Assessing the Effect of Data Quality on Distance Estimation in Smartphone-Based Outdoor 6MWT.

As a result of technological advancements, functional capacity assessments, such as the 6-minute walk test, can be performed remotely, at home and in the community. Current studies, however, tend to overlook the crucial aspect of data quality, often limiting their focus to idealised scenarios. Challenging conditions may arise when performing a test given the risk of collecting poor-quality GNSS signal, which can undermine the reliability of the results. This work shows the impact of applying filtering rules to avoid noisy samples in common algorithms that compute the walked distance from positioning data. Then, based on signal features, we assess the reliability of the distance estimation using logistic regression from the following two perspectives: error-based analysis, which relates to the estimated distance error, and user-based analysis, which distinguishes conventional from unconventional tests based on users' previous annotations. We highlight the impact of features associated with walked path irregularity and direction changes to establish data quality. We evaluate features within a binary classification task and reach an F1-score of 0.93 and an area under the curve of 0.97 for the user-based classification. Identifying unreliable tests is helpful to clinicians, who receive the recorded test results accompanied by quality assessments, and to patients, who can be given the opportunity to repeat tests classified as not following the instructions.

Time-dependent diffusion tensor imaging and diffusion modeling of age-related differences in the medial gastrocnemius and feasibility study of correlations to histopathology.

PURPOSE: Implement STEAM-DTI to model time-dependent diffusion eigenvalues using the random permeable barrier model (RPBM) to study age-related differences in the medial gastrocnemius (MG) muscle. Validate diffusion model-extracted fiber diameter for histological assessment. METHODS: Diffusion imaging at different diffusion times (Δ) was performed on seven young and six senior participants. Time-dependent diffusion eigenvalues (λ2 (t), λ3 (t), and D⊥ (t); average of λ2 (t) and λ3 (t)) were fit to the RPBM to extract tissue microstructure parameters. Biopsy of the MG tissue for histological assessment was performed on a subset of participants (four young, six senior). RESULTS: λ3 (t) was significantly higher in the senior cohort for the range of diffusion times. RPBM fits to λ2 (t) yielded fiber diameters in agreement to those from histology for both cohorts. The senior cohort had lower values of volume fraction of membranes, ζ, in fits to λ2 (t), λ3 (t), and D⊥ (t) (significant for fit to λ3 (t)). Fits of fiber diameter from RPBM to that from histology had the highest correlation for the fit to λ2 (t). CONCLUSION: The age-related patterns in λ2 (t) and λ3 (t) could tentatively be explained from RPBM fits; these patterns may potentially arise from a decrease in fiber asymmetry and an increase in permeability with age.

Barriers to nurses performing physical assessments in rehabilitation care units: An observational study.

AIMS: To describe the perceived barriers to nurses performing physical assessments of patients in rehabilitation wards. Secondarily, to investigate how sociodemographic and professional characteristics influence the use and frequency of physical assessments by nurses and their perceptions of barriers to their practice. DESIGN: A multicentre, cross-sectional, observational study. METHODS: Data were collected from September to November 2020 among nurses working with inpatients in eight rehabilitation care institutions in French-speaking Switzerland. Instruments included the Barriers to Nurses' use of Physical Assessment Scale. RESULTS: Almost half of the 112 nurses who responded reported performing physical assessments regularly. The predominant perceived barriers to performing physical assessments were 'specialty area', 'lack of nursing role models' and 'lack of time and interruptions'. Greater clinical nursing experience in rehabilitation wards and more senior nurse specialist positions were associated with significantly lower use of physical assessment procedures by nurses. CONCLUSION: The present study revealed heterogeneity in the use of physical assessment by nurses practicing in rehabilitation units and highlighted their perceived barriers to this. IMPACT STATEMENT: Most nurses working in rehabilitation care units did not routinely perform physical assessments as part of their daily clinical practice. These results should raise stakeholders' awareness of this fact. Effective interventions to increase the use of physical assessments in nursing practice are to be recommended, including continuing education or hiring enough highly qualified nurses as role models in wards. This will promote quality of care and patient safety in rehabilitation care units. PUBLIC AND PATIENT ENGAGEMENT AND INVOLVEMENT: There was no patient or public involvement in the present study.

