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.     

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.     

Physical assessment by nurses: a study of nurses' use of chest auscultation as an indicator of their assessment practices.

A non-experimental survey was conducted to determine if the factors such as years of practice, how physical assessment skills were learnt and how often these skills were utilised, influenced nurses' reluctance to implement physical assessment. A sample of 150 registered nurses was surveyed. Analysis indicated that the majority of respondents has been taught to listen to chest sounds (auscultation) but did not implement this skill on a daily basis. Chi square analysis indicated that younger nurses with less years of experience were more keen to learn chest auscultation skills than nurses who were older and had more years of nursing experience.     

Pharmacology education: a theoretical framework of applied pharmacology and therapeutics

United Kingdom Government initiatives such as The NHS Plan (DoH 2000) identified the need for nurses to undertake multi-skilled professional roles. In the United Kingdom, the transition to a larger graduate nurse workforce continues, as Universities offer nurse pre-registration courses at diploma and degree levels. Concomitant with the change in educational standard is the need to teach student nurses the theoretical principles of medication management and to develop skills in clinical reasoning skills. Both elements are limited in current educational pre-registration nurse programmes, in order to develop the future, multi-skilled workforce such courses should incorporate the theory and skills of health assessment, physical examination, applied pharmacology and clinical reasoning. This paper aims to examine how knowledge of applied pharmacology and therapeutics can be integrated into an undergraduate pre-registration nursing programme. Discussion focuses on how this generic framework can provide educators with an outline of the theoretical constructs, their application, the teaching strategies involved and instruction on how to prepare nurses to clinically reason with regard to medication management issues. This framework can be adapted to accommodate nurses studying for all parts of the register.     

Person-centred communication: design, implementation and evaluation of a communication skills module or undergraduate nursing students - an Irish context

Despite wide agreement about the importance of effective communication in nursing there is continuing evidence of the need for nurses to improve their communication skills. Consequently, there is a growing demand for more therapeutic and person-centred communication courses. Studies on communication education reveal considerable variability on the design and operationalisation of these programmes. Additionally, the literature highlights that nurse educators are continually challenged with developing and implementing these programmes. Communication skills are generally taught in years one and two of undergraduate nursing degree programmes. This is a stage when students have minimal contact with patients and clients. We suggest that a communication skills module should be included in all final years of undergraduate nursing programmes. With an array of clinical experiences to draw from, final year nursing students are better placed to apply the skills of effective communication in practice. In this paper, we present the design, implementation and evaluation of an advanced communication skills module undertaken by fourth year undergraduate nursing students completing a Bachelor of Science (BSc) degree - nursing programme at one university in the Republic of Ireland.     

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.     

Nursing harm reduction education and care for people who use drugs or who engage in sex work

Harm reduction is an evidence-based approach that could promote health equity through the implementation of pragmatic strategies for people who use drugs or who engage in sex work. The purposes of this study were to describe whether nurses received harm reduction education in their nursing programs, whether nurses are practicing harm reduction, and strategies for integrating harm reduction within nursing curriculum. An online survey was delivered to nurses and an interview with a nurse harm reductionist was conducted. Among the 30 survey participants, only 17% (n = 5) stated they were taught about harm reduction in their nursing programs. On average, survey participants practiced harm reduction less than "half of the time" by meeting people where they are in their drug use or sex work. The nurse harm reductionist described how harm reduction should be taught as a skillset for evidence-based nursing practice. By incorporating harm reduction principles into nursing education and nursing practice, nurses can provide competent care for people who use drugs or who engage in sex work.     

Correlation between work experiences and physical assessment in Japan

Abstract The purpose of this study was to obtain baseline data of Japanese nurses' knowledge, skills and attitudes concerning physical assessment. The design of the study was survey research, using a self-administered questionnaire. Nurses with more experience were more knowledgeable about almost all physical assessment skills. Fourteen of the physical assessment skills were used more often by respondents with more experience in nursing practise. Ten of the physical assessment skills were cited as more difficult to carry out by respondents with less experience in nursing. The group with more clinical practise experience had more knowledge of physical assessment skills, used the skills more frequently and had less difficulty in using them. The results of this study indicated that Japanese nurses learn physical assessment skills 'on the job'.     

Recall Rummy: learning can be fun

BACKGROUND: Nurse educators are continuously seeking creative methods to teach nursing skills. Continuing education programs have adapted and used television game show themes as effective teaching strategies. METHOD: The traditional card game of rummy has been modified into a creative learning technique for entertaining and reinforcing skill techniques for nurses practicing in a clinical setting. CONCLUSION: Imagination and creativity are important assets for planning and teaching skills that relate to the practice of nursing. Recall Rummy presents one such approach to teaching nursing skills.     

