Table 3 Evaluation of nursing students’ performed assessment skills
Patient clinical condition | Patient medical diagnosis | Nursing students’ performed physical assessment skills | Evaluation of student performance |
|---|---|---|---|
Female 74 years old. Receives home nursing follow-up after hip surgery dexter, 2 months ago | Recurrent hip luxations—surgical treatment several times, COPD1, hypertension | Heart and peripheral circulation: Inspect extremities for skin colour/hair growth, palpate distal pulses, palpate for oedema, take blood pressure, auscultate heart sounds Thorax: Inspect thoracic wall for shape and breathing effort, inspect thorax for skin colour/scar, auscultate lungs, assess SpO22 Abdomen: Take history on bowel function and perform inspection inside mouth on mucosa and teeth Neurology: Take history on neurological status/movement in legs and feet, assess mental status, cranial nerves II | Student initiates assessment through conversation. Performs suitable skills related to patient’s clinical and medical diagnosis. Takes a head-to-toe approach, where patient’s symptoms are in focus for skills application. Student references prior clinical encounters to support clinical reasoning for performed assessment skills. The current patient encounter is a starting point for reflections, and reflections go beyond the actual assessment on the audio-recording. |
Female 60 years old. Receives home nursing for maintenance and care of suprapubic catheter. Severe spinal pain—pain management. Elbow wound treatment | Several spinal surgeries—with complications, unable to hold torso upright | Heart and peripheral circulation: Inspect thorax for shape, breathing effort, assess pain sensation Abdomen: Inspect abdomen/skin around the suprapubic catheter, light abdominal palpation Neurology: Assess mental status | Student initiates encounter through conversation. No assessment skills were explicitly performed. Left out relevant assessments related to heart and peripheral circulation, pain management and abdominal assessment due to complications in torso. Student articulates which assessments and the reasoning for why they were performed. |
Female 89 years old. Receives home nursing due to age and assistance during morning care | Rheumatoid arthritis, Sjögren syndrome, heart failure, hypertension, pneumonia 12 weeks ago, ear infection 5 weeks ago | Heart and peripheral circulation: Inspect extremities for skin colour/hair growth, palpate distal pulses, palpate for oedema, estimate skin fold, assess pain sensation Thorax: Inspect thorax for shape and breathing effort, inspect thorax for skin colour/scar, palpate thorax wall for thoracic expansion and vocal fremitus, percuss lungs, auscultate lungs, assess SpO2.2 Abdomen: Perform inspection inside mouth on mucosa and teeth Neurology: Assess mental status | Student initiates assessment through conversation. Performs suitable skills related to patient’s clinical and medical diagnosis. Takes a symptom-based approach through history-taking and conversation. Student references prior clinical encounters to support clinical reasoning for performed assessment skills. The current patient encounter is a starting point for reflections, and reflections go beyond the actual assessment on the audio-recording. |
Female 94 years old. Admitted to nursing home due to failure to thrive | Asthma, former PCI3 intervention, former breast cancer and uterus cancer—no complications after surgery | Heart and peripheral circulation: Inspect extremities for skin colour/hair growth, palpate distal pulses, palpate for oedema, palpate and inspect capillary refill, evaluate extremities for skin sensation, assess fine motor skills, take blood pressure, auscultate heart sounds Thorax: Inspect thorax for shape and breathing effort, converse with patient about their breathing effort Abdomen: Take history on bowel function, inspect abdomen, auscultate abdomen for bowel sounds, abdominal palpation Neurology: Assess mental status, cranial nerves II, V and VII, tone and muscle strength in arms, sensation of touch under feet | Student initiates assessment through conversation. Performs suitable skills related to patient’s clinical and medical diagnosis. Takes head-to-toe approach, where patient’s symptoms are in focus for skills application. Student references prior clinical encounters to support clinical reasoning for performed assessment skills. The current patient encounter is a starting point for reflections, and reflections go beyond the actual assessment on the audio-recording. |