Factors associated with changes in students' self-reported nursing competence after clinical rotations: a quantitative cohort study.

BACKGROUND: The quality of nursing care in different healthcare contexts can be associated with the level of available nursing competence. Physical assessment skills are vital in nurses' assessment of patient care needs. However, in nursing education, using physical assessment skills is challenging for nursing students who struggle to apply these skills comprehensively in a clinical rotation. Therefore, this study explores changes in nursing competence, factors associated with changes after clinical rotations, and whether a Suite of Mobile Learning Tools supports changes in confident use of basic physical assessment skills. METHODS: A quantitative cohort study with an explorative pre-and post-test design. During autumn 2019 and spring 2020, 72 s-year nursing students and 99 third-year students participated in the study. The Nurse Professional Competence scale short form was used to investigate students' self-reported changes in nursing competence, and a study-specific questionnaire was used to investigate students' confidence concerning performing physical assessments. The students voluntarily used the Suite of Mobile Learning Tools for the learning of physical assessment. Linear regression analysis was used to identify factors associated with changes in nursing competence after clinical rotation. The STROBE guidelines for cohort studies were followed for study reporting. RESULTS: After the clinical rotation, both student groups reported changes in nursing competence and confidence in performing physical assessment skills, with statistically significant moderate or large changes in all areas. The Suite of Mobile Learning Tools was evaluated as being useful for learning physical assessment. The regression analysis showed that confidence in performing physical assessment skills, the usefulness of the Suite of Mobile Learning Tools, and a higher nursing competence at the start of clinical rotation were positively associated with overall nursing competence. CONCLUSION: Basic physical assessment skills are an important component of nursing competence and can be considered one of the pillars of person-centered care, as proposed by the Fundamentals of Care framework. Spaced repetition and access to digital resources are suggested pedagogical approaches to enhance student confidence in the use of assessment skills within academic and clinical contexts.

Reliability of simulated combat tasks performed by Brazilian Air Force cadets.

The Brazilian Air Force (BAF) has developed physical evaluations focused on the demands required in combat scenarios, giving rise to the Simulated Tasks (STs). Therefore, the purpose of the present study was to determine test-retest reliability and investigate learning effects of the five STs established among the BAF. Fifty-six subjects performed five STs three times, after completing a previous familiarisation session. Repeated measures analysis of variance (ANOVA) was used to determine the occurrence of learning effects, and the intraclass correlation coefficient (ICC) was used to identify the reliability of each ST. ANOVA revealed no significant differences in the subject's scores across trials for all the STs, and the ICCs ranged from 0.75 to 0.92 (p < 0.01). In conclusion, this study identified that the five STs showed no learning effects across three successive trials and exhibited high levels of reliability.

Understanding the reliability and learning effects of the STs established among the Brazilian Air Force is crucial for their potential implementation. The subjects performed five STs three times, over the course of seven days. The results highlighted no evidence of learning effects, and high levels of reliability.

Physical assessment skills practised by critical care nurses: A cross-sectional study.

