Abstract
Physical examination is a critical component of a health assessment that has transitioned from being mostly within the medical domain to a skill shared by many professions. For nurses in New Zealand, physical examination skills (PES) are first taught in the undergraduate nursing curriculum as part of a nursing assessment. In a post-graduate curriculum, these physical examination skills are usually revisited, and more specialist skills introduced into a health assessment (such as ophthalmoscope, otoscope, reflexes). In post graduate papers, the purpose of these skills is mostly to inform differential diagnoses.
Although international literature has identified personal, organisational, and educational barriers to implementing PES in clinical settings, no study has yet explored this phenomenon in New Zealand, particularly within a specific cohort of nurses who have exclusively undertaken a post-graduate health assessment education. This research aims to fill the gap in the literature by exploring the opportunities and barriers that nurses, who have completed a post-graduate advanced health assessment course encountered when implementing PES in the clinical setting.
Twenty-seven participants completed a descriptive online survey to share their experiences with the opportunities and barriers in implementing PES in the clinical setting. They rated 38 statements about barriers on a Likert scale from 1 (strongly disagree) to 5 (strongly agree), responded to four open-ended questions, and provided demographic information. The Likert-scale and demographic data were analysed using descriptive statistical methods, while the responses to the open-ended questions underwent thematic analysis.
The results revealed that among the seven PES barrier categories, two organisational factors were significant challenges: specialty area, and lack of time and interruptions. There were also five main themes that emerged from the thematic analysis: professional empowerment through advanced health assessment; professional empowerment from PES and its link to enhanced patient care outcomes; physical examination and its impact on teamwork; alignment of physical examination skills with clinical context and patient health presentations; and challenges of PES implementation.
Key discussions emerged when the qualitative and quantitative data were analysed, revealing significant links to the literature. The top two barriers were confirmed, and several opportunities for PES implementation were identified, primarily the participants' enhanced professional empowerment and its positive impact on their overall PES performance. Based on these findings, recommendations were made for nursing practice, undergraduate and postgraduate education, and future research.
Healthcare organisations are urged to address organisational barriers through policy development, nurse leader empowerment, and resource allocation. Educators, beyond teaching PES, should teach students on strategies to overcome PES barriers and to cultivate clinical judgment and the ability to interpret PES findings. The undergraduate nursing curriculum can leverage the nursing approach to PES to build a strong foundational assessment skill set, which postgraduate education can further refine using a diagnostic approach to PES. Future research should explore both comparative and longitudinal studies involving a wider and more diverse range of participants, particularly healthcare organisations, to gain a comprehensive understanding of the factors that promote and hinder PES implementation in various contexts.