Fit for practice: Exploring competence in physical assessment from the final educational year to two years as a newly graduated nurse: A qualitative study

Abstract

Background: Nurses’ competent use of physical assessment is needed to detect deterioration and initiate interventions to prevent complications from occurring. Research shows that nursing students and nurses do not perform physical assessment during daily practice, as taught on campus. Identified barriers are complex and multifaceted, with contextual differences, lack of time, lack of role models and overall workload as some of the reasons. Several studies recommend reducing the scope of physical assessment curriculum in undergraduate nursing education to overcome the barriers. In 2015, on one University of South-Eastern Norway campus, we developed and introduced a pedagogical education model designed for learning and practising physical assessment. Little is known about (a) students’ development of competence in physical assessment during their last year as an undergraduate and (b) the reasoning processes accompanying their performance and learning. Furthermore, no identified studies have explored this in depth, following the same students as they become newly graduated nurses. The motivation for the current study was thus to understand how the students practised physical assessment with patients; how they perceived their own competence development; and how the clinical context supported their learning process.

Aim: The aims of this dissertation were threefold: (1) to explore nursing students’ use of physical assessment during their clinical rotations in two consecutive rotations in their last educational year, (2) to explore the development of competence in physical assessment from the last educational year to two years after graduation, and (3) to explore contextual factors facilitating or hindering the use of physical assessment.

Developing competence in physical assessment is a complex process which transforms one’s view of what physical assessment is and how it can become an integrated part of person-centred fundamental care. However, educators and nurse managers are important to building a supportive learning environment that scaffolds both nursing students’ and newly graduated nurses’ continuing practise of physical assessment. Reflective practice – in which students perform assessment based on a symptom-based approach and clinical reasoning – may facilitate a more targeted competence development, closing the gap between learning activities on campus and in the clinical environment. Findings also indicate that close collaboration between educational institutions and the clinical environment would enhance nursing students’ and newly graduated nurses’ further physical assessment use and development. Researchers, educators, nurse managers, nurses and nursing students can benefit from these findings, as they provide new understandings of how competence in physical assessment is learned. However, future studies should explore how different clinical contexts, learning environments, and the roles of precepting nurses and nurse managers influence and scaffold the development of competence in physical assessment. Moreover, explorations of how the influencing factors inform the overall clinical judgment competence in both nursing students and nurses need further elaboration.