Follow Chris on Twitter @CtPicard
Injectable Orange Editorial: So the call went out on Twitter for eager bloggers to share their words via injectableorange.com. Little did I expect to get a response from someone whose work I am already a devoted (if not somewhat new) fan of. Chris has been putting in some brilliant review articles over at his site FOANed Reviews. I genuinely believe that the work Chris is doing is what has been missing from the nursing space online – scientific knowledge translation for nurses. Chris has come on board, beginning with some cross-posts and hopefully to be a regular future contributor. His posts on this site will focus on exploring the evidence around clinical skills within the domain of nursing. So without further preface we kick of exploring the lost art (and science) in nursing physical assessment.
Physical assessment techniques have been a core component of undergraduate nursing curricula for the last 20 years; yet new research in the International Journal of Nursing Studies is adding to a growing body of evidence that suggests Registered Nurses aren’t using the skills taught to them in university.
Osborne et al surveyed nurses across 40 acute care units in Australia to determine the frequency with which they used different physical assessment skills. The physical assessment inventory used in this study is a 133 modified skill inventory used by Giddens (2007), Birks et al., (2012), and Secrest, Norwood and DuMont (2005). Of the 133 skills on the inventory an average of only 10 skills (7.5%) were performed regularly (daily), the majority of which were required to take a complete set of vitals; an additional 18 skills (14%) are described as being used frequently; with a surprising total of 93 skills (70%) reported as never being used (Osborne,S et al., 2015).
|Frequency||Description||Skill n=133 (%)|
|5- Regularly||Daily||10 (7.5)|
|4- Frequently||Every 2-5 shifts||8 (6)|
|3- Occasionally||A few times a year||10 (7.5)|
|2- Rarely||A few time in career||12 (9)|
|1- Never||Know how but have never performed||69 (51.9)|
|0- Never learned||Do not know how to perform||24 (18)|
Several factors were identified that predicted rates of physical assessments performed by nurses. Medical/surgical nurses tended to perform more physical assessments than psychiatric/mental health nurses of similar age and experience level; Specialty areas tended to use more specific skills ex: maternity floors performing more abdominal assessment techniques. Physical assessment skill usage was also found to be inversely correlated with: time worked in the profession and years of education, this however; could be due to nurses having less patient contact as they move into supervisor/manager or educator positions.
The researchers used a “Regression coefficient” to determine the degree to which a barrier decreases the utilization of physical assessment skills by nurses. An increase of reliance on others, not performing nursing assessments that overlapped with physician roles, by one unit resulted in a core skill decrease of 36.5%. As confidence decrease of one unit resulted in a core skill use decrease of 11.9% (Osborne,S et al., 2015). This study unfortunately didn’t offer any insight into other physical assessment techniques nurses were using; nor did the offer any suggestions on how nurses can increase their use of physical assessment techniques.
Of the six barriers to nurses performing physical assessment skills identified I believe reliance on others, and lack of confidence can be directly addressed by using online education services. This, as well as other studies of a similar design have identified a disconnect between education and practice. They have suggested that the reason nurses are performing so few of the skills in the assessment, is that few of the skills are relevant to nursing practice (Birks et al., 2013, Giddens, 2007, Osborne et al., 2015, Secrest, Norwood & Dumont, 2005), this too I believe can be addressed through online education.
Associations between barriers and use of core physical assessment skills adjusted for clinical role and work area (Osborne,S et al.,2015) .
|Barrier subscale||Regression coefficient (b)||95% CI||F||p value|
|Reliance on others and technology||−.411||−.483||−.328||62.9||<.001|
|Lack of time and interruptions||−.176||−.254||−.090||14.6||<.001|
|Lack of confidence||−.234||−.305||−.157||29.6||<.001|
|Lack of nursing role models||−.126||−.208||−.035||7.1||.008|
|Lack of influence on patient care||−.317||−.414||−.204||23.9||<.001|
|Total barriers score||−.430||−.516||−.329||46.2||<.001|
A role for Free Open Access education
Free Open Access Medical Education (FOAMed) is a movement with the goal of sharing information, connecting practitioners, and decreasing knowledge translation times using social media (Life In The Fast Lane). FOAMed has also started to cross into the traditional academic forums of peer reviewed journals, with an “impact” rating system now being championed (Thoma et al, 2015). The fledgling nursing equivalent Free Open Access Nursing education (FOANed) is a continuation of the FOAM concept, with social media hosting of content applicable to Nursing.
FOANed could be used to address some of the issues identified by Osborne et al. it can be used as a forum to share the education and resources necessary for nurses to learn new skills, and to connect nurses with mentors to role model positive behaviors. FOANed creates an opportunity for clinicians practicing at the bedside to engage in the education process, to elucidate the roles, responsibilities, and skills used in nursing. As this knowledge becomes more accessible, hopefully it will be translated back to academia, so adjustments to nursing curricula can be made.
Birks, M., Cant, R., James, A., Chung, C., & Davis, J. (2013). The use of physical assessment skills by registered nurses in Australia: Issues for nursing education. Collegian, 20(1), 27-33.
Giddens, J. F. (2007). A survey of physical assessment techniques performed by RNs: lessons for nursing education. The Journal of nursing education, 46(2), 83-87.
Osborne, S., Douglas, C., Reid, C., Jones, L., & Gardner, G. (2015). The primacy of vital signs–Acute care nurses’ and midwives’ use of physical assessment skills: A cross sectional study. International journal of nursing studies.
Secrest, J. A., Norwood, B. R., & Dumont, P. M. (2005). Physical assessment skills: a descriptive study of what is taught and what is practiced. Journal of Professional Nursing, 21(2), 114-118.
Thoma, B., Sanders, J., Lin, M., Paterson, Q., Steeg, J., & Chan, T. (2015). The Social Media Index: Measuring the Impact of Emergency Medicine and Critical Care Websites. Western Journal of Emergency Medicine.