Factors Influencing Nursing Assessment Practices

Purpose: Changing acuity of hospitalised patients means sicker patients with more complex needs are at greater risk of becoming seriously ill during their stay. Frontline registered nurses (RNs) play an essential role in detecting patients at risk of clinical deterioration through ongoing assessment and timely, appropriate action in response to changing health status.  Government agencies worldwide have developed guidelines for recognition of and response to acute clinical deterioration.  Nevertheless, clinical deterioration continues when it may have been prevented.  Little research has examined factors related to registered nurses’ use of assessment skills. The purpose of this study was to explore RNs’ use of and perceived barriers to physical assessment skills used in routine assessment, recognition and response to patients at risk of deterioration.

Methods: A cross-sectional survey of RNs was undertaken. Data collectioninstruments included the validated Physical Assessment Skills Inventory, Barriers to Registered Nurses’ Use of Assessment Skills Scale and demographic data.

Results: A minimum data-set of seven skills were used by most nurses most of the time: temperature, oxygen saturation, blood pressure, evaluation of breathing effort, skin assessment, wound assessment, and mental state/level of consciousness assessment. Multivariable modelling controlling for specialty area and role revealed reliance on others and technology (p=0.001) and lack of confidence (p=0.019) were associated with use of physical assessment skills (p=0.001).

Conclusion:  Results show the majority of nurses regularly assess those physiological markers that typically form the core of early warning and rapid response protocols. Furthermore, nurses lack confidence in using the full breadth of assessment practices and indicate a reliance on technology and other clinicians. These factors pose barriers to nursing assessment practices. This, together with the assessment focus on overt signs of deterioration,  may well be distracting nurse attention away from holistic patient assessment and surveillance that could detect more subtle signs of change in health status earlier; thus, possibly preventing patients spiral down the clinical deterioration pathway.