Physical Assessment Skills Research Articles

Self-directed learning with a modified team-based strategy: A quasi-experimental study

Background and objective: Physical assessment skills are not effectively put into practice for nursing students, requiring an improvement in pre-registration programs and planning more tailored training courses for them. More flexibility in teaching methods can thus contribute to self-directed learning. The purpose of this study is to identify the effects of team-based learning when combined with an online teaching platform on self-directed learning compared to inquiry-based learning for junior college nursing students.Methods: In this quasi-experimental study, 103 students completely participated in the Self-directed Learning Instrument test before and after the course. Collected data were analysed using independent t-test and ANCOVA with the statistical package SPSS 21.0 for Windows. Qualitative focus group interviews were conducted after the survey with 14 participants.Results: Compared to the control group, the adjusted mean post-test score for self-directed learning ability was significantly higher in the intervention group. Students also reported that they were quite engaged in completing assignments and team learning activities in classroom, specifically for the group test.Conclusions: The modified team-based learning strategy was useful at engaging students to improve self-directed learning and to satisfy them. Educators are encouraged to integrate online response system technology into their classroom activities.

Improving Physical Assessment and Clinical Judgment Skills without Increasing Content in a Prelicensure Nursing Health Assessment Course.

One hundred twenty-six assessment skills are taught in prelicensure nursing health assessment courses, yet 30 skills are used on a routine basis in practice. New nurses struggle to apply their acquired knowledge in clinical settings. Method: A literature review was completed. Based on the results, a first semester health assessment course in a southeastern accelerated baccalaureate nursing program was redesigned. Lectures and skills labs were adjusted to focus on the most critical assessment skills. To foster critical thinking and clinical judgement, a health assessment post conference was added where students completed concept maps, system specific case studies, nursing priority setting, and patient teaching plans. Results: Outcome surveys were completed by second semester faculty. Prior to course adjustments, 33 percent of students did not meet the benchmark. Following course changes, all students met or exceeded the benchmark. Conclusion: Focusing on critical assessment skills will increase student nurses’ ability to deliver safe patient care.

Practices and Barriers towards Physical Assessment among Nurses Working in Intensive Care Units: Multicenter Cross-Sectional Study

Background In the intensive care units, patients need special consideration and monitor frequently with appropriate physical assessment skills. Nurses working in the intensive care units play a fundamental role in detecting patients at risk of deterioration through ongoing assessment and action in response to changing health status. Most of the nursing activities were poorly assessed in low-income countries including Ethiopia. Therefore, this study was aimed to assess the nurses' practice and barriers to physical assessment among critically ill patients in Northwest Ethiopia. Methods An institution-based multicenter cross-sectional study was conducted at Amhara regional state referral hospitals from March to September 2019. A total of 299 nurses working in the intensive care units were recruited through the convenience sampling method. A 30-item physical assessment practice and 36-item barriers to nurses' use of the physical assessment scale inventory were used. The linear regression analysis model was fitted, and the adjusted unstandardized beta (β) coefficient with a 95% confidence interval was used. A p value < 0.05 was considered statistically significant. Results The mean score of the nurses' practice towards physical assessment among critically ill patients was 101.26 ± 24.99. Greater perceived reliance on others and technology (β = −0.78, 95% CI (-1.07, -0.48)), ward culture (β = −0.48, 95% CI (-0.85, -0.11)), specialty area (β = −1.46, 95% CI (-2.01, -0.90)), lack of nursing role model (β = −0.54, 95% CI (-1.06, -0.02)), being unmarried (β = −6.10, 95% CI (1.75, 10.46)), taken training (β = 11.53, 95% CI (6.34, 16.72)), and knowledge score (β = 2.81, 95% CI (2.00, 3.63)) were the factors significantly associated with the nurses' practice score towards physical assessment. Reliance on others and technology towards physical assessment practice was the most important barrier followed by ward culture and specialty area. Conclusion Nurses working in the intensive care units had a good practice towards physical assessment among critically ill patients. Hence, to increase the practice towards physical assessment in intensive care settings, especially for married nurses, experienced critical care nurses, and specialist professionals, practice support training, modifying ward environment, and educational support care are recommended.

Peer Teaching in an Interprofessional Education Activity Focused on Professional Skills Development.