BACKGROUND: Physical assessment skills are essential to clinical decision-making in nursing as they help nurses to identify and respond to patients' deterioration. Nurses develop confidence and can detect any out-of-range parameters in diagnosing and treating patients. Prior studies surveyed 120 skills but did not explicitly assess critical care. AIM: To determine the range of physical assessment skills practised by critical care nurses and their adoption factors. STUDY DESIGN: This study uses a cross-sectional survey design. A self-administered questionnaire evaluating 40 physical assessment skills was conducted with 133 staff nurses (response rate: 96.4%) in three critical care units at a Malaysian government hospital between November 2019 and January 2020. RESULTS: Most nurses applied 32 (80%) skills during every working shift, involving the vital signs and all body systems except the gastrointestinal system. Five skills (12.5%) were occasionally applied, while three skills (7.5%) were rarely applied or not part of most nurses' clinical practice. About 20% of the nurses did not routinely check the respiration rate. Medical and surgical intensive care unit nurses (U = 1129, p < .001) and nurses who had served over 10 years (H (2) = 9.60, p = .008) used more physical assessment skills than others. Nurses felt that continuing nursing education, participating in relevant courses and implementing standardised forms to record physical assessments would improve the application of such skills. CONCLUSION: Clinical practice in these critical care settings challenges the assertion that physical assessment is vital to critical care nursing roles. Concerns highlighted by the nurses should be addressed by nursing management so that the application of physical assessment skills can be enhanced, especially in critical care settings. RELEVANCE TO CLINICAL PRACTICE: The findings indicated that physical assessment skills in critical care need to be improved. Education and training should emphasise these skills.

Variability of peak speed and sprinting actions during the same small-sided games: within- and between-player variations inspected over four consecutive weeks.

This study aimed to analyze within- and between-player variations of peak speed and sprinting actions occurring in small-sided games (SSGs: 1 v 1 and 5 v 5). The study followed a cohort study design. Twenty male youth soccer players (age: 17 years old) from the same team were observed over four consecutive weeks. Each week, the players participated in two sessions (day one and day two) during which SSGs were applied. The 1 vs. 1 format was employed with four repetitions of thirty seconds interspaced with two-minute rest intervals, while the 5 vs. 5 format with four repetitions of four minutes and two-minute rest intervals between them. The players were monitored during all training sessions with the Polar Team Pro. The peak speed attained in each game, and the number of sprints were extracted as the primary outcomes. The between-player variability revealed a lower coefficient of variations for peak speed in the 1 vs. 1 (13.9%) and 5 vs. 5 (10.9%) formats than for sprints (1 v 1: 64.7%; 5 v 5: 65.5%). Considering the within-player variability, it was observed that sprints were more variable (1 vs. 1: 62.1%; 5 v 5: 65.7%) than peak speed (1 vs. 1: 16.4%; 5 v 5: 14.0%). The between-session analysis revealed that during week 1 (day 1), peak speed was significantly higher than during week 3 (day 1) in the 1 vs. 1 format (+3.0 km/h; p = 0.031; d = 1.296). Moreover, peak speed during week 3 (day 2) was considerably lower than during week 1 (-5.9 km/h; p < 0.001; d = 1.686) and week 2 (-5.0 km/h; p = 0.001; d = 1.639). The between-session analysis showed no significant differences in the sprint between the sessions on day 1 (p > 0.05). However, on day two, the sprint was substantially higher during week one than during week four in the 5 vs. 5 format (+5.40 n; p = 0.002; d = 2.571). In conclusion, this study revealed that peak speed presents lower within- and between-player variability than the number of sprints. Considering these two measures, there are no considerable variations between the weeks. Coaches should consider identifying strategies to stabilize the stimulus regarding the number of sprints if this represents one of the targets for employing SSGs.

Building safety cultures at the frontline: An emancipatory Practice Development approach for strengthening nursing surveillance on an acute care ward.

