Mavis Weiting Tan1, Fui Ping Lim2, An Ling Siew3, Tracy Levett-Jones4, Wei Ling Chua5, Sok Ying Liaw6. 1. Woodlands Health Campus, Singapore. Electronic address: mavistan@u.nus.edu. 2. Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. Electronic address: fuiping@nus.edu.sg. 3. Tan Tock Seng Hospital, Singapore. 4. School of Nursing & Midwifery, Faculty of Health, University of Technology Sydney, Australia. Electronic address: Tracy.Levett-jones@uts.edu.au. 5. Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. Electronic address: chuaweiling@nus.edu.sg. 6. Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. Electronic address: nurliaw@nus.edu.sg.
Abstract
BACKGROUND: Physical assessment skills are taught in pre-registration nursing programs to equip nurses with the competencies to provide holistic nursing care. However, only a fraction of the skills they acquired during training are routinely performed in clinical practice thus highlighting a disconnect between learning and practicing. OBJECTIVE: To better understand the issues surrounding the teaching and practice of physical assessment skills among nurses as described in the literature. DESIGN: A systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was used. REVIEW METHOD: A search of databases including PubMed, EMBASE, CINAHL and Scopus was conducted from January 1970 to December 2019. Two independent researchers performed the methodological quality assessment using the Joanna Briggs Institute's Critical Appraisal Checklists. Twenty-one papers, including two qualitative studies, 17 quantitative studies and two mixed methods study, were selected in this review. Data were synthesised narratively. RESULTS: The review identified six overarching themes: (1) role ambiguity, (2) reliance on technology, (3) collegial support and culture, (4) practice variations across specialties, (5) a lack of confidence and knowledge, and (6) over-teaching using biomedical model. CONCLUSION: This review identified the need to improve the teaching of the physical assessment skills. There is also a need to evaluate the physical assessment content taught within nursing curricula, with emphasis on depth rather than breadth of skills. The ability to interpret physical assessment observations and develop clinical judgement need to be incorporated into the curriculum. To aid in the development of an effective care plan, the physical assessment framework should move away from a biomedical framework to include nursing models such as nursing process and clinical reasoning model. This revised framework can be used in future studies in the development and testing of teaching and evaluation tools for physical assessment skills.
BACKGROUND: Physical assessment skills are taught in pre-registration nursing programs to equip nurses with the competencies to provide holistic nursing care. However, only a fraction of the skills they acquired during training are routinely performed in clinical practice thus highlighting a disconnect between learning and practicing. OBJECTIVE: To better understand the issues surrounding the teaching and practice of physical assessment skills among nurses as described in the literature. DESIGN: A systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was used. REVIEW METHOD: A search of databases including PubMed, EMBASE, CINAHL and Scopus was conducted from January 1970 to December 2019. Two independent researchers performed the methodological quality assessment using the Joanna Briggs Institute's Critical Appraisal Checklists. Twenty-one papers, including two qualitative studies, 17 quantitative studies and two mixed methods study, were selected in this review. Data were synthesised narratively. RESULTS: The review identified six overarching themes: (1) role ambiguity, (2) reliance on technology, (3) collegial support and culture, (4) practice variations across specialties, (5) a lack of confidence and knowledge, and (6) over-teaching using biomedical model. CONCLUSION: This review identified the need to improve the teaching of the physical assessment skills. There is also a need to evaluate the physical assessment content taught within nursing curricula, with emphasis on depth rather than breadth of skills. The ability to interpret physical assessment observations and develop clinical judgement need to be incorporated into the curriculum. To aid in the development of an effective care plan, the physical assessment framework should move away from a biomedical framework to include nursing models such as nursing process and clinical reasoning model. This revised framework can be used in future studies in the development and testing of teaching and evaluation tools for physical assessment skills.
Authors: Kirsten Røland Byermoen; Tom Eide; H Ösp Egilsdottir; Hilde Eide; Lena Günterberg Heyn; Anne Moen; Espen Andreas Brembo Journal: BMC Nurs Date: 2022-05-10