Barriers in performing physical assessment among nursing students: An integrative review

Registered general nurses' health assessment practices in a tertiary hospital: A focused ethnography study

AIM

To explore the assumptions and values that influence nursing health assessment practices among registered general nurses in general medical and surgical wards.

DESIGN

The study was designed as a focused ethnography.

METHODS

A semi-structured interview guide was used to explore prevailing nursing health assessment practices of 13 registered general nurses in an attempt to explore the assumptions and values influencing health assessment practices in the study setting. Data were analysed inductively using an interpretive qualitative content analysis method.

RESULTS

Nursing health assessment practices, and underlying assumptions and values were underpinned by a central theme of a culture of low expectation relating to nursing health assessment. The culture of low expectation was highlighted in five themes: (1) Unsystematic Assessment of Health Status, (2) Purpose of Nursing Health Assessment, (3) The Role of Nursing Educational and Regulatory Institutions, (4) Ward Ethos and (5) The Role of Organizational and Ward Leadership.

IMPLICATION

The adoption of a holistic nursing health assessment framework with a clearly defined purpose of aiding nursing diagnoses can guide patient-centred care delivery and facilitate early recognition of physiological deterioration.

PATIENT OR PUBLIC CONTRIBUTION

Thirteen registered general nurses were interviewed, and the initial findings returned to them for validation.

CONCLUSION

The potential contribution of nursing health assessment to nursing practice and patient outcomes may not be fully realized if nursing health assessment is not situated within a holistic health assessment model with a clearly defined purpose for nursing practice.

Holistic Physical Assessment: A New Framework for Nursing Practice Honoring the Whole Person

Scholars have argued that standard physical assessment is based on a medical framework instead of nursing theories and philosophy. We argue that standard physical assessment is task-oriented, lacking emphasis on the whole-person and neglecting a least-to-most invasive assessment process. While holistic health assessment is person-centered and multidimensional; addressing aspects such as physical, emotional, and spiritual well-being, there is not a comprehensive explanation on how to holistically perform the physical examination portion of a holistic health assessment. Proposed is a new framework for holistic physical assessment in the hospital environment, honoring the whole-person, their background, and lived experiences. The framework builds on the holistic nursing philosophy, integrative nursing principles, and trauma-informed approach, and systematically arranges physical assessment from least invasive to most. The seven sequential assessment steps incorporate self-care and awareness into the preparation and closure of the assessment-(1) the self, (2) the space, (3) least invasive, (4) moderate invasive, (5) most invasive, (6) the space, and (7) the self. This framework can have significant implications for nursing practice and education settings, providing valuable guidance for a holistic physical assessment that emphasizes whole-person care.

Effectiveness of Using a Self-Directed Learning Program to Teach Physical Examination and Health Assessment Skills: A Quasi-Experimental Study

BACKGROUND

Conducting health assessments and physical examinations are essential skills for independent practice. Exploring how to teach these skills effectively is essential.

PURPOSE

This study was designed to validate the effectiveness of a self-directed learning program in improving nursing student outcomes in terms of their learning health assessment and physical examination skills.

METHOD

A quasi-experimental design was used, and second-year nursing students enrolled in a health assessment and physical examination course at a university of science and technology in central Taiwan were recruited using purposive sampling. Both the control and experimental groups were taught using a traditional teaching method. The experimental group additionally participated in a self-directed learning program. Structured questionnaires, including the Chinese version of the Self-Directed Learning Readiness Scale, Scales of Motivation and Learning Strategies, Interpersonal Skills Assessment Tool, the Course Satisfaction Evaluation Scale, and the Perception of Health Assessment and Physical Examination Competence Scale, were used to collect data at three time points.

RESULTS

After controlling for the effects of pretest scores, after the intervention, the experimental group achieved significantly higher scores than the control group for self-directed learning (creative learning and love of learning), learning motivation (goal orientation, work value, expected success, and test anxiety), and cognitive strategies (total score, elaboration strategy, recitation strategy, and monitoring strategy). In addition, the health assessment exercise improved interpersonal and communication skills, and learning satisfaction was significantly higher in the experimental group than the control group.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

A physical examination and health assessment course designed using the self-directed learning framework can effectively improve student competence in related skills to enhance their ability to assess patient health problems in clinical settings. This study presents an alternative approach to teaching health assessment and physical examination courses and validates the positive effect of this approach on student learning outcomes.

Nursing Students' Retention of Knowledge by Basic Knowledge Type: An Exploratory Study

Students’ interests help determine their learning effectiveness and knowledge acquisition and retention. It is necessary to confirm whether there is a difference in the way in which content being learned is remembered by the content type. In this study, we examined the characteristics of nursing students’ retention of physiological knowledge and environmental knowledge by utilizing scores obtained in class. The participants comprised 57 nursing students who had taken a class twice—once in their second year and once in their third year. Before and after each class, students completed an 11-question survey with human health and comfort items based on nursing core competencies and Sphere standards. The correct answer rate was calculated using a logistic regression model to account for inter- and intra-individual variations. The estimated correct answer rate per individual showed one of three trends: (1) increasing and decreasing depending on the lesson topic (knowledge type), (2) increasing overall after decreasing, and (3) increasing gradually. Physiological knowledge was retained well, whereas knowledge pertaining to the environment was retained poorly. Even with knowledge of the environment, the knowledge that students apply to their daily lives and social events was maintained.