title: The primacy of vital signs--acute care nurses' and midwives' use of physical assessment skills: a cross sectional study.
abstract: BACKGROUND
  Registered nurses and midwives play an essential role in detecting patients at risk of deterioration through ongoing assessment and action in response to changing health status. Yet, evidence suggests that clinical deterioration frequently goes unnoticed in hospitalised patients. While much attention has been paid to early warning and rapid response systems, little research has examined factors related to physical assessment skills.
  
  
  OBJECTIVE
  To determine a minimum data set of core skills used during nursing assessment of hospitalised patients and identify nurse and workplace predictors of the use of physical assessment to detect patient deterioration.
  
  
  METHODS
  The study used a single-centre, cross-sectional survey design.
  
  
  METHODS
  The study included 434 registered nurses and midwives (Grades 5-7) involved in clinical care of patients on acute care wards, including medicine, surgery, oncology, mental health and maternity service areas, at a 929-bed tertiary referral teaching hospital in Southeast Queensland, Australia.
  
  
  METHODS
  We conducted a hospital-wide survey of registered nurses and midwives using the 133-item Physical Assessment Skills Inventory and the 58-item Barriers to Registered Nurses' Use of Physical Assessment Scale. Median frequency for each physical assessment skill was calculated to determine core skills. To explore predictors of core skill utilisation, backward stepwise general linear modelling was conducted. Means and regression coefficients are reported with 95% confidence intervals. A p value <.05 was considered significant for all analyses.
  
  
  RESULTS
  Core skills used by most nurses every time they worked included assessment of temperature, oxygen saturation, blood pressure, breathing effort, skin, wound and mental status. Reliance on others and technology (F=35.77, p<.001), lack of confidence (F=5.52, p=.02), work area (F=3.79, p=.002), and clinical role (F=44.24, p<.001) were significant predictors of the extent of physical assessment skill use.
  
  
  CONCLUSIONS
  The increasing acuity of the acute care patient plausibly warrants more than vital signs assessment; however, our study confirms nurses' physical assessment core skill set is mainly comprised of vital signs. The focus on these endpoints of deterioration as dictated by early warning and rapid response systems may divert attention from and devalue comprehensive nursing assessment that could detect subtle changes in health status earlier in the patient's hospitalisation.
authors.affiliation: Faculty of Health, School of Nursing, Queensland University of Technology, Kelvin Grove, Brisbane, Queensland 4059, Australia; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Brisbane, Queensland 4059, Australia; Royal Brisbane and Women's Hospital, Herston, Brisbane, Queensland 4029, Australia. Electronic address: s.osborne@qut.edu.au.
authors.forename: Sonya
authors.initials: S
authors.lastname: Osborne
authors.affiliation: Faculty of Health, School of Nursing, Queensland University of Technology, Kelvin Grove, Brisbane, Queensland 4059, Australia; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Brisbane, Queensland 4059, Australia; Royal Brisbane and Women's Hospital, Herston, Brisbane, Queensland 4029, Australia.
authors.forename: Clint
authors.initials: C
authors.lastname: Douglas
authors.affiliation: Faculty of Health, School of Nursing, Queensland University of Technology, Kelvin Grove, Brisbane, Queensland 4059, Australia; Royal Brisbane and Women's Hospital, Herston, Brisbane, Queensland 4029, Australia.
authors.forename: Carol
authors.initials: C
authors.lastname: Reid
authors.affiliation: University of Queensland, Herston, Brisbane, Queensland 4059, Australia; School of Public Health, University of Queensland, Brisbane 4072, Australia.
authors.forename: Lee
authors.initials: L
authors.lastname: Jones
authors.affiliation: Faculty of Health, School of Nursing, Queensland University of Technology, Kelvin Grove, Brisbane, Queensland 4059, Australia; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Brisbane, Queensland 4059, Australia; Royal Brisbane and Women's Hospital, Herston, Brisbane, Queensland 4029, Australia.
authors.forename: Glenn
authors.initials: G
authors.lastname: Gardner
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009721:Nurse Midwives; D009741:Nursing Staff, Hospital; D055986:Vital Signs
keywords: Acute care; Barriers to physical assessment; Clinical deterioration; Health assessment; Hospital rapid response team; Nursing assessment; Nursing observation; Physical assessment; Physical examination; Vital signs