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Improving Physical Assessment and Clinical Judgment Skills in Nursing Students

By September 29, 2021No Comments

Current Problem

Did you know that over 100-120 assessment skills are typically taught in prelicensure nursing health assessment courses, yet only 30 skills are used on a routine basis by nurses in practice?

As a result of Infobesity and how nursing assessment is taught, students struggle to apply this essential content to practice and are unable to identify what aspects of a nursing assessment are most important.

By teaching the most important assessment skills that nurses use most often, nurse educators will develop a strong foundation in the first semester that can be built upon with less-used assessment skills later in the program.

This practice-based foundation of nursing assessment will also improve patient outcomes. 

“Is it enough for students to go through the motions of performing the physical assessment skills, or is the bigger concern that students do the needed skills with accurate INTERPRETATION of what they see, feel, and hear? Early identification of patient deterioration is a key to timely intervention and will prevent failure to rescue.” (Kohtz, Brown, Williams, & O’Conner, 2017). 

Improving How Nursing Assessment is Taught

Dr. Kathryn Kinyon, DNP, CPNP AHN-BC, Assistant Professor, Medical University of South Carolina, a pediatric pulmonary nurse practitioner was the primary author for the article, “Improving Physical Assessment and Clinical Judgment Skills Without Increasing Content in a Prelicensure Nursing Health Assessment Course.”

Based on the results of a literature review, Dr. Kinyon and her colleagues redesigned a first semester health assessment course in an accelerated baccalaureate nursing program. Lectures and skills labs were adjusted to focus on the most critical assessment skills. 

To foster critical thinking and clinical judgement, a health assessment post conference was added where students completed concept maps, system specific case studies, nursing priority setting, and patient teaching plans. 

Outcome surveys were completed by second semester faculty. Prior to course adjustments, 33 percent of students did not meet the benchmark. Following course changes, all students met or exceeded the benchmark. 

The team concluded that focusing on critical assessment skills will increase student nurses’ ability to deliver safe patient care.

What assessment skills ARE essential?

Respiratory

  • evaluate breathing effort
  • inspect overall skin color
  • auscultate lung/breath sounds
  • inspect chest shape
  • inspect thorax for lifts

Cardiac/Circulatory

  • auscultate heart sounds
  • inspect palpate extremities for edema
  • palpate extremities for temperature
  • inspect capillary refill
  • palpate distal pulses

GI

  • inspect abdomen
  • auscultate bowel sounds
  • palpate abdomen for tenderness or distension
  • palpate abdomen for mass

Neuro

  • evaluate speech
  • assess level of consciousness
  • Assess PERRLA
  • assess gait

Musculoskeletal

  • palpate extremities for tenderness
  • assess muscle strength
  • evaluate for movement and sensation
  • inspect muscle size and symmetry
  • observe range of motion of joints

Skin/ENT

  • inspect for skin lesions
  • inspect wounds (if present)
  • inspect facial structures
  • inspect external eyes
  • assess hearing based on conversation
  • inspect oral cavity

What assessment skills are nonessential? (TMI)

  • evaluate deep tendon reflexes
  • inspect internal ear with otoscope
  • evaluate olfactory nerve
  • test tongue for taste
  • percuss chest for heart borders
  • palpate anus for rectal tone
  • palpate fetal position
  • perform internal eye exam with opthalmoscope

This study found that nurse educators must continue to discriminate content taught in prelicensure nursing education programs and should consider the attainment of competency of those essential skills that most lend to optimal patient outcomes.

Likewise, Dr. Kinyon’s study found that “focusing on critical physical assessment skills, which include application of clinical judgement skills in real-life scenarios using case studies and concept maps will increase student nurses’ ability to observe, assess, and prioritize patient concerns, leading to an improved ability to deliver safe client care.”

In Closing

Ultimately, the most important skill all nurses must learn for both safe practice and licensure is clinical judgment. Therefore, streamlining what assessment skills are taught will help students more fully develop the most important nursing skills.

By teaching FEWER assessment skills, students will learn MORE in depth and be better prepared for practice. 

What nursing assessment skills taught in your program could you remove to strengthen student learning in your program?

Watch the video to learn more, including an interview with Dr. Kinyon:

References

  • Kinyon, K., D’Alton, S., Poston, K., Navarrete, S. (2021). Improving physical assessment and clinical judgment skills without increasing content in a prelicensure nursing health assessment course. Nursing Reports, 11, 600-607. https://doi.org/10.3390/nursrep11030057
  • Kohtz, C., Brown, S.C., Williams, R., & O’Conner, P.A. (2017). Physical assessment techniques in nursing education: A replicated study. Journal of Nursing Education, 56(5), p.287-291.

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