A collaborative approach to developing nursing skills to meet service needs

Academics, educators and health service managers came together to explore, within their local area, the nature of the perceptions of beginning registered nurses (BRNs) and Nursing Unit Managers (NUMs) to the skills utilised by BRNs within the first six months of practice. A group of 71 BRNs and nine NUMs participated in a cross-sectional survey. BRNs were also asked to rate their preparedness in each particular skill, dependent on the method of teaching--theory/lectures, nursing laboratories and clinical experience. Some 21 skills, relating to medication/fluid administration and skin and wound care, were perceived by 95 per cent or more of the graduates as being used within the first six months. Similar perceptions existed for NUMs and BRNs for 52.4 per cent of the listed skills. Differences in perceptions have led to academics altering the scope of skills being taught and focusing assessment on critical skills for BRNs, and managers increasing awareness among NUMs as to the source of the differences and developing programs to improve clinical interpretation skills. Improvements in the experience of the BRN are likely to occur when all parties work together to bring about positive change. By Barbara Somerville,     

Selecting technical skills to teach for competency

This pilot project describes a method using data from the clinical setting to assist nurse educators in the selection of technical nursing skills to teach for competency within the basic nursing program. Based on Dr. Dorothy del Bueno's proposal that skills taught should be those which are most frequently performed and considered most important in the community where new graduates are employed, five registered nurses in 16 metropolitan hospitals were asked to rate 154 technical nursing skills for frequency and importance. Findings for medical-surgical, intensive care, obstetric and pediatric areas, as well as for all groups combined, are described as skills ranking from 1) most frequent to least frequent, 2) most important to least important, and 3) most important/most frequent to least important/least frequent. Examination of skills placement within the rankings assisted faculty within an associate degree program to decide which skills to select and which to eliminate from the program.     

Family nursing education and family nursing practice in Nigeria

A survey of six Nigerian nursing program curricula was conducted to determine the extent to which family nursing theory was used as a reference for conceptualizing nursing care in Nigeria. In addition, 25 nurse clinicians were purposely selected from three levels of primary, secondary, and tertiary health care units in Ile-Ife, Nigeria, and were interviewed to determine the extent to which nurses in practice reported using family assessment tools in their practice. The survey of the postgraduate curricula showed that master's and doctorally prepared nurses specializing in community health nursing have a theoretical base in family nursing theory. The limited focus on family nursing theory in basic, postbasic, and first-degree nursing curricula was deemed inadequate to develop the knowledge and skills necessary for all practicing nurses to embrace family-focused care in Nigeria. In nursing practice, families were seen to be involved in nursing care only to the extent of meeting financial and physical care needs of their family members. Findings from this study point to the need for a reorientation of the nursing curricula in Nigeria to include more family nursing theory. Specialized education of family nurse practitioners who would function at all levels of care also is a desirable goal to provide holistic health care to Nigerian families.     

Determining the use of physical assessment skills in the clinical setting

This study examined the clinical application of physical assessment skills by baccalaureate nurses. Fifty-nine pediatric staff nurses practicing in two different hospitals in Southern California completed a questionnaire which surveyed how frequently assessment skills were utilized and what deterrents, if any, inhibit their use. Approximately one-third of the 36 skills listed were utilized daily by at least 74% of the participants, and respondents selected a variety of deterrents to the utilization of other skills. There was no significant difference in the utilization of skills between nurses who had taken a separate course in physical assessment and those from an integrated curriculum.     

Physical assessment: a continuing need for clarification

PROBLEM. Physical assessment skills are a mainstay of the nursing process and are taught to pre‐licensure learners. Little research has been conducted on the skills that are actually used in practice compared to those that are taught in pre‐licensure education. METHOD. This article provides an integrated literature review regarding physical assessment skills and their practical application. FINDINGS. Physical assessment skills are consistently referred to as part of the first step of the nursing process, but further clarification about which skills are included in the definition is needed. CONCLUSIONS. Further research is needed to clarify if what is taught is actually used and to what extent in clinical practice.     