Male 82 years old. Admitted to nursing home due to rehabilitation and mobilization and rehabilitation after cardiac arrest 14 days ago | Diabetes 2, hypertension, atrial fibrillation, atrial flutter, heart failure, anxiety, sleeping disorders, urinary retention, sacral pressure ulcer—fourth degree, heel ulcers on both feet, cardiac arrest—14 days ago, vertigo | Heart and peripheral circulation: Inspect extremities for skin colour/hair growth, palpate distal pulses, palpate for oedema, palpate and inspect capillary refill, assess fine motor skills, take blood pressure, auscultate heart sounds Thorax: Inspect thorax for shape, breathing effort, palpate thorax wall for thoracic expansion and vocal fremitus, percuss lungs, auscultate lungs, assess SpO22 Abdomen: Inspect abdomen, auscultate abdomen for bowel sounds, abdominal palpation, percuss for kidney tenderness Neurology: Assess mental status, cranial nerves II, III, IV, VI, VII, VIII, IX, XI and XII | Student initiates assessment through conversation. Performs suitable skills related to patient’s clinical and medical diagnosis. Takes a head-to-toe approach where patient’s symptoms are in focus for skills application. Left out relevant assessments related to blood glucose The current patient encounter is a starting point for reflections, where the student mainly focuses on which B-PAS requires more practice. Gives rationale for performed assessments without further elaboration on why. |
Female 87 years old. Admitted to nursing home for post-operative rehabilitation, mobilization and pain management after acute compression fracture in L44 surgery | Hypertension, macular degeneration—10% eyesight, glaucoma, ischemic heart disease, osteoporosis, hiatus hernia, former ischemic cerebral insult and heart attack | Heart and peripheral circulation: Inspect extremities for skin colour/hair growth, palpate distal pulses, palpate for oedema, palpate and inspect capillary refill, assess fine motor skills, take blood pressure, auscultate heart sounds Thorax: Inspect thorax for shape and breathing effort, percuss the lungs, auscultate lungs, assess SpO22 Abdomen: Take history on bowel function, inspect abdomen, auscultate abdomen for bowel sounds, abdominal palpation. Neurology: Assess mental status | Student initiates assessment through conversation. Performs suitable skills related to patient’s clinical and medical diagnosis. Takes a symptom-based approach through history-taking and conversation. The current patient encounter is a starting point for reflections, where the student mainly focuses on clinical reasoning for performed assessments. |
Male 65 years old. Receives home nursing due to diabetic ulcer wound care on right foot | Diabetes 1, neuropathy | Heart and peripheral circulation: Inspect extremities for skin colour/hair growth, palpate distal pulses, palpate and assess distal pulses, palpate for oedema, evaluate extremities for skin sensation, assess fine motor skills on feet Neurology: Assess mental status | Student initiates assessment through conversation. Performs suitable skills related to patient’s clinical and medical diagnosis. Takes a symptom-based approach through history-taking and conversation. Student references prior clinical encounters to support clinical reasoning for performed assessment skills. The current patient encounter is a starting point for reflections, and reflections go beyond the actual assessment on the audio-recording. |
Female 83 years old. Admitted to nursing home due to assessment of COPD1 exacerbation | COPD1 | Heart and peripheral circulation: Inspect extremities for skin colour/hair growth, palpate distal pulses, palpate for oedema, palpate and inspect capillary refill, evaluate extremities for pain, take blood pressure, auscultate heart sounds Thorax: Take history on breathing effort, inspect thorax for shape and breathing effort, inspect thorax for skin colour/scar, auscultate lungs, assess SpO22 Abdomen: Take history on bowel function Neurology: Assess mental status | Student initiates assessment through conversation. Performs suitable skills related to patient’s clinical and medical diagnosis. Takes a head-to-toe approach where patient’s symptoms are in focus for skills appliance. Student references prior clinical encounters to support clinical reasoning for performed assessment skills. The current patient encounter is a starting point for reflections, and reflections go beyond the actual assessment on the audio-recording. |