Use Of Physical Assessment Research Articles

Nurses' attitude and barrier toward of performing physical assessment in medical and surgical wards

Background: Physical Assessment is essential in identifying the actual and potential patient problems and evaluating patient response to care. previous studies on the use of physical assessment in a clinical setting found that there are skills sometimes used, and some rarely or never used in the practice which reveals evidence of practice gap. Improper patient assessment rose the concern about the actual nursing practice which fail to recognize patient deterioration. Method: A quantitative descriptive correlation cross-sectional design of 253 nurses recruited from five hospitals in Al Madinah Al Munawarah in Saudi Arabia is used to study the relationship between the nurses' attitudes and the barriers to perform physical assessment and understand the influence of the participants' demographic data on the physical assessment practices. Finding: There was an agreement that physical assessment is an integral part of nursing care and around half of them showed a positive attitude toward performing the physical assessment. There was a positive significant association between attitude and perceived barriers of self-confidence, time limitation during the shift, and reliance on others and technology.

Revitalizing physical assessment in undergraduate nursing education - what skills are important to learn, and how are these skills applied during clinical rotation? A cohort study

BackgroundThe preparedness of newly graduated registered nurses for a demanding work environment and care practices takes form during nursing education. Norwegian nursing education at one university has implemented a selection of basic physical assessment skills (B-PAS) in the nursing curriculum in order to prepare nursing students for a demanding work environment post-graduation.MethodsA mixed-method cohort design. We evaluated nursing students’ self-reported use of B-PAS during their clinical rotation using the “Survey of Examination Techniques Performed by Nurses” questionnaire (30 items). In addition, two focus group interviews elicited factors that hinder or facilitate the actual use of B-PAS during clinical rotation. We recruited students from a bachelor’s degree programme for nursing at a Norwegian university. Three hundred and sixty-three of 453 eligible nursing students in the first, second, and third year of the bachelor’s degree programme participated in the study (80%).ResultsANOVA showed a significant progression (p < 0.016) in students’ self-reported use of B-PAS. Auscultation and percussion skills were graded below the median score of 3, which indicates that these skills were less used throughout the programme. The nursing students highlighted contextual factors for their use of B-PAS when in clinical rotation. Preceptors are important gatekeepers for successful implementation, and there is a need for close collaboration between the university and clinical practice.ConclusionDespite the reduced PAS taught in the curricula, there is still a lack of application of such skills in clinical rotations. This study highlights that research should explore how different work environments influence the utilisation of learned skills, and which learning strategies are appropriate or most successful for stimulating clinical reasoning and the extensive use of physical assessment.

Hospital Pharmacists’ Use of Physical Assessment: Attitudes and Frequency

Hospital Pharmacists’ Use of Physical Assessment: Attitudes and Frequency

A pilot study demonstrating the efficacy of transcutaneous bilirubin meters to quantitatively differentiate contusions from Congenital Dermal Melanocytosis

ObjectiveCongenital Dermal Melanocytosis (CDM) can be difficult to differentiate from contusions. The need for a prompt and accurate diagnosis is best illustrated in cases where child abuse and maltreatment is of concern. Transcutaneous bilirubin (TCB) spectrophotometry has been well established to measure bilirubin under the skin for jaundice in infants. The use of TCB spectrometry has not been used to identify or differentiate contusions from CDM. We hypothesized that bilirubin, a degradation product of hemoglobin, would be elevated in contusions but not in CDM thus demonstrating the efficacy of a novel diagnostic technique to compliment or improve on physical assessment alone. MethodsPilot study with thirty-seven infants and children noted to have CDM and fifty-six infants, children and adults with contusions underwent measurement of their lesion with TCB spectrometry. In each patient, the affected skin was scanned along with the adjacent unaffected native skin allowing an internal control for individual pigment variation. ResultsTCB measurements of CDM resulted in lower transcutaneous bilirubin values that were not significantly different from adjacent native skin pigmentation. This was in contrast to cutaneous contusions, which resulted in a higher measured value (mean 5.01 mg/dL) compared to adjacent native tissue (1.24 mg/dL) demonstrating a four-fold increase in measurement at the lesion site (P < 0.001). Direct comparison of a ΔTCB value (lesion measurement minus the adjacent tissue) demonstrated a significantly higher value in contusions compared to CDM with a mean value of 3.77 and 0.12 mg/dL, respectively (P < 0.001). ConclusionsTCB Spectrometry as a novel diagnostic technique has the potential to discern contusions from CDM and may therefore have the ability to compliment the use of physical assessment alone.

Too much knowledge for a nurse? Use of physical assessment by final-semester nursing students.

There is debate around the scope of physical assessment skills that should be taught in undergraduate nursing programs. Yet this debate is largely uninformed by evidence on what is learned and practiced by nursing students. This study examined the pattern and correlates of physical assessment skill utilization by 208 graduating nursing students at an Australian university, including measures of knowledge, frequency of use, and perceived barriers to physical assessment skills during clinical practice. Of the 126 skills surveyed, on average, only five were used every time students practiced. Core skills reflected inspection or general observation of the patient; none involved complex palpation, percussion, or auscultation. Skill utilization was also shaped by specialty area. Most skills (70%) were, on average, never performed or learned and students perceived nursing physical assessment was marginalized in both university and workplace contexts. Lack of confidence was, thus, a significant barrier to use of skills. Based on these findings, we argue that the current debate must shift to how we might best support students to integrate comprehensive physical assessment into nursing practice.