新上岗护士护理操作培训需求调查分析及对策

目的探讨新上岗护士护理操作培训的方法。方法拟定护理操作培训需求调查表，调查新上岗护士67名。结果87．5％的新上岗护士在操作上存在困难，95．31％的护士认为操作培训重要，190％的护士认为全部操作需要进行示范，96．87％的护士认为需要情景模拟，67．19％的护士要求培训地点在临床。操作上存在困难的原因有：18．75％的护士操作中的沟通交流存在困难，14．06％的护士对仪器设备的操作不熟悉，23．44％的护士操作的流程不熟悉，9．38％的护士对流程中的重点掌握不好，34．37％的护士认为在工作中练习的机会很少。结论编写适合本院的护理操作手册、急救流程手册；基础护理操作考核；专科护理操作培训；建立院内进修制度；急救技术的专项培训；沟通交流能力的培养；仪器使用的培训。     

新上岗护士护理操作培训需求调查分析及对策

目的探讨新上岗护士护理操作培训的方法。方法拟定护理操作培训需求调查表,调查新上岗护士67名。结果87.5%的新上岗护士在操作上存在困难,95.31%的护士认为操作培训重要,100%的护士认为全部操作需要进行示范,96.87%的护士认为需要情景模拟,67.19%的护士要求培训地点在临床。操作上存在困难的原因有:18.75%的护士操作中的沟通交流存在困难,14.06%的护士对仪器设备的操作不熟悉,23.44%的护士操作的流程不熟悉,9.38%的护士对流程中的重点掌握不好,34.37%的护士认为在工作中练习的机会很少。结论编写适合本院的护理操作手册、急救流程手册;基础护理操作考核;专科护理操作培训;建立院内进修制度;急救技术的专项培训;沟通交流能力的培养;仪器使用的培训。     

Intellectual disability health content within nursing curriculum: An audit of what our future nurses are taught

BackgroundIndividuals with intellectual disability experience chronic and complex health issues, but face considerable barriers to healthcare. One such barrier is inadequate education of healthcare professionals.ObjectiveTo establish the quantity and nature of intellectual disability content offered within Australian nursing degree curricula.DesignA two-phase national audit of nursing curriculum content was conducted using an interview and online survey.SettingAustralian nursing schools offering pre-registration courses.ParticipantsPre-registration course coordinators from 31 universities completed the Phase 1 interview on course structure. Unit coordinators and teaching staff from 15 universities in which intellectual disability content was identified completed the Phase 2 online survey.MethodsQuantity of compulsory and elective intellectual disability content offered (units and teaching time) and the nature of the content (broad categories, specific topics, and inclusive teaching) were audited using an online survey.ResultsOver half (52%) of the schools offered no intellectual disability content. For units of study that contained some auditable intellectual disability content, the area was taught on average for 3.6 h per unit of study. Units were evenly distributed across the three years of study. Just three participating schools offered 50% of all units audited. Clinical assessment skills, and ethics and legal issues were most frequently taught, while human rights issues and preventative health were poorly represented. Only one nursing school involved a person with intellectual disability in content development or delivery.ConclusionDespite significant unmet health needs of people with intellectual disability, there is considerable variability in the teaching of key intellectual disability content, with many gaps evident. Equipping nursing students with skills in this area is vital to building workforce capacity.     

Writing exceptional (specific,student and criterion-focused) rubrics for nursing studies

Effective assessment of nurses in higher education is dependent on the interpretation and demonstration of learning outcomes by students and educators/academics. Rubrics can effectively communicate unit learning outcomes to students and may contribute towards the academic rigour of nursing courses, when assessment criteria are articulated clearly and consistently to both students and educators/academics. This paper aims to describe the different types and uses of rubrics, as well as outline the steps required to develop exceptional rubrics whilst using the literature as a basis for suggestions. Well written rubrics can facilitate consistency of marking across a student cohort, which may result in decreased student anxiety regarding assessment expectations, uniformity of assessment style and layout and may ensure that educators/academics across a teaching team are interpreting assessment criteria, consistently. Exceptional rubrics can empower students to success in academic assessments.     

High‐Fidelity Simulation and Emergency Preparedness

ABSTRACT Ongoing threats of bioterrorism and the consequences of natural disasters require nurses entering the workforce to be competent in emergency preparedness. Nurses need to collaborate with multidisciplinary teams and use their critical thinking skills to provide safe nursing care during potentially chaotic public health emergencies. Using Institute of Medicine recommendations and Quality and Safety Education for Nurses competencies, the authors describe a public health emergency simulation exercise with undergraduate senior nursing students enrolled in a public health clinical course. Students applied chronic disease, mental health, and pharmacology knowledge acquired in previous nursing courses to an unfolding infectious disease outbreak while practicing their assessment, treatment, delegation, organizational, and leadership skills. The students' quantitative evaluation of the experience indicated that 90.36% thought the purpose of the experience was clear, 91.5% thought the importance of delivering safe care during a public health emergency was stressed, and 79.5% thought the presimulation briefing and postsimulation debriefing helped them understand and participate in the drill. Qualitatively, the students' reflections of the exercise indicated that although they initially felt overwhelmed and anxious, they realized the importance of participating in emergency preparedness and recognized their ability to apply nursing skills learned in previous courses.