The impact of surgical ward nurses practising respiratory assessment on positive patient outcomes.

OBJECTIVE: A literature review to examine the incorporation of respiratory assessment into everyday surgical nursing practice; possible barriers to this; and the relationship to patient outcomes. PRIMARY ARGUMENT: Escalating demands on intensive care beds have led to highly dependent patients being cared for in general surgical ward areas. This change in patient demographics has meant the knowledge and skills required of registered nurses in these areas has expanded exponentially. The literature supported the notion that postoperative monitoring of vital signs should include the fundamental assessment of respiratory rate; depth and rhythm; work of breathing; use of accessory muscles and symmetrical chest movement; as well as auscultation of lung fields using a stethoscope. Early intervention in response to changes in a patient's respiratory health status impacts positively on patient health outcomes. Substantial support exists for the contention that technologically adept nurses who also possess competent respiratory assessment skills make a difference to respiratory care. CONCLUSIONS: Sub-clinical respiratory problems have been demonstrated to contribute to adverse events. There is a paucity of research knowledge as to whether respiratory education programs and associated inservice make a difference to nursing clinical practice. Similarly, the implications for associated respiratory educational needs are not well documented, nor has a research base been sufficiently developed to guide nursing practice. Further research has the potential to influence the future role and function of the registered nurse by determining the importance of respiratory education programs on post-operative patient outcomes.     

Physical assessment: implications for nurse educators and nursing practice

AIM: In New Zealand, the physical assessment of a patient has traditionally been the domain of the medical profession. As a country implementing advanced practice roles, with an expectation that both nurse practitioners and registered nurses will use physical assessment skills, the relevancy of physical assessment for each scope of practice has currency. The aim of this literature review was to discover what could be learnt from the experiences of Western countries that already incorporate physical assessment skills into nurses' health assessment. FINDINGS: Nurses in the USA, and more recently Canada and Australia, readily incorporate physical assessment skills into their nursing practice as a component of health assessment. The international literature identified that any change to the nurse's role in health assessment, to include physical assessment skills, requires strategies that involve the regulatory, educational and practice components of nursing. CONCLUSION: Nurses and other health professionals must perceive that this role expansion will improve health outcomes for the diverse populations accessing health care. Teaching physical assessment skills within a holistic health model will enable nurses to contribute a more comprehensive health assessment to the planning and monitoring of people's health care.     

Continuing education in physical assessment: a pilot study

This study examines the effectiveness of a five day educational program designed to teach registered nurses (RNs) comprehensive physical assessment techniques and associated skills. Tests and questionnaires measured nurses' knowledge and use of physical assessment skills before and three months after its completion. It was found that the group had increased its physical assessment knowledge and the majority were using the learned skills.     

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.     

A survey of physical assessment techniques performed by RNs: lessons for nursing education

There is ongoing concern about the adequacy of the educational preparation of nursing graduates; at the same time, there is concern regarding excessive content within nursing curricula. The purpose of this study was to identify physical examination skills performed by practicing nurses to better understand the competencies needed by graduates of nursing programs. A sample of 193 nurses completed a survey indicating the frequency they performed various physical assessment techniques. Thirty skills routinely performed by nurses were identified; the remaining skills were reportedly performed occasionally or were not performed. The fact that only 30 skills were reportedly performed regularly by the sample raises questions about the depth at which examinations should be conducted in the clinical setting and the depth at which physical examination skills should be taught in nursing programs. Nurse educators should assess the skills currently taught in nursing programs and consider what skills graduates actually need to enter nursing practice.     

Empowering students on medication for asthma to be active participants in their care: an exploratory study.

This article is part of a larger study of young students with asthma. It focuses on the observations of school nurses and comments from parents and students pertinent to school nursing practice. The study shed light on the educational needs of 9- to 11-year-old students with asthma and identified some areas where the school nurse could easily enhance the health management of these students. Responses from students and parents about asthma provided insight into the daily challenges faced by students with asthma. Students with asthma may or may not fully understand the seriousness of their chronic condition or how to recognize and treat symptoms. The purpose of this pilot study was to identify strategies school nurses might use to determine the knowledge level of students and to determine the effects of asthma education programs. School nurses who participated in the study were provided with a comprehensive package containing current asthma information and an education program to update knowledge and skills. These school nurses also received Open Airways for Schools, an American Lung Association education program for students in grades three to five. The study was a two-group exploratory, quasi-experimental design. Questionnaires were prepared for students, school nurses, and parents to collect information on knowledge and perceptions about asthma. Students who participated in the educational program were reported by their school nurses to have increased knowledge and management skills related to their disease.     