The purpose of this study was to assess the impact of a peer-taught interprofessional education (IPE) activity on pharmacy and physician assistant (PA) student self-assessed confidence and attitudes related to professional skills. First-year pharmacy (n = 210) and PA (n = 45) students participated in a two-hour IPE activity. Forty-five teams consisting of one PA and at least four pharmacy students completed three peer-teaching stations focused on diabetes device education, pulmonary device teaching/case workup, and physical assessment skills. Students completed a pre- and post-activity confidence survey and a post-activity attitudes survey. For pharmacy students, highest confidence gains were noted on the items related to performing a physical exam. For PA students, largest gains were noted on the items related to insulin delivery systems. Eighty-three percent of students either agreed or strongly agreed with the statement “I learned things during this IPE activity that I will implement in clinical practice.” Seventy six percent of students felt that the physical assessment station was “beneficial or very beneficial” to their learning. A vast majority of students noted the IPE activity “somewhat or definitely” enhanced their communication with other health professionals and promoted a climate of mutual respect. In conclusion, peer teaching improved student attitudes and confidence.

Physical assessment skills taught in nursing curricula: a scoping review.

This scoping review sought to establish the current state of knowledge regarding physical assessment skills taught globally in undergraduate nursing curricula. Explicitly, the review aimed to determine which skills are being taught via curricula and which skills are performed by students in clinical placements, as well as what physical assessment skills are being used by registered nurses in practice. Nursing programs are expected to teach the physical assessment skills required for entry-level registered nurses to practice competently. The discrepancy lies in determining which skills are essential to teach entry-level nurses and which are unessential. Studies that examined physical assessment skills taught to students in any undergraduate registered nursing program or used by registered nurses in practice were considered. Physical assessments included all techniques or skills taught in any year of a university or college teaching global registered nursing curricula. Databases searched included MEDLINE (Ovid), CINAHL Complete (EBSCO), Scopus, and Cochrane Central Register of Controlled Trials (Ovid). Sources of unpublished studies included ProQuest Dissertations and Theses Global, OpenGrey, Open Access Theses and Dissertations, and Google Scholar. Studies published in English between January 2008 and November 2019 were included. Two independent reviewers screened titles and abstracts. Studies meeting the inclusion criteria were imported into the Covidence systematic review manager. Extracted data were presented in a descriptive format, including characteristics of included studies and relevant key findings. Thirteen records were extracted for synthesis: one integrated review, one author reflection, one mixed methods study, and 10 quantitative studies. The sources represented a global context: the United States, New Zealand, Turkey, Australia, Norway, Korea, Italy, and one of unknown origin. Three studies examined physical assessment skills routinely taught in global nursing curricula. Three studies explored physical assessment skills routinely used by students during nursing programs. Seven studies examined which physical assessment skills were routinely performed by registered nurses in practice. In the studies, there were 98 to 122 physical assessment skills taught in global nursing programs. However, only 33 skills were routinely taught in curricula, and of those, only 20 were the same across all studies (core skills). Students in nursing programs routinely performed 30 physical assessment skills, and six of the 30 skills were the same across all studies (core skills). Of the six core skills routinely performed by students, five were also routinely taught in nursing curricula in the included studies. Registered nurses routinely performed 39 physical assessment skills, and 11 skills were the same across all studies (core skills). Ten of the physical assessment skills taught in curricula were routinely performed by registered nurses in practice. This scoping review provides insight into physical assessment skills taught in nursing curricula and used by registered nurses in practice. This knowledge is essential for curriculum revisions and planning as it provides insight on how to best meet the needs of future nursing students.

Physical assessment in pharmacy practice: Perspectives from pharmacists, nonpharmacist health care providers and the public

