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.     

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.     

Virtual patients for assessment of clinical reasoning in nursing -- a pilot study

In different nursing programmes, one important learning outcome is clinical reasoning (CR) skills. However, to date, there is limited number of methods available for assessment of CR skills; especially for distance-based courses. This study investigates students' opinions about the feasibility of using Virtual Patients (VPs) for assessing CR in nursing education. VPs were introduced as an assessment tool in three different nursing courses at two universities, comprising 77 students in total. Students' overall acceptance of this assessment tool, including its applicability to the practise of nursing and the potential of VP-based assessment as a learning experience, were investigated using questionnaires. Course directors used the Web-SP system to assess students' interactions with VPs and their answers regarding diagnoses, caring procedures and their justifications. Students' found the VP cases to be realistic and engaging, and indicate a high level of acceptance for this assessment method. In addition, the students' indicated that VPs were good for practising their clinical skills, although some would prefer that the VP system be less "medical" and asked for more focus on nursing. Although most students supplied correct diagnoses and made adequate clinical decisions, there was a wide range in their ability to explain their clinical reasoning processes.     

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.     

The effectiveness of an education program to teach Australian nurses comprehensive physical assessment skills

This study investigates the effectiveness of an educational program to teach 22 registered nurses comprehensive physical assessment skills. Administration of questionnaires and tests provided measures of the nurses: a) use of physical assessment skills; b) knowledge of physical assessment; c) changes in nursing practice since learning the skills; d) barriers to the use of these learned skills. The major post program findings regarding increases in the nurses' knowledge and use of physical assessment skills, positive changes in their nursing practice and lack of barriers to their use of these skills indicates that the participants did benefit from this educational experience.     

A survey of first year student nurses' experiences of learning blood pressure measurement

Blood pressure (BP) measurement is an important clinical nursing skill. Informal evaluation triggered concerns about first year student nurses' opportunities to practise it. Therefore 447 first year pre-registration nursing students completed evaluative questionnaires following two 6-week clinical placements. The data were analysed using SPSS v.13 for analysis; open comments were analysed thematically. A third of the respondents (n=137) had pre-course experience in measuring BP. Ninety-five percent (n=425) attended the university skills laboratory session. Only 36% (n=158) of students measured BP using both electronic and manual equipment in both placements and 6% (n=27) did not practise this skill in either placement. Students undergoing non-hospital placements reported fewer practice opportunities. A large number of students reported never having been supervised while measuring BP; they were more likely to be supervised while measuring BP manually than electronically. Students' self-confidence in BP measurement increased over the first year but larger number of students were confident in electronic BP. To conclude, experiences of learning BP measurement varied in terms of opportunities to practise, equipment used, supervision levels and self-confidence. Students' experiences of learning other clinical skills may also differ, which has implications for healthcare education generally.     

Predictors of recognition and practice of family nursing among healthcare professionals in Japan

Abstract Background. Although many nurses have become aware of the importance of family‐centered nursing, very little is known about the advanced knowledge and intervention skills of family nursing in Japan. Objectives. We examined the characteristics of their recognition of family nursing and factors related to the practice of family nursing. Methods. The subjects were nursing staff at a large hospital in Fukuoka, Japan (n = 596). A study using self‐administered questionnaires was conducted in October 2002. Factor analysis and multiple linear regression analysis were used to analyse the data. Results. Of 596 nurses, 376 returned questionnaires (63·6%). The study achieved the following findings. (1) The nurse's recognition of family nursing had four subscales: skills required to interview family members to construct a trusted relationship; assessment of family structure and family functioning; interventional skills of family nursing; and skills to collect information on family members. (2) The predictors of family nursing recognition were ‘gender’, ‘job position in hospital’, ‘individual experience of caring for their family members’, ‘length of clinical experience’ and ‘types of wards where they work’. (3) The predictors of practice of family nursing were ‘interventional skills of family nursing’, ‘skills to collect information on family members’ and the ‘total of four skills’. Conclusions. It is implied that the acquisition of knowledge and skills of family nursing in hospital settings are invaluable to consciousness‐raising and practice of family nursing. Relevance to clinical practice. As the factors related to practice or recognition of family nursing have been identified, the present findings are useful for hospital administrators who want to promote family nursing in their hospitals.     

Registered nurses' and student nurses' assessment of pain and distress related to specific patient and nurse characteristics

Previous studies examining the influence of patient and nurse characteristics on assessments of pain and distress are not consistent in their results. Few studies have focused on the influence of nurses' personality factors on the assessment of pain and distress. The aims of this study were to compare registered nurses' and student nurses' assessments of patients' pain and distress and to identify if the assessment relate to specific patient and nurse characteristics. Seventy-one registered nurses and 184 student nurses assessed pain and distress in three hypothetical cases and responded to personality factors scales. The assessments of pain and distress regarding the patients showed significant differences. The respondents were divided into two groups, respectively, for each patient according to whether the patient's experiences of pain and distress were assessed as more or less intense. Both the groups of registered nurses and student nurses showed significantly differences on personality factors. The groups of student nurses also differed on nursing experience. Patients' age, and type and stage of illness, personality factors, and nursing experience influenced the respondents' assessments. These findings can be used to help educators in nursing to develop strategies to improve skills and knowledge in the assessment at pain and distress.     

