers


P Q R S T P Q R S T
1
2
3
4
5
6

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7
8
9
10
11
12
13
14
15
16
17
18
19
20

AppendixIII—Questionnaire
Department: Class:
1. Are youfamiliarwithPQRST? □Yes □No
2. In whichcoursehaveyouheardofPQRST?
□ClinicalPractice □NursingCourse □NursingEnglishCourse
3. Meaningfor PQRST
3-1 What is the meaningordefinition oftheletter"P"inthecontextofthePQRSTstrategy?
□patient □provocative □problem
3-2 Whatisthemeaningordefinition oftheletter "Q"inthecontextofthe PQRSTstrategy?
□quality □quit □quickly
3-3 Whatisthemeaningordefinitionoftheletter"R"inthe contextofthePQRSTstrategy?
□redial □radiation □rapid
3-4 Whatisthemeaningordefinitionoftheletter "S"inthe contextofthePQRSTstrategy?
□severity □slight □smile
3-5 Whatisthe meaningordefinitionofthe letter "T"inthecontext ofthePQRSTstrategy?
□tablets □tools □times
4.In light of the theories you have acquired during your nursing course, do you believe that the PQRST strategy is
beneficial for your clinical practice?
□veryhelpful □helpful □sometimes helpful □rarelyhelpful □nothelpful
5. How do you incorporate the PQRST strategy into your Nursing English Conversation? (Explain in details)
6. In which situations during nursing clinical practice in the hospital would you utilize the PQRST strategy?
(Explain in details)

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