Hospice nursing: the specialty

The purpose of this study was to identify and delineate what experienced hospice nurses perceive as the knowledge and skills base essential to their practice of hospice nursing as a specialty. Little of this specialty is taught in basic nursing programs, so another purpose was to determine the methods hospice nurses use for knowledge and skills acquisition. The qualitative study method of focused ethnography was used. This method allowed the researcher to examine hospice nurses in the context of their own community-based agency, enter the research arena with specific questions, describe the topic from the viewpoint of the participants, use multiple data sources, and begin data analysis concurrently with data collection, which continued until saturation was reached. During data analysis, 11 categories emerged. Four of these categories involved skills: (a) assessment skills, (b) communication skills, (c) technical skills, and (d) management skills; and seven categories primarily involved knowledge: (a) end-stage disease process, (b) signs of impending death, (c) palliative therapeutics, (d) collaboration between disciplines, (e) advocacy, (f) philosophy and ethics of hospice care, and (g) family dynamics. Of these 11 categories, the one discussed and observed most often was that of assessment skills. It was found that the hospice nurses learned their specialty by doing it. However, the need for graduate education in hospice nursing became apparent.     

“Integrity is integrity. IT doesn't matter the context”: A qualitative exploratory study of academic integrity in an undergraduate nursing program

Academic integrity is integral to the development of knowledge, clinical skills, and the professional development of nursing students, and provides an inextricable link to the standards for professional nursing practice. A semi-structured interview of 11 nursing academics was undertaken to explore academic integrity in an undergraduate nursing program in a large, Australian metropolitan university. An inductive approach to thematic analysis was used to identify the following themes (1) Graduate attributes: the participants believed academic integrity was important in equipping nurses with the knowledge, skills, critical thinking, and moral integrity necessary to support decision making in clinical practice. They expressed concerns that dishonest behavior may be transferred into clinical practice and threaten patient safety. (2) Gatekeepers: participants viewed themselves as gatekeepers, with vested interest to protect patients and the professional reputation of nursing. (3) Role models: participants instilled integrity in students nurses through dialog and role modeling of discipline-specific values. (4) Curriculum: participants believed that assessment design, course content and the physical environment influenced a student's ability to maintain integrity. Based on these findings, the participants identified a greater focus on the importance of academic integrity in the development of graduate attributes should be made more explicit to nursing students throughout their studies. A focus to learning with integrity will create notable learning opportunities and better prepare students for future professional practice.     

Physical assessment skills: a developing dimension of clinical nursing practice.

This paper proposes that the current use of physical assessment skills within critical care nursing practice is part of a on-going nursing role development process. A review of the critical care nursing role highlights how nurses in this setting have always been responsive to patient management needs. In exploring one recent nursing role development, the critical care outreach nurse, it is suggested that enhanced assessment skills enable these practitioners to safely and competently assess critically ill patients out of the intensive care environment. The use of patient case studies in this paper, demonstrate how the theory of a more intensive physical assessment knowledge base can be applied in the everyday practice of an critical care outreach nurse. Through such systematic patient review, patient management plans can be agreed and ward based practitioners can be supported in the on-going treatment of sick ward patients. The use of the cases presented also highlights the complexity of the outreach nurse's practice in addressing clinical management and team management issues.     

Use of physical assessment skills by Australian nurses.

The use of physical assessment skills, though limited, has been an integral part of nursing since the time of Florence Nightingale, when aids such as sight and touch were relied upon to assess patients. Now with more nurses involved in primary health the use of a wider range of physical assessment has become necessary. Below is a report of how Australian nurses are putting more of these skills into practice.     