Background:Physical assessment in pharmacy practice is not a new concept, yet the idea is still unfamiliar to many people. Canadian pharmacy graduates are expected to be trained in physical examination as it relates to drug therapy. However, standard delivery of course content in this area has not been clearly established, and previous publications have reported low uptake of this practice despite formal training. To aid the future development of a physical assessment course for pharmacists that is relevant to practice and will contribute to patient care, it is important to gather insight from practising pharmacists, health care providers and the public.Objective:To determine the type of physical assessment skills that would be of value to pharmacy practice and the benefits and barriers of these skills in practice from the perspectives of pharmacists, health care providers and the public.Methods:This was a cross-sectional online survey of pharmacists, nonpharmacist health care providers and the public. Descriptive statistics and thematic analysis were used to describe data.Results:A total of 348 respondents (98 pharmacists, 154 nonpharmacist health care providers, 96 public) completed the survey. Most (64%) nonpharmacist providers were physiotherapists or occupational therapists (only 6.5% physicians). Most respondents felt that performing basic vital signs was relevant to pharmacy practice (79% pharmacists, 69% other providers, 79% public) and felt confident and comfortable about pharmacists using these skills. Palpation, percussion and auscultation were rated less favourably (<50% for most respondents). Nonpharmacist providers tended to be less favourable than pharmacist and public respondents. Seven themes related to benefits and 13 themes related to disadvantages of pharmacists performing physical assessment were identified.Conclusion:These findings provide insight into opinions about the value of pharmacists performing physical assessments. Consensus recommendations on performance expectations to improve recognition of pharmacists in this area is needed in the future. Can Pharm J (Ott) 2021;154:xx-xx.

Design and Implementation Of Blended Learning Approach For Simulation Education Among Undergraduate Nursing Students

The importance of undergraduate nursing education has never been higher due to the aging population and complexity of patients. The blended simulation combined two and more educational methods and is an effective strategy in nursing education. This study was to evaluate the effectiveness of blended simulation using standardized patients and patients simulation. Using a convenience sampling, a quasi-experimental study was conducted. Forty undergraduate nursing students enrolled and were allocated into the experimental group (n=20) or the control group (n=20). CPX (clinical performance examination) was used to evaluate physical assessment skills. Self-reporting questionnaires were used for communication skill and learning satisfaction. χ2-test/Fisher’s exact test and Mann-Whitney U test were conducted for statistical analysis. After completing the educational program, there were statistically significant higher levels of physical assessment and communication skills in the blended simulation group (p&lt;.001) compared with the control group. Regarding learning satisfaction, there were also statistically significant differences with higher level of satisfaction among students in blended simulation group (p=.002). This blended simulation has high potential to successfully achieve learning outcomes in undergraduate nursing education. Providing students diverse educational methods ensures an optimal learning experience.

Implementation and evaluation of an interprofessional physical assessment skills workshop for Wisconsin pharmacists

BackgroundPharmacists have a critical, expanding role in health care delivery. In particular, pharmacists in community pharmacy and ambulatory care settings are important and frequent access points for health care services. ObjectiveWe describe the interprofessional development and implementation of an interactive, broadly applicable physical assessment skills–based continuing pharmacy education program to provide an avenue for the attainment of this warranted set of skills for pharmacists who desire to provide advanced patient care services in their respective practices. MethodsPharmacists, in collaboration with family medicine and emergency medicine physicians, developed workshop content, design, and flow. The structure of the workshops consisted of didactic training, hands-on practical application, simulated practice, and case-based certification examinations. ResultsOn a postworkshop survey, all respondents answered “agree” or “strongly agree” when asked if the workshops were useful, advanced their skills, and advanced their confidence. It was also found that more than 50% of the participants used their physical assessment skills monthly and 11% daily. The most common assessment performed was obtaining an accurate manual blood pressure. ConclusionThe interprofessional development and implementation of workshops dedicated to physical assessment skills education is feasible and led to the incorporation of these skills into pharmacists’ practice, particularly in the community and ambulatory care settings.

Configuration of Mobile Learning Tools to Support Basic Physical Assessment in Nursing Education: Longitudinal Participatory Design Approach.

