title: Nursing physical assessment for patient safety in general wards: reaching consensus on core skills.
abstract: OBJECTIVE
  To determine consensus across acute care specialty areas on core physical assessment skills necessary for early recognition of changes in patient status in general wards.
  
  
  BACKGROUND
  Current approaches to physical assessment are inconsistent and have not evolved to meet increased patient and system demands. New models of nursing assessment are needed in general wards that ensure a proactive and patient safety approach.
  
  
  METHODS
  A modified Delphi study.
  
  
  METHODS
  Focus group interviews with 150 acute care registered nurses at a large tertiary referral hospital generated a framework of core skills that were developed into a web-based survey. We then sought consensus with a panel of 35 senior acute care registered nurses following a classical Delphi approach over three rounds. Consensus was predefined as at least 80% agreement for each skill across specialty areas.
  
  
  RESULTS
  Content analysis of focus group transcripts identified 40 discrete core physical assessment skills. In the Delphi rounds, 16 of these were consensus validated as core skills and were conceptually aligned with the primary survey: (Airway) Assess airway patency; (Breathing) Measure respiratory rate, Evaluate work of breathing, Measure oxygen saturation; (Circulation) Palpate pulse rate and rhythm, Measure blood pressure by auscultation, Assess urine output; (Disability) Assess level of consciousness, Evaluate speech, Assess for pain; (Exposure) Measure body temperature, Inspect skin integrity, Inspect and palpate skin for signs of pressure injury, Observe any wounds, dressings, drains and invasive lines, Observe ability to transfer and mobilise, Assess bowel movements.
  
  
  CONCLUSIONS
  Among a large and diverse group of experienced acute care registered nurses consensus was achieved on a structured core physical assessment to detect early changes in patient status.
  
  
  CONCLUSIONS
  Although further research is needed to refine the model, clinical application should promote systematic assessment and clinical reasoning at the bedside.
authors.affiliation: School of Nursing, Queensland University of Technology (QUT), Kelvin Grove, Qld, Australia.|Institute of Health and Biomedical Innovation (IHBI), Kelvin Grove, Qld, Australia.
authors.forename: Clint
authors.initials: C
authors.lastname: Douglas
authors.affiliation: Royal Brisbane and Women's Hospital (RBWH), Herston, Qld, Australia.
authors.forename: Catriona
authors.initials: C
authors.lastname: Booker
authors.affiliation: Royal Brisbane and Women's Hospital (RBWH), Herston, Qld, Australia.
authors.forename: Robyn
authors.initials: R
authors.lastname: Fox
authors.affiliation: School of Nursing, Queensland University of Technology (QUT), Kelvin Grove, Qld, Australia.|Institute of Health and Biomedical Innovation (IHBI), Kelvin Grove, Qld, Australia.
authors.forename: Carol
authors.initials: C
authors.lastname: Windsor
authors.affiliation: School of Nursing, Queensland University of Technology (QUT), Kelvin Grove, Qld, Australia.|Institute of Health and Biomedical Innovation (IHBI), Kelvin Grove, Qld, Australia.|Royal Brisbane and Women's Hospital (RBWH), Herston, Qld, Australia.
authors.forename: Sonya
authors.initials: S
authors.lastname: Osborne
authors.affiliation: School of Nursing, Queensland University of Technology (QUT), Kelvin Grove, Qld, Australia.|Institute of Health and Biomedical Innovation (IHBI), Kelvin Grove, Qld, Australia.
authors.forename: Glenn
authors.initials: G
authors.lastname: Gardner
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D032921:Consensus; D003422:Critical Care; D003697:Delphi Technique; D017144:Focus Groups; D006801:Humans; D009726:Nurses; D009730:Nursing Assessment / Q000592:standards*; D061214:Patient Safety / Q000592:standards*; D010362:Patients' Rooms; D010808:Physical Examination / Q000451:nursing*; D011795:Surveys and Questionnaires
keywords: Delphi method; clinical deterioration; early recognition; general wards; nurse surveillance; nursing assessment; patient assessment; patient observations; patient safety; physical assessment skills