Utilization of Physical Assessment Techniques by Registered Nurses

Monday, 30 October 2017

Kelli A. Hand, DNP, MBA
Tessa Mullinax-Baker, MSN
Rosebelle Peters, MSN
Robyn B. Tobias, MSN, BSN
School of Nursing, University of Tennessee at Chattanooga, Chattanooga, TN, USA


The purpose of this study is to determine the frequency of physical assessment techniques utilized by registered nurses in relation to current content in undergraduate health assessment textbooks.


Three undergraduate nursing health assessment textbooks were reviewed to determine physical assessment content that serves as a resource for nurse educators (D’Amico & Barbarito, 2016; Weber & Kelley, 2014; Wilson & Giddens, 2013). A literature review was conducted to determine if there is a relationship between what physical assessment techniques are currently being taught in undergraduate health assessment courses and the utilization frequency of physical assessment techniques by registered nurses (Birks, Cant, James, Chung, & Davis, 2012, Osborne, Douglas, Reid, Jones, & Gardner, 2015).


This research is significant to the nursing profession as it will identify the frequency of use of physical assessment techniques by current registered nurses. This identification of generalist skills that are utilized by practicing nurses may help nurse educators prioritize and focus their teaching of physical assessment skills. By more fully understanding which physical assessment skills are utilized by practicing nurse across different specialty areas, nurse educators can structure their teaching of physical assessment skills with a concentration on those assessment techniques that are high frequency. With a greater concentration on generalist high frequency physical assessment techniques in the undergraduate curriculum, we expect that the novice nurse will be more confident and competent in those physical assessment techniques upon graduation and entrance into the nursing profession.


Assessment is a vital first step in the nursing process and it guides registered nurses in planning and providing individualized holistic care. The Joint Commission has established nursing practice guidelines (2017) to ensure each client has an initial nursing assessment, which includes both a health history and physical assessment, performed and documented by a registered nurse within 24 hours of inpatient admission. Secrest, Norwood, and DuMont (2005) surveyed 12 educators and 51 practicing nurses to determine if current physical assessment techniques taught in an undergraduate nursing assessment course were reflective of the assessment techniques and skills utilized by registered nurses practicing. “never” used, 33 skills of practicing nurses (34%) were used “monthly/occasionally,” and 25 skills of practicing nurses (29%) were used “daily/weekly.” Giddens (2007) surveyed 193 nurses in both the outpatient and inpatient settings from a large university-based health care facility and found that out of 126 physical examination items, only 30 of these were core skills utilized by practicing nurses, with the majority of these examination techniques involving inspection and general observation. The majority of the physical examination techniques were not performed at all by practicing nurses and 28 examination techniques were identified to be performed occasionally or rarely (Giddens, 2007). Birks, Cant, James, Chung, & Davis (2012) looked at the use of physical assessment skills by registered nurses in Australia. A survey was completed by 1,220 registered nurses of varied practice areas. Approximately 34% of the 121 physical assessment items surveyed were reported as performed routinely, 31% were reported as rarely used, and 35.5% were reported as “not used at all.” Of the 34% used routinely, only 10.7% were used every shift that a registered nurse worked. These results raise questions about the relevance of all physical assessment skills taught in pre-licensure nursing programs (Birks et al., 2012). Osborne, Douglas, Reid, Jones, & Gardner (2015) conducted a hospital-wide survey of registered nurses and midwives practicing in the acute care setting in Australia. Four hundred and thirty-four acute care registered nurses and midwives participated in the survey and on average, participants reported 10 (7.5%) of the 133 physical assessment skills surveyed were performed on a regular basis (Osborne, Douglas, Reid, et al., 2015). Douglas, Windsor, and Lewis (2015) examined the pattern and correlates of skill utilization by graduating nursing students at an Australian University. Online surveys measured the use of 126 physical assessment techniques and were sent to 208 undergraduate baccalaureate nursing students. This study revealed that on average, 70% of skills taught were not performed in the clinical settings.

Undergraduate nursing assessment textbooks tend to focus on a comprehensive approach to teaching physical assessment techniques (D’Amico & Barbarito, 2016; Weber & Kelley, 2014). However, there are a few nursing assessment textbooks that present the comprehensive physical assessment but delineate which of those physical assessment skill are core examination techniques or advanced practice techniques (Wilson & Giddens, 2013; Jensen, 2015). In order to best educate the registered nurse on assessment techniques that are most frequently used in practice, nurse educators must first know what physical assessment skills are currently being utilized by practicing registered nurses and with what frequency these skills are being utilized. Research has been conducted in the United States (Giddens, 2007; Secrest, Norwood, & DuMont, 2005) and outside of the United States (Birks, Cant, Ainsley et al., 2012; Osborne, Douglas, Reid et al., 2015; Douglas, Windsor, & Lewis, 2015); that supports an average of 70% of skills taught in undergraduate nursing programs were not performed on a daily basis. We feel that additional research is warranted to determine if the results from these studies are still relevant and applicable to our current nursing practice in the United States.


The results of this research will determine which techniques are utilized in the clinical setting, frequency of utilization, utilization in relation to practice settings, and education level of the nurse performing physical assessment techniques (ADN, BSN, & MSN). The results will guide nurse educators in structuring health assessment course curriculum.

Projected implications from this study will be to ensure nursing educator are able to prioritize physical assessment techniques taught in undergraduate health assessment class. Through prioritization, educators will be able to make certain undergraduate students have a solid foundation of general skills that can be utilized in any practice area.