PAEDAITRIC PHYSICAL ASSESSMENT

Paediatric Physical Assessment and Advanced Nurse Practitioner Role

Paediatric Physical Assessment and Advanced Nurse Practitioner Role

Introduction

Assessment acknowledged as the definitive first step of the nursing process; however, most authors do not separate physical assessment from other nursing assessment tasks, such as health history and psychosocial assessment. The nursing process based on the nursing theory developed in the late 1950s by Ida Jean Orlando. During the 1960s, nursing theorists began to describe nursing practice as a unique entity among the healthcare professions establishing the five methods that define the nursing process. These five nursing process steps—assessment, diagnosis, outcome identification and planning, implementation, and evaluation—were institutionalized in 1973 when the American Nurses Association's (ANA) Congress for Nursing Practice established Standards of Practice for direct nursing perforsmance. With the development, of these Standards of Practice came the introduction of physical assessment as part of the nurse's role. Physical assessment was then incorporated into the nursing curriculum in virtually the same format as the medical curriculum (Reilly, 2003, 1100). Physical assessment was also defined as an important part of the nurse practitioner role in the 1960s.

More recently, researchers reviewed the literature about nurse health assessment that included criteria for evaluating assessment knowledge and skill level. The criteria included the nurse's ability to (a) perform a focused assessment (assessment of a specific body function), and (b) describe how each body system assessed. Another criterion included the ability to identify adverse findings, analyze results, and develop a plan of care. Furthermore, their review identified how nurses perceived physical assessment as a medically focused practice, whereas they perceived interview and communication skills as nursing-focused practice.

Background

Assessment is the first step of the nursing process. Physical assessment is a key component of that the assessment process. Along with history taking and psychosocial assessment, it provides the foundation for the following nursing process steps: diagnosis and planning. Although physical assessment has become a well-known concept in nursing, as well as an integral part of nursing practice, little research conducted correlating the competencies of physical assessment skills, which skills are actually used compared to what they taught, and the relation they have to nurses' clinical decision making. Also, physical assessment is a shared skill with the medical profession as well as other healthcare professions, which blurs the boundaries of professional responsibilities. Physical assessment is a comparatively new concept for the nursing profession compared to other professions, but the importance of competency in physical assessment skills for clinical decision making may be paramount to the entire nursing process (Norwood, 2005, 118).

Significance of the Physical Assessment

Physical assessment skills are defined as the systematic and ongoing collection of patient data using the skills of inspection, auscultation, percussion, and palpation. Physical assessment (i.e., a component of the overall patient assessment) forms the groundwork for any planned nursing intervention and a framework against which consequent events during hospitalization can be compared. Part of the overall assessment process includes the development of the nurse-patient relationship, another important aspect of ...