Nursing physical assessment for patient safety in general wards: reaching consensus on core skills

Douglas, Clint and Booker, Catriona and Fox, Robyn and Windsor, Carol and Osborne, Sonya and Gardner, Glenn (2016) Nursing physical assessment for patient safety in general wards: reaching consensus on core skills. Journal of Clinical Nursing, 25 (13-14). pp. 1890-1900. ISSN 0962-1067


Aims and objectives. To determine consensus across acute care specialty areas on core physical assessment skills necessary for early recognition of changes in patient status in general wards.

Background. Current approaches to physical assessment are inconsistent and have not evolved to meet increased patient and system demands. New models of nursing assessment are needed in general wards that ensure a proactive and patient safety approach.

Design. A modified Delphi study.

Methods. Focus group interviews with 150 acute care registered nurses at a large tertiary referral hospital generated a framework of core skills that were developed into a web-based survey. We then sought consensus with a panel of 35 senior acute care registered nurses following a classical Delphi approach over three rounds. Consensus was predefined as at least 80% agreement for each skill across specialty areas.

Results. Content analysis of focus group transcripts identified 40 discrete core physical assessment skills. In the Delphi rounds, 16 of these were consensus validated as core skills and were conceptually aligned with the primary survey: (Airway) Assess airway patency; (Breathing) Measure respiratory rate, Evaluate work of breathing, Measure oxygen saturation; (Circulation) Palpate pulse rate and rhythm, Measure blood pressure by auscultation, Assess urine output; (Disability) Assess level of consciousness, Evaluate speech, Assess for pain; (Exposure) Measure body temperature, Inspect skin integrity, Inspect and palpate skin for signs of pressure injury, Observe any wounds, dressings, drains and invasive lines, Observe ability to transfer and mobilise, Assess bowel movements.

Conclusions. Among a large and diverse group of experienced acute care registered nurses consensus was achieved on a structured core physical assessment to detect early changes in patient status.

Relevance to clinical practice. Although further research is needed to refine the model, clinical application should promote systematic assessment and clinical reasoning at the bedside.

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Item Type: Article (Commonwealth Reporting Category C)
Refereed: Yes
Item Status: Live Archive
Additional Information: Files associated with this item cannot be displayed due to copyright restrictions.
Faculty/School / Institute/Centre: Current - Faculty of Health, Engineering and Sciences - School of Nursing and Midwifery
Date Deposited: 15 May 2019 06:12
Last Modified: 30 May 2019 03:19
Uncontrolled Keywords: clinical deterioration, Delphi method, early recognition, general wards, nurse surveillance, nursing assessment, patient assessment, patient observations, patient safety, physical assessment skills
Fields of Research : 11 Medical and Health Sciences > 1110 Nursing > 111003 Clinical Nursing: Secondary (Acute Care)
Socio-Economic Objective: E Expanding Knowledge > 97 Expanding Knowledge > 970111 Expanding Knowledge in the Medical and Health Sciences
Identification Number or DOI: 10.1111/jocn.13201

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