Effects of a multifaceted neurological assessment educational program in nursing students: A randomized crossover study

AimThis study aimed to verify the effects of a multifaceted neurological assessment educational program on neurological assessment-related knowledge, skills, communication ability and self-efficacy in nursing students.BackgroundNurses should be equipped with optimal neurological assessment competency to ensure quality care for patients with neurological symptoms.DesignThis study involved a waitlist control group with a randomized crossover design.MethodsFourth-year nursing students were randomly assigned to an intervention group (n = 28) or a waitlist control group (n = 27). Pre- and post-intervention differences in neurological assessment knowledge, skills, communication ability and self-efficacy between the intervention and the waitlist control group were analyzed using generalized estimated equations.ResultsThe nursing students in the intervention group showed significantly improved knowledge, skills, communication ability and self-efficacy scores compared with those in the waitlist control group. Scores related to knowledge, skills and communication ability were maintained and self-efficacy scores had further increased at 2 weeks after the educational program in the intervention group.ConclusionsOur multifaceted neurological assessment educational program is useful for improving nursing students' knowledge, skills, communication ability and self-efficacy.     

Chinese nursing students' attitudes toward traditional Chinese medicine

In this study, we examined Chinese nursing students' attitudes toward and use of traditional Chinese medicine (TCM). Survey questionnaires were distributed to 439 nursing students, 263 of whom (60%) returned them. Of the respondents, 92% had used TCM, while 48% had used TCM at least once during the previous year. Forty-five percent of respondents reported positive attitudes toward TCM use, 52% had neutral attitudes, and only 3% reported negative attitudes. The majority of respondents (76%) reported no change in their attitude toward TCM after studying nursing. Mean scores related to the adequacy of the current curriculum in TCM training and the state of respondents' TCM knowledge were generally low. Of the respondents who had used TCM during the past year, the most common use was for upper respiratory tract infection. The most common type of TCM used by respondents was herbal tea or soup. Final-year nursing students were more likely to have used TCM during the previous year, report they would like more courses on TCM, and consult Western medicine physicians before using TCM; they were also less likely to develop more negative attitudes toward TCM after studying nursing.     

Nursing work in NHS Direct: constructing a nursing identity in the call-centre environment

The introduction of nurse-led telephone helplines for patients to have access to information and advice has led to the development of a new kind of practise for nurses. This study focuses on the ways NHS Direct (NHSD) nurses construct a nursing identity and shape their work in a call-centre environment. The empirical findings are drawn from a study investigating the impact of NHSD on professional nursing issues that was part of a wider evaluation of the service in South Wales, UK. Data were gathered from responses to free text questions included in a questionnaire sent to nurses in three NHSD sites. Further data were collected from focus groups held with NHSD nurses. The nurses defend their identity as nurses rather than call-centre workers. The discourses of the nurses show a strong alignment with the traditional values of nursing, encompassing holistic and empathetic practise that has moved with the nurses across locales. We argue that the nurses frame a nursing identity in NHSD around the importance of previous experience and claim to practise holistic nursing. However, the development of new skills and adaptation of old skills in response to the demand of NHSD work challenges normative notions of traditional 'hands-on' models of practise and indicates a possible movement towards a cognitive model of nursing based upon knowledge, analytical and communication skills that reflects the transformative and dynamic nature of professional identity and boundaries.     

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.     

Internationally educated nurses' perceptions of their clinical competence

Excelsior College, an educational institution with a strong background in nursing education assessment, partnered with the Commission on Graduates of Foreign Nursing Schools to conduct a study that assessed self-perceptions of nursing knowledge and the clinical needs of international nurses. The Clinical Competency Survey developed for this study was used to measure perceived proficiency in activities related to safe and effective nursing practice. These included conducting physical assessments, planning nursing care, administering medications, performing treatments, managing specific disease conditions, and using technology. Analyses indicate that international nurses perceived themselves to be less proficient in cardiac assessment and interventions and the use of technology and more proficient in wound and skin management and general physical assessments.     

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.     

Inadequate care in Norwegian nursing homes – as reported by nursing staff

Studies have shown that inadequate care, also referred to as abuse, violence, neglect and maltreatment occur in nursing homes in many countries. The aim of this study was to describe the frequency and types of inadequate care committed by staff in nursing homes. Another aim was to investigate if nursing staff reported differently depending on age, education level and years of experience working at nursing homes. A questionnaire survey was conducted among nursing staff (n = 616) in 16 nursing homes in the central part of Norway. Twenty items concerned staff behaviour in forms of acts of inadequate care. The respondents were asked to report how often they had observed colleagues commit acts and how often they themselves had committed such acts. The response rate was 79%. All in all, 91% of the nursing staff reported that they had observed at least one act of inadequate care and 87% reported that they had committed at least one act of inadequate care. Acts of negligent and emotional character were most frequently reported, both as observed and committed. Depending on the higher educational level that the nursing staff had more acts of all types were observed and committed. The oldest staff and those with longest experience at the present nursing home reported more observed and committed acts of physical character than did the others. The extent of inadequate care confirms that this is a common part of activities in nursing homes. Because emotional and negligent acts can be just as harmful as physical acts, more knowledge is needed about the reasons in order to take preventive actions.