Sometimes as healthcare professionals, we are trained to look at the numbers. We run tests and examine the heck out of lab values and vital signs to discern how our patient is doing today. This is all very important, and ultimately it allows physicians to assist in determining what the patient’s official diagnosis is, or help nurses to paint a picture of a patient’s condition, but it doesn’t tell the whole story. What is missing, however, is the subjective data.
Last week I talking to a good friend who is an ICU nurse, and she told me that her patient was wearing oxygen and his oxygen saturation’s were reading 99% but that when she asked him how he was feeling he was saying that he was very short of breath. Some nurses would’ve argued with him and told him that he’s fine, but my friend listened to him and took steps to relieve his dyspnea.
There are definitely times when we need to allow the numbers do the talking, but there are other times when we need to allow our patients to tell us what is going on as well! Below, let’s discuss the differences between subjective data and objective data, and why we need both of them together to help us take excellent care of our patients.
What is Subjective Data?
During the first phase of the nursing process (the Assessment), we gather data. Subjective data is what the patient tells us their symptoms are, including feelings, perceptions, and concerns. This kind of data is imperative, because it gives you the background as to why they came into the hospital (or doctor’s office), and listening to them is critical to understanding the whole picture. Taking notes creates an overall view of the patient. These nurse’s notes help to tell the patient’s story. A patient knows themselves better than you do, so listening to what ails them will ultimately make their outcome better. Listening allows us to better perform patient advocacy.
In the above example about my friend, the subjective evidence gathered from her meeting with her patient would be him saying that he’s short of breath. Often, patients can tell us what’s wrong before any objective data brings anything to light! Like when a patient tells us they have an impending feeling of doom – YOU BETTER PAY ATTENTION!
Pain is a very important piece of subjective data and is often called the fifth vital sign. There’s no true way to put a number from an objective stand point. The patient gives us a number from one to ten. But unlike the other four vital signs, there’s no real way to measure it with a tool. We are relying on the patient’s report, the subjective evidence that they are giving to us, to tell us how severe the pain is. Pain is one of the very earliest indicators that there is something that needs to be addressed.
With the pain situation, we can’t know exactly how severe pain is, but we can use other information to gauge the accuracy of someone’s reported pain level. For example, if a patient rates their pain a 10/10 most, but are eating Cheetos and talking on their phone, it’s probably not a good idea to give them 2mg of Dilaudid.
What is Objective Data?
For those numbers junkies out there, objective data is much different than subjective data, you can let out a sigh of relief! Whereas there is a lot of room for interpretation and misunderstanding in somebody’s subjective statement, objective data is the complete opposite and cannot really be argued. Objective data is observable and measurable and can be obtained through vital signs, physical examination, and laboratory/diagnostic testing. There’s not much room for debate with objective data. Palpating a radial pulse of 90 is objective. Checking a patient’s CBC count and seeing that their white blood cells are 20,000 is objective. Taking your patient to a ct scan of the brain and seeing an occipital lobe infarct…that is objective.
Most nurses are more comfortable with objective data over subjective data. Objective data is quick and to the point; often times (sadly), we are too hurried to sit down and listen. My co-worker went on a medical missions trip to Central America where they didn’t have much technology to perform objective measurements, so they relied a lot on the person to tell them what is wrong. Here in America and many other westernized countries, we have all the technology at our fingertips to be able to rely heavily on our objective data.
Putting it All Together
Subjective and objective data are vastly different but equally important. In the initial assessment, the nurse usually begins by talking to the patient, seeing how they’re doing and what brought them in today. Respecting their point of view and their understanding of what is going on is beyond important. Allow them to give you all the information they know, and that actually could help you to pinpoint exactly what the problem is. After collecting this subjective data, nurses usually go on to do a full head to toe assessment (objective data gathering) and taking vital signs. Depending on all of that, further tests or exams may be ordered.
By now, I hope that you can see why we need both subjective data, as well as objective data, to make our full assessment of the patient. No real assessment is complete without both sets of data. Each works in tandem with the other, and you can get a much better and much more accurate clinical picture when you utilize each.
Mosby’s Guide to Physical Examination – Elsevier eBook on VitalSource (Retail Access Card), 7eNursing Assessment: Head-to-Toe Assessment in Pictures (Health Assessment in Nursing)Health Assessment in Nursing