AIM: To evaluate an emancipatory Practice Development approach for strengthening nursing surveillance on a single medical-surgical ward. BACKGROUND: Registered nurses keep patients safe in acute care settings through the complex process of nursing surveillance. Our interest was understanding how frontline teams can build safety cultures that enable proactive nursing surveillance in acute care wards. DESIGN: A year-long emancipatory Practice Development project. METHODS: A collaborative relationship was established around a shared interest of nursing surveillance capacity and researcher embedded on a medical-surgical ward. Critical analysis of workplace observations and reflection with staff generated key sites for collective action. Ward engagement was supported by creative Practice Development methods including holistic facilitation, critical reflection and action learning. An action learning set was established with a group of clinical nurses, facilitating practitioner-led change initiatives which strengthened nursing surveillance and workplace learning. Evaluation supported an iterative approach, building on what worked in an acute care context. Immersive researcher evaluation, drawing on multiple data sources, generated an analysis of how ward nursing surveillance capacity can be strengthened. COREQ criteria guided reporting. RESULTS: The ward moved through a turbulent and transformative process of resistance and retreat towards a new learning culture where nursing surveillance was visible and valued. Staff developed and sustained innovations including the 'My MET Call series', a 'Shared GCS initiative', an enhanced 'Team Safety Huddle', and staff-led Practice Development workshops. These new practices affirmed nurses' agency, asserted nurses' clinical knowledge, positioned nurses to participate in team decision-making and humanised care. CONCLUSION: Working collaboratively with frontline staff enabled bottom-up sustainable innovation to strengthen nursing surveillance capacity where it mattered most, at the point of care. RELEVANCE TO CLINICAL PRACTICE: Emancipatory Practice Development enables the profound impact of small-scale, microsystem level practice transformation. It is an accessible methodology for clinical teams to develop effective workplace cultures.

Paper towel test as independently self-administered to quantify cough-related urine loss: Compliance and comparisons with survey-only data in SWAN.

AIMS: The epidemiologic Study of Women's Health Across the Nation (SWAN) includes urinary incontinence (UI) questionnaire items. We introduced an independently self-administered paper towel test (PTT-ISA; invention disclosure #2021-347) to objectively demonstrate UI. Aims were to determine: (1) PTT-ISA compliance and (2) relationship to questionnaire results. METHODS: 276 community women were invited to complete both SWAN questionnaire and PTT-ISA. For PTT-ISA, a woman holds a trifold brown paper towel against her perineum while coughing hard three times. She checks the towel for wetness and compares it with pictorial showing wetted area gradations (dry towel through >6 ml/saturated). She then selects the best photo match for her towel. A newly conceptualized variable constructed as PTT-ISA plus questionnaire results was formed. RESULTS: Of 276 women, noncompliance with PTT-ISA was 2.2% (6 women). Four others (1.5%) were missing questionnaires. For the remaining 266 women, conceptual cohesiveness between questionnaire-only and PTT-ISA + questionnaire was demonstrated in 165 (62.0%). Lack of cohesiveness occurred in 101 (38.9%), including 41 women who said "no" to the questionnaire item indicative of stress UI and had leakage on PTT-ISA; leakage degree varied across the full pictorial spectrum from drops to saturated. CONCLUSION: PTT-ISA demonstrates high compliance, with rate comparable to survey compliance. It is a novel measure for objective sign of urine loss when independently self-administered by community women outside of a clinic environment. Further research comparing PTT-ISA with clinician-observed cough test is warranted. As independently self-administered, PTT-ISA is simple, noninvasive, inexpensive, and an acceptable test that adds value to otherwise survey-dependent research.

Correlation of New Criteria for Malnutrition Assessment in Hospitalized Patients: AND-ASPEN Versus SGA.

