Techniques for Physical Examination In Nursing Understanding Physical Assessment

Physical assessment, often termed physical examination, is a cornerstone of nursing practice, involving a meticulous examination of the human body through various specialized techniques. This detailed examination aims to gather objective data crucial for clinical decision-making (Cole, Hill, & Saunders, 2012; Cox, 2010). Physical assessment encompasses four primary techniques: inspection, palpation, percussion, and auscultation, in addition to measuring vital signs. Each technique plays a unique role in assessing different aspects of a patient’s health.

• Inspection involves visually examining the patient to identify any abnormalities or signs of disease. This technique can reveal significant information about a patient’s overall health, including skin color, posture, and any visible abnormalities.
• Palpation is the use of touch to assess various aspects of the body, such as texture, temperature, and tenderness. It is especially useful in detecting masses, organ size, and other physical characteristics that may not be visible.
• Percussion involves tapping on the body’s surface to assess the underlying structures. The sound produced can indicate whether a structure is solid or filled with fluid.
• Auscultation is listening to internal sounds of the body, typically using a stethoscope. It is crucial for evaluating heart, lung, and bowel sounds, providing insight into the functioning of these systems.

In advanced nursing practice, a comprehensive or advanced physical assessment follows a thorough health history, integrating both the detailed examination and patient history to form a holistic view of the patient’s health (Cox, 2010).

Competencies of Nurses in Physical Examination

The American Association of Colleges of Nursing (2008) delineates the competencies required of nurses, highlighting physical assessment as a critical skill. At the baccalaureate level, nursing education integrates physical assessment as a core component of the curriculum. This competency is essential for nursing practice and is thus included in the core curricula of nursing programs across the United States, Canada, and the United Kingdom (Coombs & Moorse, 2002; Solomon, 1990).

Nursing programs typically offer physical assessment instruction either as an independent course or integrated throughout the curriculum. Baccalaureate programs are more likely to include dedicated physical assessment courses compared to associate degree programs (Giddens & Eddy, 2009). In these courses, students learn through didactic presentations, focusing on body systems, normal physiology, and the practical application of assessment techniques. They then practice these techniques in various clinical settings, applying theoretical knowledge to real-life scenarios.

A comprehensive approach, often taught from head to toe, covers major systems such as skin, head/neck, musculoskeletal, and neurologic assessments (Giddens & Eddy, 2009). Both associate degree nursing (ADN) and baccalaureate nursing (BSN) programs include over 120 physical assessment skills (Giddens, 2006, 2007; Secrest, Norwood, & DuMont, 2005). Despite this extensive training, there is an ongoing debate about the adequacy and application of these skills in clinical practice.

Literature on Physical Examination in Nursing

The literature on nursing education regarding physical assessment is sparse, with most research focusing on the depth and delivery of physical assessment content in nursing programs. Studies have explored the efficacy of independent versus integrated physical assessment courses and their impact on clinical practice. For instance, a survey of 110 BSN programs revealed that 98% included physical assessment content in their curricula, with nearly two-thirds considering it fundamental to all clinical courses (Solomon, 1990).

The survey also indicated that 64% of programs integrated physical assessment skills into other courses rather than offering a standalone course. Moreover, 60% of respondents placed physical assessment content in junior-level courses, despite a consensus that it should be introduced earlier in the curriculum. Solomon’s findings suggest that incorporating assessment skills into existing courses might be more practical than creating separate courses.

Further research by Giddens and Eddy (2009) involved nearly 200 faculty members from ADN and BSN programs, focusing on curriculum factors, teaching methods, and content related to physical assessment. The study revealed no significant difference in educational preparation or teaching experience between ADN and BSN faculty. However, BSN programs were more likely to teach physical assessment as an independent course, allocating more didactic credits to this content. BSN programs also reported covering more assessment categories compared to ADN programs. Despite these differences, Giddens’ earlier study (2006) found no significant difference in the frequency of physical assessment skills used by ADN and BSN graduates, suggesting that advanced skills taught at the BSN level might have limited practical utility.

Zambas (2010) critiqued the relevance of advanced physical assessment skills, noting that many skills taught in systematic physical assessments are rarely used in clinical practice. This observation was supported by a late 1990s survey of baccalaureate students in New Jersey, who reported using only half of the physical assessment skills taught in their courses. Cardiovascular and respiratory assessments were identified as the most commonly performed skills.

A later survey by Giddens (2007) found an even smaller proportion of physical assessment skills used in clinical practice (24%). The core skills most frequently utilized were general observation and inspection, as well as cardiovascular and respiratory assessments. Giddens argued that nursing education should align more closely with actual nursing practice, focusing on teaching skills that are frequently applied in clinical settings.

Physical Examination and the Nursing Process

Physical assessment is the foundational step in the nursing process, crucial for effective care delivery and integration throughout nursing education. The extensive physical assessment curriculum might not be necessary for all baccalaureate generalist nurses. Further research is needed to identify the specific physical assessment skills most required by nurses in various clinical settings.

Partnerships with healthcare organizations could provide continuing education opportunities for nurses to acquire specialized skills relevant to their practice areas. Additionally, the use of technology, such as avatars and virtual environments like Second Life, in teaching physical assessment skills warrants further investigation. Evaluating the effectiveness of standardized patients compared to real-life scenarios and simulation exercises could also provide insights into the most effective methods for teaching physical assessment.

Current research has predominantly focused on the content and teaching methods rather than the actual utilization of physical assessment skills. There is a lack of studies examining the competence of nurses in conducting physical assessments as outlined in the Essentials of Baccalaureate Education for Professional Nursing Practice (2008). This area of research is crucial for ensuring that nursing education adequately prepares nurses to perform physical assessments effectively in their professional roles.

In summary, while physical assessment is a fundamental component of nursing education and practice, there is ongoing debate and research regarding the most effective methods of teaching and applying these skills. As the field of nursing evolves, continuous evaluation and adaptation of physical assessment curricula and teaching strategies will be essential to ensure that nurses are well-prepared for their clinical responsibilities.