Physical assessment: whose role is it anyway?

Abstract

The increasing acuteness of care and developing technologies present new opportunities and challenges for the nursing profession. The NHS Plan emphasizes the need for change to meet these demands, especially in the area of patient assessment. Nurses are extending their repertoire of skills to include those that were once the domain of junior doctors. These new skills tend to be used mostly by experienced nurses such as the specialist or advanced nurse practitioner. One such skill is physical assessment. Traditionally viewed as part of the doctor's role, physical assessment has not routinely been taught in nurse training. With the advancement of nursing roles, it has been argued that physical assessment has become a key nursing skill. This article discusses the use of physical assessment as part of the growing role of the nurse in critical care. Nurses deliver holistic care, based on assessment. This assessment is incomplete, if a detailed physical assessment is omitted and, as a consequence, care is delivered in the absence of an appreciation of the impact of pathophysiological adaptations. This article argues that the ability to physically assess the patient in a principled and systematic fashion, in conjunction with routine health assessment, is a necessary skill for the modern nursing professional working in critical care. It is further argued that, within the current climate of advancing nursing practice, the acquisition of this skill is important for all nurses, to improve patient care, not to supplant the skills of the junior doctor.

Effect of a physical assessment educational program on clinical practice

“…West [25] suggested that physical assessment to enhance safe and effective patient care must include in contemporary nursing practice. Physical assessment education has two perspectives: positivism and interpretivism.…”

Nurse perception of Bispectral Index monitoring as an adjunct to sedation scale assessment in the critically ill paediatric patient

“…Comments included scattered complaints about inadequate pre-implementation education, suggestions that additional education about the innovation might improve patient outcomes, and strong recommendations that such education should be delivered to all nursing and medical staff on the unit. West (2006) has pointed out that education plays a pivotal role in preparing intensive care nurses to meet expanded responsibilities for patient assessment as their scope of practice evolves). However, the critical care nurses in both this study and that of Weir and O'Neill (2008) placed education in a much broader perspective when they recommended that education about practice innovation should extend beyond the boundaries of their own profession.…”

Inter-Rater Agreement of Auscultation, Palpable Fremitus, and Ventilator Waveform Sawtooth Patterns Between Clinicians

“…12 This therefore warrants the need for other timely bedside assessment to support accurate monitoring and diagnoses of respiratory dysfunction and, in turn, supports clinical decision making in real time. 13,14 Bedside respiratory assessments are most commonly performed by doctors, nursing staff, 15 physical therapists, 13 and respiratory therapists 16 to differentiate between a range of pulmonary disorders, including pulmonary edema, consolidation, atelectasis, interstitial lung disease, bronchospasm, and retained secretions. 1 One of the most common bedside respiratory assessments performed in clinical practice is lung auscultation, 1,17 which is considered an integral part of the clinical reasoning process for qualified and training health-care professionals.…”