Nursing students’ development of using physical assessment in clinical rotation—a stimulated recall study

Abstract

Background The overall aim of this study was to explore third-year bachelor nursing students’ stimulated recall reflections on their physical assessment competence development. The choice of learning strategies in nursing education seems to have great impact on nursing students’ use of physical assessment skills while in clinical rotation. There is a need to explore nursing students’ learning processes related to the use of physical assessments. Methods Explorative qualitative design using a triangulation of data collection methods. Nine final-year nursing students’ physical assessment performances during patient encounters were audio-taped and observed. Shortly after, an individual stimulated recall interview based on the audio-recorded patient encounter and observation notes was conducted. A two-fold analysis was conducted: 1) analysis of students’ performed assessments, and 2) phenomenological hermeneutical analysis of the stimulated recall interviews. Results Nursing students assessments shifted from a checklist approach to a symptom-based, more holistic and person-centred approach, emphasizing conversation as part of their assessments. The nursing students also reported that a safe and stimulating learning environment was a prominent feature for their continuing development. Learning from skilled role models with expectations to them using physical assessment skills facilitated their continuing skills appliance, interprofessional communication and reflective practice. Conclusions This study contribute with a novel, comprehensive and in-depth description of what influenced nursing students’ learning processes experiences of using physical assessment skills during clinical rotation. The results reveal the need for targeted course designs by implementing scaffolded learning activities in practical and theoretical courses aimed at strengthening students’ learning of physical assessment skills—building upon and emphasizing their prior knowledge and competence, which may lead to more confident registered nurses and promote patient safety in different health care contexts. We propose using stimulated recall systematically as a novel reflective learning activity in nursing education to foster clinical reasoning and metacognition skills and achieve deep learning.

Newly graduated nurses use and further development of assessment skills—An in‐depth qualitative study

“…Basic communication skills have shown to be paramount for nursing students' learning of assessment skills. Sufficient time to practice enable students to take patients' perspectives and needs into account through a more holistic and symptom‐based approach (Byermoen et al, 2021; Byermoen et al, 2022). Our findings show that the quality of the nurse–patient relationship during communication also influences nurses' assessment processes.…”

“…Their development process do align with what could be called to be in an advanced beginner stage (Benner, 1984). Nursing students' development processes seemed to be moving from insecurity when eliciting and performing specific assessment skills towards having an internalization when using assessment skills (Byermoen et al, 2021; Byermoen et al, 2022). When entering the professional nursing role, some of the nurses in this study seemed to deepen this internalization, employing a more holistic approach by grasping the entirety of the patient's situation and using a more analytical investigating method—not unlike a ‘Sherlock Holmes’ approach (Sopeña, 2014).…”

“…Concerning sample size and obtaining information power, as defined by Malterud et al (2016), it can be questioned whether our sample size was sufficient. As we aimed to explore nurses' assessment skills development and use in a longitudinal perspective, we believe that the inclusion of eight participants from our two prior studies (Byermoen et al, 2021; Byermoen et al, 2022), together with the rigorous data analysis, provided sufficient information power.…”

“…Data were collected in March and April 2021. Eleven nurses who had participated in two previous studies (Byermoen et al, 2021; Byermoen et al, 2022) were invited to take part in this final follow‐up study; approximately 21 months after their graduation. We sent an e‐mail with detailed information about the study and a consent form.…”

Usefulness of physical examination in the professional practice of nurses

“…Obtaining subjective and objective data through physical assessment enables nurses to accurately assess the health status of patients. A standardized, interdisciplinary pattern of assessment performed improves the overall quality of care for patients in complex clinical situations [2].…”