BackgroundAs many students in higher education are skilled users of mobile technology, mobile learning (mLearning) can be a promising educational strategy to enhance their learning experience. mLearning might also be well suited for nursing students as they navigate between multiple learning contexts in their educational curriculum. As an educational strategy, mLearning may also reduce challenges caused by the theory-practice gap in nursing by supporting skills and knowledge transfer between the university and clinical settings. As the introduction of basic physical assessment skills (B-PASs) into Norwegian bachelor’s degree education in nursing occurred quite recently, there is a lack of competence in supervision and teaching in both university and clinical settings. As such, mLearning appears to be a good strategy to support student B-PAS learning and knowledge transfer across learning contexts.ObjectiveThis study aims to explore and elicit the perspectives of students regarding the way in which a selection of digital learning resources supports B-PAS learning and application in clinical rotation, which of the selected digital learning resources are beneficial to include in a suite of mLearning tools, and how the selected digital learning resources could support the transfer of skills and knowledge from the academic to clinical context.MethodsWe used a longitudinal participatory design approach to co-design a suite of mLearning tools. The co-design processes took place in several workshops (WSs) over a period of 3 months: 2 WSs with first-year students (n=6), 3 WSs with second-year students (n=6), and 3 WSs with third-year students (n=8). The students evaluated several digital learning resources in both academic and clinical contexts. The digital learning resources included digital simulation with virtual patients, massive open online courses, and multimedia learning material. In the co-design WS, the potential and benefits of these digital learning resources for the learning and application of B-PASs were explored.ResultsThe students reported that the digital learning resources stimulated learning in 7 different ways. They also emphasized the importance of including all selected and tested digital learning resources. Moreover, students supported the inclusion of additional learning material, such as multiple-choice tests and written assignments, aimed at providing feedback and contributing to knowledge development.ConclusionsThe co-design processes and collaboration with the nursing students provided insight into how a suite of mLearning tools may support the learning and application of B-PASs and human bioscience knowledge in clinical rotation. From the students’ perspective, one of the strengths of the suite of mLearning tools was the range of content, as this met a broader range of student learning preferences regarding learning B-PASs. The suite of mLearning tools contributes to and supports skills training and knowledge transfer between multiple learning contexts.

A Survey on the Implementation of Physical Assessment Skills for Visiting Nursing Activities

A Survey on the Implementation of Physical Assessment Skills for Visiting Nursing Activities

Effects of Blended Simulation Applied for Respiratory System Assessment in Undergraduate Nursing Education

The importance of undergraduate nursing education has never been higher due to the aging population and complexity of patients. The blended simulation combined two and more educational methods and is an effective strategy in nursing education. This study was to evaluate the effectiveness of blended simulation using standardized patients and patients simulation. Using a convenience sampling, a quasi-experimental study was conducted. Forty undergraduate nursing students enrolled and were allocated to the experimental group (n=20) or the control group (n=20). CPX (clinical performance examination) was used to evaluate physical assessment skills. Self-reporting questionnaires were used for communication skill and learning satisfaction. χ2-test/Fisher's exact test and Mann-Whitney U test were conducted for statistical analysis. After completing the educational program, there were statistically significant higher levels of physical assessment and communication skills in the blended simulation group (p&lt;.001) compared with the control group. Regarding learning satisfaction, there were also statistically significant differences with a higher level of satisfaction among students in blended simulation group (p=.002). This blended simulation has high potential to successfully achieve learning outcomes in undergraduate nursing education. Providing students with diverse educational methods ensure an optimal learning experience.

Reflection on actions: Identifying facilitators of and barriers to using physical assessment in clinical practice

Current research suggests that nursing students do not apply all sets of physical assessment skills (PAS) learned in their nursing education. The aim of this study was to evaluate third-year nursing students' process of clinical judgment using PAS in clinical rotation. Specific focus was on how the process of clinical judgment affected when the nursing students performed physical assessment, and which types of knowledge were implied in their practice. Ten nursing students performed PAS independently while in clinical rotation; these performances were audiotaped and observed. Shortly after, individual semi-structured stimulated recall interviews (SRI) took place. Regardless of the nursing students’ stated level of PAS utilization, self-efficacy or scientific knowledge, clinical judgment was primarily based on contextual factors and personal prerequisites. This study contributes to in-depth knowledge about how nursing students perform physical assessment, how they describe their clinical judgment process and their strategies towards systematically and confidently using PAS. We conclude the paper with pedagogical strategies and learning activities that can facilitate reflection-in-action and reflection-on-action.

An Online Asynchronous Physical Assessment Lab (OAPAL) for Graduate Nursing Students Using Low-Fidelity Simulation With Peer Feedback

Physical assessment courses typically include a didactic component and a skills laboratory component. It is a challenge to create laboratory components in fully online nursing courses. This article reports on the use of an online asynchronous physical assessment laboratory using low-fidelity simulation with peer feedback to teach physical assessment skills to postlicensure nursing students in a fully online advanced health assessment course within an RN to MS program. Students found the online asynchronous physical assessment laboratory favorable, relevant, and engaging and believed it advanced their current skills.

