Physical assessment skills practised by critical care nurses: A cross-sectional study

BACKGROUND

Physical assessment skills are essential to clinical decision-making in nursing as they help nurses to identify and respond to patients' deterioration. Nurses develop confidence and can detect any out-of-range parameters in diagnosing and treating patients. Prior studies surveyed 120 skills but did not explicitly assess critical care.

AIM

To determine the range of physical assessment skills practised by critical care nurses and their adoption factors.

STUDY DESIGN

This study uses a cross-sectional survey design. A self-administered questionnaire evaluating 40 physical assessment skills was conducted with 133 staff nurses (response rate: 96.4%) in three critical care units at a Malaysian government hospital between November 2019 and January 2020.

RESULTS

Most nurses applied 32 (80%) skills during every working shift, involving the vital signs and all body systems except the gastrointestinal system. Five skills (12.5%) were occasionally applied, while three skills (7.5%) were rarely applied or not part of most nurses' clinical practice. About 20% of the nurses did not routinely check the respiration rate. Medical and surgical intensive care unit nurses (U = 1129, p < .001) and nurses who had served over 10 years (H (2) = 9.60, p = .008) used more physical assessment skills than others. Nurses felt that continuing nursing education, participating in relevant courses and implementing standardised forms to record physical assessments would improve the application of such skills.

CONCLUSION

Clinical practice in these critical care settings challenges the assertion that physical assessment is vital to critical care nursing roles. Concerns highlighted by the nurses should be addressed by nursing management so that the application of physical assessment skills can be enhanced, especially in critical care settings.

RELEVANCE TO CLINICAL PRACTICE

The findings indicated that physical assessment skills in critical care need to be improved. Education and training should emphasise these skills.

Physical assessment skills taught in nursing curricula: a scoping review

OBJECTIVE

This scoping review sought to establish the current state of knowledge regarding physical assessment skills taught globally in undergraduate nursing curricula. Explicitly, the review aimed to determine which skills are being taught via curricula and which skills are performed by students in clinical placements, as well as what physical assessment skills are being used by registered nurses in practice.

INTRODUCTION

Nursing programs are expected to teach the physical assessment skills required for entry-level registered nurses to practice competently. The discrepancy lies in determining which skills are essential to teach entry-level nurses and which are unessential.

INCLUSION CRITERIA

Studies that examined physical assessment skills taught to students in any undergraduate registered nursing program or used by registered nurses in practice were considered. Physical assessments included all techniques or skills taught in any year of a university or college teaching global registered nursing curricula.

METHODS

Databases searched included MEDLINE (Ovid), CINAHL Complete (EBSCO), Scopus, and Cochrane Central Register of Controlled Trials (Ovid). Sources of unpublished studies included ProQuest Dissertations and Theses Global, OpenGrey, Open Access Theses and Dissertations, and Google Scholar. Studies published in English between January 2008 and November 2019 were included. Two independent reviewers screened titles and abstracts. Studies meeting the inclusion criteria were imported into the Covidence systematic review manager. Extracted data were presented in a descriptive format, including characteristics of included studies and relevant key findings.

RESULTS

Thirteen records were extracted for synthesis: one integrated review, one author reflection, one mixed methods study, and 10 quantitative studies. The sources represented a global context: the United States, New Zealand, Turkey, Australia, Norway, Korea, Italy, and one of unknown origin. Three studies examined physical assessment skills routinely taught in global nursing curricula. Three studies explored physical assessment skills routinely used by students during nursing programs. Seven studies examined which physical assessment skills were routinely performed by registered nurses in practice. In the studies, there were 98 to 122 physical assessment skills taught in global nursing programs. However, only 33 skills were routinely taught in curricula, and of those, only 20 were the same across all studies (core skills). Students in nursing programs routinely performed 30 physical assessment skills, and six of the 30 skills were the same across all studies (core skills). Of the six core skills routinely performed by students, five were also routinely taught in nursing curricula in the included studies. Registered nurses routinely performed 39 physical assessment skills, and 11 skills were the same across all studies (core skills). Ten of the physical assessment skills taught in curricula were routinely performed by registered nurses in practice.

CONCLUSION

This scoping review provides insight into physical assessment skills taught in nursing curricula and used by registered nurses in practice. This knowledge is essential for curriculum revisions and planning as it provides insight on how to best meet the needs of future nursing students.

Lack of pediatric mental health clinical experiences among FNP students

BACKGROUND

Mental health disorders accounted for approximately 5% of outpatient child and adolescent visits between 2008 and 2011, and 34.8% of these children were seen by a primary care provider. As primary care providers, family nurse practitioners (FNP) are positioned to address mental health issues across the lifespan; however, they require appropriate training and experience.

AIM

The study examined pediatric mental health assessment clinical experiences in a national survey of FNP students.

METHODS

A secondary analysis was performed on a data set of FNP students (N = 3940). Frequencies and chi-square analyses were performed to examine pediatric mental health assessment clinical experiences.

RESULTS

Nearly 30% (n = 1118) of FNP students reported experiencing two or fewer pediatric mental health assessments during their clinical rotations. More than half (53%) of these students were required to set up their own preceptors and clinical sites.

CONCLUSION

Despite the growing need for mental health care in the U.S, students reported lacking pediatric mental health assessment clinical opportunities. Moreover, students who set up their own clinical sites and preceptors were even less likely to assess pediatric patients' mental health. FNP educators and programs are encouraged to provide students with the support and opportunity for adequate pediatric practice, including mental health assessment.