KNOWLEDGE AND PRACTICE OF SKILLS FOR PHYSICAL ASSESSMENT OF PATIENTS BY NURSES IN THE GREATER ACCRA REGIONAL (RIDGE) HOSPITAL

ABSTRACT
Physical assessment is fundamental to the nursing process which forms an integral part of nursing practice and a standard of professional practice. This research aimed at determining level of knowledge and practice of physical assessment skills among nurses at the Greater Accra Regional (Ridge) Hospital. A descriptive cross- sectional survey was employed. A sample size of 262 nurses/midwives was used for the study. The study employed census as the sampling method. A self-administered structured questionnaire was used for data collection on level of knowledge, practice and barriers of physical assessment. Data was analysed using SPSS version 22. The findings revealed that nurses at Ridge Hospital have good knowledge on physical assessment, however their knowledge does not translate into practice. Physical assessment skills was good for observation, satisfactory for palpation and percussion but poor for auscultation. Lack of confidence, inadequate time and interruptions, specialty area, lack of resources, and lack of ward culture were perceived as barriers whiles reliance on others/technology, and lack of nursing role model were not perceived as barriers. There was an association between educational qualification and level of knowledge, p< 0.001. However, there was no significant difference between ranks and practices, [F = 1.655, P .> .05]. Despite having high knowledge on physical assessment, practice was poor among the nurses. It was recommended that the Ministry of Health and the training institutions should emphasize on physical assessment in the curriculum. Ghana Health Service and health service institutions should organize in-service training for their staff to enhance their physical assessment practices for quality care.


CHAPTER ONE
INTRODUCTION 
Background to the Study
Physical assessment, coupled with history taking form the first step of the nursing process. Physical assessment is the objective data collection on a patient for planning care and intervention of health problems, (Cutler, 2002). Physical assessment is a nursing responsibility and requires the skills of inspection, palpation, percussion and auscultation and is usually done using the head-to-toe approach or the body systems approach (Munro & Campbell, 2000; Baid, 2006). Conducting physical assessment on a patient provides the nurse with database for making nursing diagnosis and planning care. The physical assessment may be done as an initial comprehensive assessment, an ongoing or partial assessment, a focused or problem-oriented assessment, or an emergency assessment (Weber & Kelley, 2003). Physical assessment is taught at various levels of nursing education to better prepare nurses to function in the health care delivery system. The fact that physical assessment is taught in nursing education provides proof that it is part of nursing roles and a unique one which is not merely practiced (Yamauchi, 2001), but required as a standard for professional practice (American Nurses Association, ANA, 2004).

The move by recognised bodies in the nursing profession to incorporate physical assessment skills into daily practice has become necessary due to the demands contemporary health care systems place on the profession. Existing literature provide evidence of benefits of incorporating physical assessment into everyday practice as bringing about the early establishment of nurse-client relationship, enhances effective communication, enhances recognition of changes in patient’s condition, promotion of nursing decision making and management, and increases job satisfaction (Lont, 1992; Yamauchi, 2001). The type of physical assessment skills deemed necessary for effective nursing practice may however differ by speciality area or the work setting.

It is evident that in some cases nurses may have the basic knowledge to perform physical assessment, but lack confidence to perform the skills of physical assessment due to the competency levels related to the various physical assessment skills (Shin, Kim & Kang, 2009). In the face of the constant changing health needs of society, it has become necessary that the nursing profession incorporates physical assessment as a component of nursing assessment to make nursing care effective in meeting the diverse health care needs of the population. Despite its importance, there is a growing concern about the gap between the physical assessment skills taught in nursing education and what is applied in clinical practice. This is because despite the range of physical assessment skills taught in nursing education, the practice has been limited by some nurses to observation of temperature, pulse, respiration, blood pressure, oxygen saturations, height, weight, urinalysis, mobility, skin color and integrity (West, 2006). Accurate physical assessment leads to appropriate planning and intervention, and ultimately better nursing outcomes, but nurses are however limited in various ways in applying their knowledge in practice. Nurses have also been recognized in playing pivotal roles in preventing accidents and emergencies that are directly related to nursing care such as falls, pressure areas, deep vein thrombosis, urinary tract infections and pneumonia through performance of risk assessments on patients (Considine & Botti, 2004). Nurses are considered to be instrumental in achieving early medical input, intervention in adverse events and optimal patient outcomes through the practice of physical assessment (Duff et al, 2007). Therefore, inappropriate application of these physical assessment skills has implications on the quality of nursing care rendered to the patients.

There has been argument among researchers that the increase in clinical deterioration can be attributed to inadequate assessment by nurses (Douglas et al., 2014), whiles others share the view that what nurses are taught is outside the domain of the nursing profession, making it difficult for nurses to apply them in clinical practice. Some studies have reported that only a few of the physical assessment skills learned in nursing education are used by nurses in clinical practice as others apply the physical assessment skills in performing a comprehensive assessment on patients (Giddens, 2007; Giddens

Eddy, 2009;Yamauchi, 2001). Other studies have also reported that nurses use only those physical assessment skills that are relevant to their area of practice (Douglas et al, 2014). Some studies have indicated some factors influencing nurses’ use of physical assessment skills as well as barriers to nurses’ use of physical assessment skills. Most of the findings from the studies conducted on nurses’ physical assessment practices were similar, though the settings differ.

While it is evident there is literature on what pertains to the practice of physical assessment skills in Australia, Canada, New Zealand, Japan, United States of America and United Kingdom among others (West, 2006; Shinokazi Yamauchi, 2007; Lexa & Dixon, 2007), there is limited published research on the use of physical assessment skills among registered nurses in Ghana. This raises questions about the level of nurses’ knowledge in physical assessment, how nurses practice physical assessment skills, factors influencing the nurses’ use of physical assessment skills and barriers to the practice of physical assessment skills as well as the implication on nursing practice in our local setting. This limited knowledge has prompted a research to conduct an assessment of nurses’ knowledge and practice of physical assessment skills among nurses specifically in the Greater Accra Regional Hospital.

Statement of the Problem
It is documented that accurate physical assessment can aid nurses to make accurate nursing diagnosis, plan intervention and improve patients’ outcome whiles inadequate assessment put patients at risk of clinical deterioration (Weber & Kelly, 2003). A good knowledge of physical assessment and making it a routine will bring about better outcomes of patients’ conditions and satisfaction to nurses. Studies done on the issue in Canada, New Zealand, United States of America, Japan among others indicates that nurses have good knowledge of physical assessment and have successfully incorporated it into their daily practice (Yamauchi, 2001; West, 2006; Lexa & Dixon, 2007; Douglas et al, 2014). As a contributory factor in the effective utilisation of the nursing process, physical assessment is a standard for professional practice (ANA, 2004). Despite being a part of the nursing process, the issue has not been adequately dealt with by the nursing profession in Ghana as has been done in the western countries. This has prompted this research to understand the reality of physical assessment practices among nurses at the Greater Accra Regional Hospital.

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Item Type: Ghanaian Project Material  |  Attribute: 107 pages  |  Chapters: 1-5
Format: MS Word  |  Price: GH50  |  Delivery: Within 30Mins.
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