Nurse perceptions of physical assessment skills for detecting acute progression of heart failure

The study purpose was to investigate whether years of clinical experience and experience of encountering heart failure affect perceptions of the need for physical assessment, and the nature of the association between perceptions and years of clinical experience. This study was survey-based. Of hospitals in Japan with ≥200 beds, 298 hospitals were randomly selected as candidate research sites. Ultimately, 44 hospitals agreed to participate in this study. A self-administered questionnaire measuring 48 physical assessment skills was developed and distributed to nurses. The questionnaire rated the perceived need for 48 skills assessing acute progression of heart failure. Of 1,113 nurses sampled, 373 (33.5%) responded. Of these, 347 completed questionnaires (response rate: 93.0%). Nurses' perceived need for skills involving systematic or cardiovascular system assessment decreased with clinical experience. Nurses' perceived need for skills involving cardiovascular symptoms and circulatory failure assessment increased with clinical experience. We found four patterns of change for nurses' perceptions of physical assessment skills according to clinical experience. The findings showed that differences in nurses' perceived need for physical assessment skills were associated with differences in clinical experience. Nurses with more experience selected more suitable skills for detecting acute progression of heart failure. Nurses' perceptions of the need for specific skills were proportional to years of clinical experience, and there may be a threshold value of years of experience.

The educational needs of triage nurses

The role of triage nurses is critical to ensuring patient safety and timely access to emergency care. Continuing professional development and ongoing support is required to effectively support the competence of triage staff. To date, very few studies have sought to describe the educational needs of triage nurses.This study aimed to identify which type of educational support nurses feel they need to manage the triage process.A validated questionnaire was used to explore triage nurses’ perceived educational support needs in relation to managing the triage process.On average, participants had 11.33 years of experience in their current role (SD = 7.27), 15.43 in emergency (SD = 9.80) and 13.44 in triage (SD = 9.16). Triage nurses (n = 27) identified the introduction of new ideas at triage to increase efficiency as the area in which they were in greatest need of training. Priority education needs that focused on clinical tasks, such as physical assessment skills, particularly in relation to observations and vital signs, to inform triage decision making were also identified. These priority education needs will inform the design of education programs and the development of the capabilities of the nursing workforce.Future research should seek to explore the traditional responsibilities of triage nurses, particularly to address queuing and delays at triage.

Physical assessment educational programs for pharmacists and pharmacy students: A systematic review

AbstractIntroductionThe scope of pharmacy practice has evolved to include physical assessment (PA) as part of the management of drug therapy.ObjectiveTo describe programs developed to teach pharmacists/pharmacy students PA and identify factors associated with improved knowledge, skill, confidence, and utilization.MethodsA librarian‐assisted search was performed of MEDLINE, Embase, and Cumulative Index to Nursing and Allied Health Literature using the terms “pharmacist,” “student,” and “physical examination,” supplemented with manual reference searches. Studies published exclusively as abstracts were excluded. No language restrictions were applied. Extracted data included design, location, participants, methods of instruction, PA skills taught, assessment, utilization, and follow‐up.ResultsThe search yielded 635 unique citations, which were independently reviewed by two authors. Twenty‐eight articles were reviewed in full and 16 were included. Most studies were conducted in the United States or Canada. Thirteen studies enrolled pharmacy students (mainly second or third year), which focused on comprehensive PA skills or blood pressure measurement. Length of instruction ranged from a single session to a full‐year course. Generally, any type of instruction improved knowledge and confidence with PA. Students preferred pharmacist instructors to other clinicians, and live subjects to simulators/manikins. Three studies evaluated courses for practicing pharmacists, which included comprehensive PA instruction and consisted of 2‐30 contact hours. Participants' confidence with performing PA improved from precourse to postcourse surveys. One study showed improved confidence with performing PA 6 months after the course, while another study showed no improvement in confidence but increased PA use at 6 months postcourse. Utilization of PA after 6 months ranged from 49% to 66%.ConclusionsA variety of programs have been developed to teach PA skills to pharmacists/pharmacy students. Limited data suggest that sessions which included pharmacist instructors and live subjects to practice PA skills were preferred. Courses for practicing pharmacists improved confidence with performing PA, but persistent confidence and utilization at 6 months were variable.

