Abstract:

Performing an accurate, comprehensive physical assessment is the primary professional skill of a registered nurse. The physical assessment is a systematic examination of each body system that provides objective data. This patient-specific objective data is compared to a range of expected normal findings. The objective data measured by the physical assessment informs the nurse’s clinical judgment and decision-making to formulate patient-specific nursing diagnoses, plan for care, implement interventions and evaluate effectiveness. Undergraduate nursing students are required to successfully perform a head-to-toe assessment before mid-semester of the first nursing program course, Fundamentals in Nursing. Sequential performance of all critical elements of examining each body system correctly is required for continuation in the nursing program. Students must demonstrate proper assessment techniques using inspection, auscultation, palpation, and percussion as well as proper use of assessment equipment such as a stethoscope and penlight among others. These techniques are in the tactual/kinesthetic learning domain. To further demonstrate acceptable performance of the physical assessment, the students are also required to verbalize each critical element for each body system assessment as a method of demonstrating patient education. Doing so demonstrates the verbal/auditory learning domain.

Faculty preparing students and assessing their ability to perform this career-defining skill are challenged to create practice self-assessments that identify knowledge gaps and skills deficits. To meet the objective of helping students self-assess their competence and confidence in their ability to accurately perform all required components of the comprehensive physical assessment, a five-item form was developed. Using pencil and paper to complete the form, students were asked to list the anatomic sites, equipment and skills to assess each body system as well as the nine required critical categories of the comprehensive physical assessment. Below each list, they identified their confidence in their ability to correctly identify the system-specific skills. Madrazo and colleagues discuss accurate self-assessment as being “the ability to assess one’s own performance globally”. They further state that accurate self-assessment “is critical to lifelong learning” because learners can set appropriate goals while identifying their strengths and weaknesses. (Madrazo, L, Lee, C., McConnell,M., Khamisa, K. 2018)

Review of these completed forms revealed numerous instances of incomplete responses for all five items to several forms that were thoroughly completed. Reported confidence assessments ranged from not confident to very confident.

The students reported that completing this form and assessing their confidence in their ability to accurately perform all required elements of the physical assessment helped them identify their knowledge/skills gaps. This information helped them better focus on what they needed to review and practice. After performing the assessment in lab, the students reported that completing the form greatly contributed to their success.

Keywords:

Confidence Assessment, Undergraduate Nursing, Physical Assessment Skills, Learning Styles, Lifelong Learning.