Revitalizing physical assessment in undergraduate nursing education - what skills are important to learn, and how are these skills applied during clinical rotation? A cohort study

Abstract

Background The preparedness of newly graduated registered nurses for a demanding work environment and care practices takes form during nursing education. Norwegian nursing education at one university has implemented a selection of basic physical assessment skills (B-PAS) in the nursing curriculum in order to prepare nursing students for a demanding work environment post-graduation. Methods A mixed-method cohort design. We evaluated nursing students’ self-reported use of B-PAS during their clinical rotation using the “Survey of Examination Techniques Performed by Nurses” questionnaire (30 items). In addition, two focus group interviews elicited factors that hinder or facilitate the actual use of B-PAS during clinical rotation. We recruited students from a bachelor’s degree programme for nursing at a Norwegian university. Three hundred and sixty-three of 453 eligible nursing students in the first, second, and third year of the bachelor’s degree programme participated in the study (80%). Results ANOVA showed a significant progression ( p < 0.016) in students’ self-reported use of B-PAS. Auscultation and percussion skills were graded below the median score of 3, which indicates that these skills were less used throughout the programme. The nursing students highlighted contextual factors for their use of B-PAS when in clinical rotation. Preceptors are important gatekeepers for successful implementation, and there is a need for close collaboration between the university and clinical practice. Conclusion Despite the reduced PAS taught in the curricula, there is still a lack of application of such skills in clinical rotations. This study highlights that research should explore how different work environments influence the utilisation of learned skills, and which learning strategies are appropriate or most successful for stimulating clinical reasoning and the extensive use of physical assessment.

Configuration of Mobile Learning Tools to Support Basic Physical Assessment in Nursing Education: Longitudinal Participatory Design Approach

“…Although digital simulation as a part of the suite of mLearning tools is an individual learning activity, it also seems to be important to plan the digital simulation as a group activity to increase the learning outcome. As we have shown earlier and, in this study, because of a lack of adequate supervision with regard to B-PASs [ 17 ], the suite of mLearning tools plays an important role in supporting the learning and development of these skills and knowledge. Research shows that digital simulation alone can strengthen self-efficacy, performance of clinical skills, decision making [ 28 ], clinical reasoning processes [ 35 , 36 ], and nontechnical skills [ 37 ] of students.…”

“…Nevertheless, there is a need for further exploration of how mLearning should be implemented across the nursing curriculum; this could be done by critically exploring which learning processes mLearning aims to support. Although mLearning alone might not be the best educational strategy in nursing education, in combination with other activities, it might represent a good educational approach [ 17 , 23 ].…”

“…The nursing students learn PAS in preclinical courses at the university but apply these skills in clinical rotation. Therefore, learning and developing competence and confidence in performing PAS and the ability to articulate relevant knowledge are based on how these skills are taught on campus and on the supervision of preceptors during the clinical rotation [ 16 , 17 ].…”

“…To overcome the barriers identified in international studies [ 14 ], our university implemented selected PASs focusing on respiratory, peripheral circulation, abdominal, and neurological assessments in the curriculum in 2015. These PASs are considered to be the basic skills necessary for clinical competence for undergraduate nursing students and are, therefore, referred to as Basic PAS (B-PAS; Figure 1 ) [ 17 ].…”

“…In a previous study, we identified that a lack of knowledge and practical use of B-PASs among the faculty and preceptors limited students in their learning of and performing these skills [ 17 ]. This points to a theory-practice gap with regard to developing these specific skills and underlying knowledge.…”