Objectives: Identifying malnutrition in the hospitalized patient is important as it correlates with increased morbidity. The Subjective Global Assessment (SGA) is recognized in the literature as a standardized and validated method for diagnosing malnutrition. The Academy of Nutrition and Dietetics (AND) and the American Society for Parenteral and Enteral Nutrition (ASPEN) developed a comprehensive method (AND-ASPEN criteria) for diagnosing malnutrition that has yet to be validated. In effort to validate the AND-ASPEN criteria for identifying malnutrition, this study investigated whether AND-ASPEN criteria would correlate with SGA in hospitalized patients.Methods: A cohort of patients >18 years old admitted to a tertiary hospital and assessed for malnutrition using AND-ASPEN criteria were randomly selected, and a retrospective review was completed. Criteria needed to perform SGA were extracted from the electronic medical record and SGA data were calculated and compared to AND-ASPEN malnutrition scoring. Spearman's correlation coefficient was used to assess correlation between the SGA and AND-ASPEN malnutrition score. Data are presented as mean ± standard deviation, median or frequency.Results: A total of 409 patients were reviewed and 225 (55%) met inclusion criteria. SGA malnutrition scores classified 47.1% (n = 106) of subjects as well-nourished, 32% (n = 72) moderately malnourished, and 20.9% (n = 47) severely malnourished. The AND-ASPEN malnutrition scores classified 43.8% (n = 179) of the subjects as well-nourished, 26.2% (n = 107) as moderately malnourished, and 30.1% (n = 123) severely malnourished. The SGA score and AND-ASPEN malnutrition diagnosis were found to be correlated (p < 0.001). There was no association between age or length of stay with either assessment tool.Conclusions: The AND-ASPEN criteria for diagnosing malnutrition correlated with SGA in identifying nutritional status in hospitalized adult patients. Future prospective studies capturing the impact of malnutrition diagnosis, medical and nutrition interventions with patient outcomes are warranted to confirm the impact of early and accurate identification of malnutrition of patient outcomes.

Association of index finger palpatory assessment of pubovisceral muscle body integrity with MRI-documented tear.

AIMS: Pubovisceral (PV) muscle tears are associated with pelvic floor disorders. The goal of this study was to determine whether index finger palpatory assessment of PV muscle body integrity through the lateral vaginal wall is a reliable indicator of PV muscle tear severity diagnosed by magnetic resonance imaging (MRI). METHODS: We studied 85 women, 7 weeks after vaginal birth. All had at least one risk factor for obstetric-related PV muscle tear. The ordinal outcome measure of MRI-documented PV muscle tear was defined as: none, less than 50% unilateral tear, 50% or greater unilateral tear or less than 50% bilateral tear, and 50% or greater bilateral tear. PV muscle body integrity by palpatory assessment was scored on a matrix, with each side scored independently and classified as PV muscle body "present" (assuredly felt), "equivocal" (not sure if felt), or "absent" (assuredly not felt). Proportional odds models were constructed to estimate the relationship between PV muscle body integrity palpatory assessment and MRI-documented PV muscle tears. RESULTS: Thirty-five percent of study participants exhibited varying degrees of MRI-documented PV muscle tears. Using palpatory assessment, we identified "PV muscle body present bilaterally" in 20%, "equivocal unilaterally or present contralaterally" in 8%, "equivocal or absent unilaterally" or "equivocal bilaterally" in 62%, and "absent bilaterally" in 9%. The odds ratio for estimating MRI results from palpatory assessment was 3.62 (95% confidence interval = 1.70-7.73, P = 0.001). CONCLUSIONS: A rapid and inexpensive palpatory assessment in the clinic was highly associated with the risk of MRI-documented PV muscle tear and is a useful component of a clinical assessment.

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.

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.

Supporting a comprehensive and coordinated evaluation of the elderly with diabetes by integrating cognitive and physical assessment in the evaluation process.

BACKGROUND: Successful ageing with diabetes is challenged by co-morbidities, which may present barriers to self-care. Currently, measurement of physical and cognitive status is not part of routine care of the older person with diabetes, and these are not taken into account when devising the treatment plan. OBJECTIVE: To describe a novel approach that integrates cognitive and physical assessment into the routine evaluation of the older person with diabetes and the tailor-made treatment plan devised accordingly. To provide estimates of the relative contribution of cognitive and physical disabilities in this population. METHODS: Cognitive and physical assessments were added to the standard evaluation. A composite measure of cognitive and of physical status categorizing each individual to intact, mild, or severe impairment was generated. In addition, all recommendations provided were categorized and tabulated. RESULTS: Of 119 individuals, over the age of 60 with type 2 diabetes who were referred because of difficulties in managing their disease, 16% and 3% of individuals met the criteria for severe cognitive/physical impairment, respectively, and 42% and 21% met the criteria for mild cognitive/physical impairment; 72%, 12.5%, 61% received recommendations related to intensification of physical activity, cognitive treatment, change in pharmacological agents, respectively. 25% were referred for further emotional treatment. CONCLUSIONS: These data suggest that a substantial proportion of individuals with diabetes over the age of 60 may have cognitive/physical impairment. It highlights the importance of measuring these as part of the multidisciplinary evaluation and being able to provide a tailor made treatment plan.