The primacy of vital signs – Acute care nurses’ and midwives’ use of physical assessment skills: A cross sectional study

BackgroundRegistered nurses and midwives play an essential role in detecting patients at risk of deterioration through ongoing assessment and action in response to changing health status. Yet, evidence suggests that clinical deterioration frequently goes unnoticed in hospitalised patients. While much attention has been paid to early warning and rapid response systems, little research has examined factors related to physical assessment skills. ObjectivesTo determine a minimum data set of core skills used during nursing assessment of hospitalised patients and identify nurse and workplace predictors of the use of physical assessment to detect patient deterioration. DesignThe study used a single-centre, cross-sectional survey design. Setting and participantsThe study included 434 registered nurses and midwives (Grades 5–7) involved in clinical care of patients on acute care wards, including medicine, surgery, oncology, mental health and maternity service areas, at a 929-bed tertiary referral teaching hospital in Southeast Queensland, Australia. MethodsWe conducted a hospital-wide survey of registered nurses and midwives using the 133-item Physical Assessment Skills Inventory and the 58-item Barriers to Registered Nurses’ Use of Physical Assessment Scale. Median frequency for each physical assessment skill was calculated to determine core skills. To explore predictors of core skill utilisation, backward stepwise general linear modelling was conducted. Means and regression coefficients are reported with 95% confidence intervals. A p value <.05 was considered significant for all analyses. ResultsCore skills used by most nurses every time they worked included assessment of temperature, oxygen saturation, blood pressure, breathing effort, skin, wound and mental status. Reliance on others and technology (F=35.77, p<.001), lack of confidence (F=5.52, p=.02), work area (F=3.79, p=.002), and clinical role (F=44.24, p<.001) were significant predictors of the extent of physical assessment skill use. ConclusionsThe increasing acuity of the acute care patient plausibly warrants more than vital signs assessment; however, our study confirms nurses’ physical assessment core skill set is mainly comprised of vital signs. The focus on these endpoints of deterioration as dictated by early warning and rapid response systems may divert attention from and devalue comprehensive nursing assessment that could detect subtle changes in health status earlier in the patient's hospitalisation.

What factors influence nurses' assessment practices? Development of the Barriers to Nurses' use of Physical Assessment Scale

To develop and psychometrically test the Barriers to Nurses' use of Physical Assessment Scale. There is growing evidence of failure to recognize hospitalized patients at risk of clinical deterioration, in part due to inadequate physical assessment by nurses. Yet, little is known about the barriers to nurses' use of physical assessment in the acute hospital setting and no validated scales have been published. Instrument development study. Scale development was based on a comprehensive literature review, focus groups, expert review and psychometric evaluation. The scale was administered to 434 acute care Registered Nurses working at a large Australian teaching hospital between June and July 2013. Psychometric analysis included factor analysis, model fit statistics and reliability testing. The final scale was reduced to 38 items representing seven factors, together accounting for 57·7% of the variance: (1) reliance on others and technology; (2) lack of time and interruptions; (3) ward culture; (4) lack of confidence; (5) lack of nursing role models; (6) lack of influence on patient care; and (7) specialty area. Internal reliability ranged from 0·70-0·86. Findings provide initial evidence for the validity and reliability of the Barriers to Nurses' use of Physical Assessment Scale and point to the importance of understanding the organizational determinants of nurses' assessment practices. The new scale has potential clinical and research applications to support nursing assessment in acute care settings.

Examination of a case of suspected Marfan syndrome

Marfan syndrome is a heritable disorder affecting approximately 1 in 5000 of the UK population. The condition is a multisystem disorder principally affecting the ocular, skeletal and cardiovascular systems. The clinical variability and similarity with other heritable disorders makes Marfan syndrome difficult to diagnose and the condition may not be evident until the patient becomes symptomatic. This article provides an overview of the condition and the case study aims to illustrate how the use of physical assessment and cardiac auscultation can lead to suspicion of Marfan syndrome. In this case, the patient did not meet all of the criteria but had many of the traits. This highlights the importance of comprehensive history taking, management of symptoms and follow up of patients and their families.

Physical assessment: whose role is it anyway?

The increasing acuteness of care and developing technologies present new opportunities and challenges for the nursing profession. The NHS Plan emphasizes the need for change to meet these demands, especially in the area of patient assessment. Nurses are extending their repertoire of skills to include those that were once the domain of junior doctors. These new skills tend to be used mostly by experienced nurses such as the specialist or advanced nurse practitioner. One such skill is physical assessment. Traditionally viewed as part of the doctor's role, physical assessment has not routinely been taught in nurse training. With the advancement of nursing roles, it has been argued that physical assessment has become a key nursing skill. This article discusses the use of physical assessment as part of the growing role of the nurse in critical care. Nurses deliver holistic care, based on assessment. This assessment is incomplete, if a detailed physical assessment is omitted and, as a consequence, care is delivered in the absence of an appreciation of the impact of pathophysiological adaptations. This article argues that the ability to physically assess the patient in a principled and systematic fashion, in conjunction with routine health assessment, is a necessary skill for the modern nursing professional working in critical care. It is further argued that, within the current climate of advancing nursing practice, the acquisition of this skill is important for all nurses, to improve patient care, not to supplant the skills of the junior doctor.