Nursing Techniques for Physical Examination In Nursing Education

Techniques for Physical Examination In Nursing

Whats Is Physical Assessment,Competencies of Nurses for Physical Examination,Nursing Literature Related to Physical Examination,Physical Examination and Nursing Process.

Whats Is Physical Assessment

    Physical assessment is the detailed examination of the human body using specialized techniques to collect objective data used in clinical decision making (Cole, Hill, & Saunders, 2012: Cox, 2010). Inspection, palpation, percussion, and auscultation are techniques systematically used (Coombs & Moorse, 2002) as well as measurement of vital signs. At the advanced practice level of nursing, the advanced or comprehensive physical assessment follows the completion of a comprehensive health history (Cox, 2010).

Competencies of Nurses for Physical Examination

    The American Association of Colleges of Nursing (2008) outlined competencies required at the completion of baccalaureate generalist education, which include the integration of knowledge and skills critical to nursing practice. One component of the identified critical skill set is the ability to conduct a physical assessment. As such, most nursing programs in the United States, Canada, and the United Kingdom include instruction on physical assessment in the core curricula (Coombs & Moorse, 2002: Solomon, 1990). 

    The content can be taught as an independent course or integrated throughout the curriculum, with baccalaureate programs more likely to have independent courses than associate degree programs (Giddens & Eddy, 2009). Physical assessment content is delivered through didactic presentation of techniques, emphasizing body systems, and the identification of normal physiology. Students are then given the opportunity to implement and practice the techniques in a variety of settings and clinical environments. 

    A systems approach from head to toe is generally taught and includes the major systems from the skin, head/neck, to musculoskeletal, and neurologic assessments (Giddens & Eddy, 2009). Both associate degree nursing (ADN) and baccalaureate nursing (BSN) programs commonly teach more than 120 physical assessment skills (Giddens, 2006, 2007; Secrest, Norwood, & DuMont, 2005).

Nursing Literature Related to Physical Examination

    There is a paucity of nursing education literature published in the past 30 years related to physical assessment. Most focus on the depth of physical assessment being taught, the differences between independent versus integrated courses for physical assessment, and whether physical assessment skills learned are beneficial to clinical nursing practice. Results from a survey of 110 BSN programs confirmed that 98% reported content for physical assessment in their coursework, with nearly two thirds “declaring that assessment is a fundamental part of nursing process basic to all clinical courses” (Solomon, 1990, p . 195). 

    In this sample, 64% of programs reported integrating physical assessment skills into another course, rather than having a stand-alone course. Sixty percent of survey respondents reported placement of physical assessment content in junior-level nursing courses, despite the fact that two thirds of respondents indicated that assessment ment should be “introduced early in a nursing curriculum” (p. 195). Based on his survey results, Solomon concluded that assessment skills should be incorporated into existing courses rather than adding to an already overloaded program.

    Nearly 200 faculty members from ADN and BSN programs were queried regarding curriculum factors, teaching methods, and content taught related to physical assessment (Giddens & Eddy, 2009). Results showed no statistical difference between educational preparation of the faculty and years of teaching experience in ADN and BSN programs. There was a difference in the method of instruction, with 80% of BSN programs teaching physical assessment as an independent course and allotting more didactic credits to the content. 

    Additionally, more BSN programs than ADN programs reported teaching 15 out of 18 assessment categories (Giddens & Eddy, 2009, p. 27) In an earlier study, Giddens had compared the frequency with which physical assessment skills were employed by associate degree and baccalaureate degree graduates (Giddens, 2006). This study showed no difference between utilization of physical assessment skills based on educational preparation. Giddens suggested that this may reflect the lack of utility of advanced physical assessment commonly taught at the BSN (and not at the ADN) level.

    Although many nursing programs teach advanced physical assessment, Zambas (2010) suggested that many skills taught within a systematic physical assessment are rarely used in clinical practice. Evidence for this proposition existed in a late 1990s' survey of baccalaureate students in New Jersey (Barbarito, Carney, & Lynch, 1997). These students reported using only half of the physical assessment skills taught in their formal assessment course in clinical practice, with cardiovascular and respiratory assessments identified as the ones most commonly performed. 

    A survey by Giddens in 2007 supported the findings where she identified an even smaller number of physical assessment skills used in clinical practice (24%)) by registered nurses. In this study, most of the utilized core skills were isolated to general observation and inspection, as well as involved cardiovascular and respiratory assessments. Giddens asserted that nursing education should reflect nursing practice. and should focus on teaching content and skills that will be implemented in the practice setting

Physical Examination and Nursing Process

    As the first step in the nursing process, assessment is critical to successful care delivery and should be integrated throughout nursing preparation. Evidence suggests the heavily laden physical assessment curriculum may not be required or appropriate for the baccalaureate generalist nurse. More. research is needed to verify which physical assessment skills are needed by most nurses This information could be gathered from the clinical sites. 

    Partnerships with health care organizations that employ nurses could offer continuing education for nurses in specialty areas to learn skills that are more specialized Utilization of technology for teaching physical assessment skills should be further explored as well. Research studies are needed to investigate the effect of using avatars and virtual worlds such as Second Life when teaching clinical skills. Use of the standardized patient when teaching physical assessment needs to be evaluated and compared to real-life situations and simulation scenarios. 

    Researchers have focused on the content taught and the teaching methods used rather than the utilization of skills. No studies were found looking at the competence of nurses to conduct a physical assessment as identified in the Essentials of Baccalaureate Education for Professional Nursing Practice (2008) Again, this is an area that warrants further investigation.