Clinical Competencies for Community Health Nursing

Cost-containment strategies initiated in the early 1980s caused a major shift in site of care delivery for persons needing nursing care. Where once the majority of clients were cared for in the acute-care setting until they were self-sufficient, now most are discharged to the home environment still requiring acute-care nursing interventions as well as community health nursing skills. This rapid shift in practice sites has placed severe strain on community health nursing agencies. Not only are more nurses required to fill the increased demand for services, but the demand comes at a time when we are experiencing a severe nursing shortage. This has forced many agencies to hire acute care nurses who have little or no community health nursing experience. These nurses come to community health nursing expecting to use the same set of skills and knowledge base used in their acute-care practice; however, the skill levels and concepts required for community health nursing are quite different from the acute care setting. Educational preparation has not kept pace with this shift in practice. Consequently, many nurses are not adequately prepared to enter community health nursing. Preparation must include theoretical and experiential components that focus on assessment skills (of the community and individual), decision making, case management, health systems management, teaching, and leadership. Collaborative efforts between community health organizations and educational institutions would seem to be one solution that would ensure adequately prepared nurses for community health nursing. The establishment and maintenance of strong staff-development programs within community health nursing agencies are also required.     

The doctorate in nursing practice: moving advanced practice nursing even closer to excellence

One of the most significant events to affect advanced practice nursing is the practice doctorate. The doctor of nursing practice (DNP) is firmly established as an educational alternative to the traditional academic research doctoral degree. This option empowers nurses to advance knowledge and skills in clinical practice. This article reviews the historical context that led to the introduction of the DNP and the proposal of the DNP as entry into practice for advanced practice nurses, DNP program parameters, and some of the evolving issues related to nursing's practice doctorate.     

A population-based approach to pediculosis management

Pediculosis is a population-based problem that is a priority concern for many communities. Public health nurses in a county health department collaborated with epidemiologists, nursing students, and faculty to design and implement an effective population-based pediculosis management project. The focus of the project was the development of pediculosis treatment and prevention guidelines based on recognized best practices that were acceptable to both epidemiologists and practicing public health nurses. Public health nurses disseminated these guidelines to community providers and reinforced their use through consultation and educational sessions. Two critical changes occurred as a result of the project. First, community providers significantly changed their recommendations for the treatment of pediculosis after nursing intervention. Second, public health nurses increased their population-based practice skills, continued to use those skills to address pediculosis, and extended those skills to additional population-based initiatives.     

Physical assessment skills: a descriptive study of what is taught and what is practiced.

The purpose of this study was to investigate physical assessment skills taught in undergraduate baccalaureate nursing programs and the physical assessment skills used by practicing nurses. Twelve educators teaching physical assessment and 51 practicing nurses were surveyed on 120 physical assessment skills listed in standard nursing textbooks. Median scores were computed on all the skills. The educators taught all of the skills, 92.5% of the skills were taught and practiced in class and 7.5% were taught but not practiced. For the practicing nurses, 37% of the skill were never used, 29% were used on a daily/weekly basis, with 34% used on a monthly/occasional basis. Based on these findings, we recommend that the content of physical assessment courses be reevaluated, with courses focusing on what nurses need to know to practice nursing.     

Are Australian general practice nurses underutilised?: An examination of current roles and task satisfaction

BackgroundThe general practice nursing workforce in Australia has grown exponentially in the last fifteen years. To understand the contribution and issues relating to this workforce we need to explore the evolution of the nurses’ role and the nurses’ perceptions of the work that they undertake.AimTo describe trends in general practice nurse clinical activities, the extent to which GPNs use their knowledge and skills and their satisfaction with the general practice nurse role.MethodsWithin a larger mixed methods project, a national cross-sectional survey of Australian primary health care nurses was undertaken. This paper details the survey findings related to the role of nurses working in general practice, the extent to which they use their knowledge and skills and their satisfaction with their role. Data about nurse roles was compared with previous workforce data to elucidate changes over time.FindingsOf the 1166 primary health care nurses who responded to the survey, 950 reported being employed in general practice. Participants reported undertaking activities related to health promotion and chronic disease management more frequently now than previously. They identified a desire to spend the same or less time on administrative activities and more time on health promotion, patient education and patient assessment. Nearly half of participants reported that often they feel that they could do more, or most of the time they don’t use their skills to the full extent.ConclusionNurses working in general practice are increasingly undertaking activities related to health promotion and chronic disease management. However, these nurses remain underutilised. Having nurses working to their full scope of practice has the potential to increase job satisfaction and nurse retention, as well as improve patient health outcomes.     