Investigating the relationship between the HJHS and HAL in routine clinical practice: A retrospective review.

INTRODUCTION: Comprehensive musculoskeletal assessment for monitoring joint health in haemophilia includes both physical assessment with Haemophilia Joint Health Score (HJHS) and assessment of self-reported function by Haemophilia Activities List (HAL). METHODS: Correlation between physical assessment and joint function was undertaken between HJHS and HAL in patients with SHA and SHB who had both assessments at the same visit over a one-year period. RESULTS: Data from 120 patients (96-SHA/24 = SHB) with a median age 33 years (range 19-73) were included. Median total HJHS was 19, increasing with age: 18-30 years-7, 31-50 years-25 and 51-73 years-44. Similarly, median total HAL score was 80 with decreased function associated with increasing age: 18-30 years-90.4, 31-59 years-71.7, 51-73 years-49.5. Median Total HJHS and HAL demonstrated strong correlation (rs  = 0.66, P < 0.01). Moderate-to-strong correlations were seen across the entire age group between the HJHS LL and UL subtotals and corresponding limb HAL domains. Within age groups, correlations were less significant particularly for the upper UL domains in HAL and the UL HJHS score. The wide range of ROM in joints categorized as markedly affected (ie, ROM loss score = 3) highlights the potential ceiling effect of this domain score and its use in chronically damaged joints. CONCLUSION: HJHS and HAL showed moderate-to-strong correlation with discrepancy in some individual patients. Prospective studies are required to better understand the clinical utility of both especially in severe joint disease where HAL may have a potential advantage.

Electronic Assessment of Physical Decline in Geriatric Cancer Patients.

PURPOSE OF REVIEW: The purpose of this review is to explore state-of-the-art remote monitoring and emerging new sensing technologies for in-home physical assessment and their application/potential in cancer care. In addition, we discuss the main functional and non-functional requirements and research challenges of employing such technologies in real-world settings. RECENT FINDINGS: With rapid growth in aging population, effective and efficient patient care has become an important topic. Advances in remote monitoring and in its forefront in-home physical assessment technologies play a fundamental role in reducing the cost and improving the quality of care by complementing the traditional in-clinic healthcare. However, there is a gap in medical research community regarding the applicability and potential outcomes of such systems. While some studies reported positive outcomes using remote assessment technologies, such as web/smart phone-based self-reports and wearable sensors, the cancer research community is still lacking far behind. Thorough investigation of more advanced technologies in cancer care is warranted.

Atrioventricular Canal and Dextrocardia: A Case Report with Implications for Community-Based Providers.

Congenital heart defects (CHD) are the most common congenital malformation reported in the literature, with a global incidence of eight per every 1,000 live births. In the United States approximately 40,000 infants are born each year with a CHD. Of the infants diagnosed with a CHD, one in every four heart defects are life threatening in origin. Early identification and treatment of congenital heart lesions, beginning with a comprehensive physical assessment after birth, are critical. For infants delivered at community-based hospitals, the importance of the physical assessment, timing of diagnostic strategies, anticipatory planning, and interprofessional collaboration among referring and accepting centers cannot be understated. This article presents a rare case of an infant with atrioventricular canal complicated by dextrocardia. Embryology, pathophysiology, epidemiology, symptomology, cardiac assessment, diagnostics, treatment, and nursing strategies for facilitating transfer of care from community-based hospitals to tertiary medical centers are discussed.