Developing Physical Assessment Skills in Pharmacy Students through Participation in a Creative Movement Workshop: An Interdisciplinary Study between Pharmacy and Dance

The role a pharmacist plays in the care of patients is continually changing and expanding. Most recently, there is movement towards including pharmacists in the physical assessment of patients. We developed a creative movement workshop with the purpose of increasing students’ levels of comfort with touch, ability to interpret non-verbal mannerisms, to increase empathy for the patient, and to increase student comfort in conducting physical exams. In this interventional study, surveys were administered to third year pharmacy students, before and after the creative movement workshop, in order to assess participant’s change in level of comfort with a variety of behaviors needed to conduct effective physical assessment. The two hour workshop involved: partner stretching, mirroring, and creative spatial exploration between bodies. The 11-item survey evaluated students’ perceptions on touch, nonverbal communication, and sharing personal space. Our results showed that the level of comfort improved for the ability to give touch (p = 0.001), the ability to receive touch (p = 0.002), and the ability to share personal space (p = 0.001). Participants commented that the workshop increased their understanding of how important confidence is when performing physical assessment and reported an increased appreciation for how much non-verbal mannerisms can communicate to another. This study explores how an interdisciplinary workshop between pharmacy and dance has the potential to increase student effectiveness as future healthcare professionals, by targeting skills not often focused on within traditional pharmacy curriculums, including: sharing personal space, displaying empathy, and providing a comforting and confident touch.

Physical Assessment Skills Performing Hurdles Among Nursing Students

Physical Assessment Skills Performing Hurdles Among Nursing Students

Use of a virtual patient simulation program to enhance the physical assessment and medical history taking skills of doctor of pharmacy students

IntroductionTo evaluate if utilizing a virtual simulated patient program in a required pharmacy course improves the health history taking and physical assessment skills of first-year professional pharmacy students. MethodsDuring a 14-week course students registered for a web-based virtual patient simulation program. Students were assigned a virtual patient case to complete during weeks one and 13 of the course. Scores from the pre- and post-interventions were compared focusing on the students' ability to perform a physical exam, take a medical history, provide patient education, and display empathy. Students were also asked to self-assess their skills after having been exposed to the virtual simulation program throughout the semester. ResultsThe total number of paired observations used in the final analysis of the pre- and post-virtual patient test case was 171 students. The overall student performance index, which includes the scoring of subjective/objective data and patient education/empathy, improved from 52% at week one to 78.42% at week 14. The individual scoring of subjective/objective data and patient education/empathy significantly improved from week one to week 13. Approximately 76.54% of the class strongly agreed or agreed that the virtual simulation program made them feel more confident in their ability to obtain a medical history from patients. ConclusionsVirtual patient simulation programs are effective teaching methods for students to develop and improve upon their medical history taking and physical assessment skills.

Self-efficacy and concerns of nursing students regarding clinical experiences

BackgroundIt is important for nurses to provide safe, high-quality care for patients, and clinical experiences allow nursing students to integrate theory into practice. However, many students have anxiety about clinical rotations. ObjectivesThe concerns of nursing students about clinical experiences and factors relating to self-efficacy in a rural Bachelor of Science in Nursing (BSN) program were examined. DesignThis was a mixed-methods study, and students were surveyed prior to and at the end of their clinical experiences. SettingThe study location is a public liberal arts university in the rural, southeast United States. ParticipantsJunior level students (first and second semester) and senior level students (first and second semester) levels of BSN students participated in this project. ResultsQualitative themes were identified, including concerns regarding clinical competence, expectations of learning, aspects of patient/peer/instructor interactions, as well as learning strategies and preferences. The student's level of confidence regarding communication to patients and physicians, assessment of heart and lung sounds, interview skills, documentation, and discussion of nursing procedures increased significantly from pre to post-survey. Confidence levels in physical assessment skills rose significantly after the clinical experience (t′ = −6.3718 with 140 df, p < .001). ConclusionStrategies that nurse educators can use prior to, during, and after the clinical experience to address student concerns about clinical experiences include the use of caring, competent clinical instructors, orientation to clinical sites, laboratory and simulation days, self-reflection, peer-support, and debriefing.