The systematic collection of all data and information relevant to the care of patients, their problems, and needs. The initial step of the assessment consists of obtaining a careful and complete history from the patient. If this cannot be done because the mental or physical condition of the patient makes communication impossible, the nursing history is obtained from those who have information about the patient and the reason(s) for his or her need of medical and nursing care. Obtaining an accurate and comprehensive history requires skill in communicating with individuals who are ill, including those who are reluctant or unable to share important life experiences and medical data. The skilled nurse will be able to obtain the essential information despite resistance. Next in the assessment is the physical examination of the patient in order to determine how the disease has altered physical and mental status. To do this requires that the nurse be capable of performing visual and tactile inspection, palpation, percussion, and auscultation and have knowledge of what represents deviation from the norm and how disease and trauma alter the physical and mental condition of a patient. After these two steps have been completed, the nurse will be able to establish a nursing diagnosis.