A qualitative study of advanced nurse practitioners' use of physical assessment skills in the community: shifting skills across professional boundaries.

AIMS AND OBJECTIVES: To explore multiple perspectives on the use of physical assessment skills by advanced nurse practitioners in the UK. BACKGROUND: Physical assessment skills practices are embedded in advanced nursing practice roles in the UK. There is little evidence on how these skills are used by advanced nurse practitioners in the community. DESIGN: Case study. METHODS: A qualitative interpretative single-embedded case study of 22 participants from South of England. A framework method analysed interview data collected by the researcher between March-August 2013. Participants included nurses, doctors, nurse educators and managers. FINDINGS: Physical assessment skills education at universities is part of a policy shift to develop a flexible workforce in the UK. Shared physical assessment practices are less to do with role substitution and more about preparing practitioners with skills that are fit for purpose. Competence, capability and performance with physical assessment skills are an expectation of advanced nursing practice. CONCLUSIONS: These skills are used successfully by community advanced nurse practitioners to deliver a wide range of services in response to changing patient need. The introduction of physical assessment skills education to undergraduate professional preparation would create a firm foundation to develop these skills in postgraduate education. RELEVANCE TO CLINICAL PRACTICE: Physical assessment education prepares nurses with the clinical competencies to carry out healthcare reforms in the UK. Shared sets of clinical assessment competencies between disciplines have better outcomes for patients. Levels of assessment competence can depend on the professional attributes of individual practitioners. Unsupportive learning cultures can hinder professional development of advanced nursing practice.

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

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.

Physical assessment techniques performed by Italian registered nurses: a quantitative survey.

AIMS AND OBJECTIVES: The aims of the study were to describe which of the core techniques of the physical assessment are regularly performed by a sample of Italian nurses, and to investigate the potential predictors of a more complete examination. BACKGROUND: Physical examination is among the essential tasks of nursing professionals, who are requested to perform a correct and complete physical assessment. DESIGN: Cross-sectional survey. METHODS: The study was performed between August 2013 and January 2014 in 17 Italian regions. A total of 1182 questionnaires were collected. RESULTS: Most participants were females (age range 41-50 years), and worked in Internal Medicine, Intensive Care and Surgical hospital units. Of the 30 core techniques that are currently taught and performed according to the Italian Baccalaureate degree requirements, 20 were routinely performed, 6 were seldom used and 4 were learnt but almost never performed (auscultation of lung, heart and bowel sounds and spine inspection). Graduate and postgraduate nurses, working in Intensive Care Units and Nursing Homes, were more prone than the others to carry out a more complete physical assessment. CONCLUSIONS: The skills to perform a physical assessment are suboptimal among this sample of Italian nurses. Health and educational providers should pose more attention and efforts to provide nurses with an acceptable training in physical examination practice. RELEVANCE TO CLINICAL PRACTICE: This study describes the specific physical techniques performed by nurses in real practice and provides information on which skills require more attention in nursing educational programmes.

Too much knowledge for a nurse? Use of physical assessment by final-semester nursing students.

There is debate around the scope of physical assessment skills that should be taught in undergraduate nursing programs. Yet this debate is largely uninformed by evidence on what is learned and practiced by nursing students. This study examined the pattern and correlates of physical assessment skill utilization by 208 graduating nursing students at an Australian university, including measures of knowledge, frequency of use, and perceived barriers to physical assessment skills during clinical practice. Of the 126 skills surveyed, on average, only five were used every time students practiced. Core skills reflected inspection or general observation of the patient; none involved complex palpation, percussion, or auscultation. Skill utilization was also shaped by specialty area. Most skills (70%) were, on average, never performed or learned and students perceived nursing physical assessment was marginalized in both university and workplace contexts. Lack of confidence was, thus, a significant barrier to use of skills. Based on these findings, we argue that the current debate must shift to how we might best support students to integrate comprehensive physical assessment into nursing practice.