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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