Education in nursing diagnosis: evaluating clinical outcomes

This article describes the development, implementation, and evaluation of an educational program to update the knowledge and skills of nurses in the use of the nursing process and nursing diagnoses. Results 1 year later suggest improvement in participants' knowledge of the phases of the nursing process. Chart audits demonstrated this knowledge was more specifically applied to improved documentation of nursing diagnoses.     

Promoting personal safety in community health: four educational strategies

Nurse educators must confront the issue of nursing students' personal safety in community health practice, provide the necessary knowledge and skills, and document their actions. Learning opportunities are required to assist students to recognize and evaluate risks, and prevent their consequences. Thematic analysis of interviews with 56 public health nurses in Alberta, Canada uncovered knowledge, skill, and attitudinal components of risk assessment. Categories under the theme framing personal risk in work environments and the sub-themes framing for action and framing for no action provided a conceptual framework for planning educational strategies. Based on how these nurses framed their personal risk, 4 educational strategies are presented: a checklist, small group learning activities, a template for Web-based courseware, and a problem-based learning scenario.     

Assessing clinical competence in physical medicine & rehabilitation residency programs

OBJECTIVE: Evaluation of resident clinical competence is a complex task. A multimodal approach is necessary to capture all of the dimensions of competence. Recent guidelines from the Accreditation Council for Graduate Medical Education delineate six general competencies that physicians should posses. Application of these guidelines presents challenges to residency program directors in defining educational experiences and evaluation methods. DESIGN: We surveyed 81 physical medicine and rehabilitation program directors regarding assessment tools used in their programs. Seventy-five percent responded. The most frequently used assessment tools included: In-training self-assessment examinations, faculty evaluations, direct observation, and conference participation. Program directors assigned the highest values to direct observation, faculty evaluations, self-assessment examinations, and oral examinations. RESULTS: Of the general competencies, more than 90% of program directors believed they did an adequate job rating dimensions of patient care, medical knowledge, professionalism, and communication skills. Approximately one-third, however, thought they did a less than fair job rating practice-based learning and improvement and systems-based practice. The majority of programs reported that they were able to identify a resident with difficulties during the first year of training, 44% within the first 6 months. Program directors reported that their residents spend a significant amount of their time with nurses and therapists during their inpatient rotations; however, this was not reflected in their evaluation practices, in which only one-fourth of programs reported the use of nurses and therapists in evaluating residents. CONCLUSIONS: Survey results indicate that physical medicine and rehabilitation program directors apply a variety of assessment tools in evaluating resident clinical competence. Although perceptions about the relative value of these tools vary, most programs report a high value to direct observation of residents by faculty. Of the six general competencies, program directors struggle the most with their evaluation of practice-based learning and improvement and systems-based practice.     

Irish psychiatric nurses' self-reported sources of knowledge for practice

Evidence-based practice (EBP) is an approach to health care in which health professionals use the best evidence available to guide their clinical decisions and practice. Evidence is drawn from a range of sources, including published research, educational content and practical experience. This paper reports the findings of a study that investigated the sources of knowledge or evidence for practice used by psychiatric nurses in Ireland. The paper is part of a larger study, which also investigated barriers, facilitators and level of skills in achieving EBP among Irish psychiatric nurses. Data were collected in a postal survey of a random sample of Irish psychiatric nurses using the Development of Evidence-Based Practice Questionnaire. The findings revealed that the majority of survey respondents based their practice on information which was derived from interactions with patients, from their personal experience and from information shared by colleagues and members of the multidisciplinary team, in preference to published sources of empirically derived evidence. These findings are consistent with those of the previous similar studies among general nurses and suggest that Irish psychiatric nurses face similar challenges to their general nursing counterparts in attaining of EBP.