Development of the Barriers to Nurses' Use of Physical Assessment Scale

Purpose:  

There is growing evidence of failure to recognise hospitalised patients at risk of clinical deterioration, in part due to inadequate physical assessment by nurses. Yet, little is known about the barriers to nurses’ use of physical assessment in the acute hospital setting and no validated scales have been published. Complex intervention studies designed to address these barriers and improve nursing assessment skills are also needed. However, before interventions targeting nurses’ assessment practices can be developed, a valid and reliable measure of barriers to physical assessment skills is required. The purpose of the study was to develop and psychometrically test the Barriers to Nurses’ use of Physical Assessment Scale.

Methods:

Scale development was based on a comprehensive literature review, focus groups, expert review and psychometric evaluation. The scale was administered to 434 acute care registered nurses working at a large Australian teaching hospital between June and July 2013. Psychometric analysis included factor analysis, model fit statistics and reliability testing.

Results:

The final scale was reduced to 38 items representing seven factors, together accounting for 57.7% of the variance: (1) reliance on others and technology, (2) lack of time and interruptions, (3) ward culture, (4) lack of confidence, (5) lack of nursing role models, (6) lack of influence on patient care, and (7) specialty area. Internal reliability ranged from .70 to .86.

Conclusion:

Findings provide initial evidence for the validity and reliability of the new scale and point to the importance of understanding the organisational determinants of nurses’ assessment practices. Barriers to nurses’ use of physical assessment may impair timely recognition of patient deterioration and interventions targeting these factors may improve patient outcomes. This new measure should encourage future researchers and clinicians to assess the barriers to nurses’ use of physical assessment, to better understand how to support nursing assessment in acute care settings.