Study Ont The Physical Assessment Framework For Nurses Working In Internal Department

BACKGROUNDHealth assessment is the most important part of nursing program, physical assessment as part of health assessment is a basic method to abtain health status and fuction of the body and provide objective basis for nursing diagnosis .2010 Jan Ministry of Health mentioned in "the notice about the strengthening of clinical nursing work" the duties of nurse performing to patients including:close observation of vital signs and patient condition changes; correctly implementation of the treatment, medication and nursing measures, and observe the response; provide daily care and medical help to the client; provide guidance of rehabilitation and health for patientsUndoubtedly emphasize the observation in nursing and highlight the importance of making correct implementation of physical assessment technique in clinical.At present, physical assessment techniques focusing on rational reasoning rather than empirical study, clinical nurses are more concentrated in the cognitive aspects of physical assessment techniques, research in this area still remains in the relationship between behavior and influencing factors of physical assessment techniques.practice of clinical nuses level and relevant assessment tool has not been reported.Therefore, based on this, the present research attempts to focus mainly on the quantification and understanding the actual condition of physical assement techniques in clinical nursing, and explore the influential factors on their level of assessment.OBJECTIVE1. Full account of clinical nursing mode, the development level of physical assessment, drawing on the experience of other countries, Hong Kong and Taiwan. Using of the system scale development techniques, the preparation of the questionnaire of physical assessment skills, in order to understand the current status of physical assessment to provide reliable data.2. This research focuses on the practice of nurses engaged in clinical medicine based on practical character, consult nursing specialists advice to develop "physical assessment framework "for medical nurses, for better implementation of the assessment activities to provide a unified, rational, targeted standards.OBJECTS AND METHODS1. The physical assessment skills questionnaire designed based on literature review and expert consultation.2. Using convenience sampling method, respondents are selected in the hospitals of 6 provinces, and follow the criteria of inclusion and exclusion.3. Preparation physical assessment framework for nurses working in internal department according to the findings of 401 internal medicine nurses combined with previous literature review and expert interview.4. Totally 18 experts based on their professional reputation and research domain were selected to form a panel and 2 round Delphi method was adopted to form the first draft of physical assessment framework.5. Using SPSS13.0 software for statistical analysis.RESULTS1. Physical assessment skills investigate①There have 171 assessmet items in the questionair,4% items in which are regularly use,19.3% items are frequently used,76.7% of them are used occasionally.②In the all the systems of physical assessment, general condition scoring points is the highest(82.4%), the rest of the system from high to low in turn for, skin (73.3%), head and neck (55.3%), thoracic lung (54.4%) spine and the extremities (53.4%), abdomen (52.2%), cardiovascular system (51.2%), lymph nodes (50.7%), nervous system (50.5%), genitals and rectum, anus (49.1%).2. Item pool of physical assessment framework for nurses working in internal department The importance of items are evaluated by clinical research and expert interviews, then categorize four dimensions by expected structure into inspection, palpation, percussion, auscultation, consisting of 119 indicators for the "physical assessment framework. "3. The structure of physical assessment framework for nurses working in internal department(1) Result of the first round consultation:The positive coefficient of experts is 90%. The mean concerning authority coefficient of item evaluated by 18 experts is 0.920. the total coordination coeffient(Kendall'W coefficient) of each item evaluated by 18 experts is 0.205. the 77 items falling into 4 domains were obtained according to the mean of transformed importance value and experts' updated suggestion on the items. There have 46 items in the inspection,23 items in the palpation,2 items in the percussion,6 items in the auscultation.(2) Result of the second round consultation:The positive coefficient of experts is 94.44%. the total coordination coeffient(Kendall'W coefficient) of each item evaluated by 18 experts is 0.311. There have 54 items are deleted, which are 33 items in the inspection,18 items in the palpation,2 items in the percussion,1 items in the auscultation. Eventally have 31 items in the assessment framework.CONCLUSION1. Physical assessment skills investigateRegional, hospital-level assessment of technology and education leading to uneven development of the main factors, nurses age, grade and frequency of nursing assessment was negatively correlated with technology applications; rational allocation of human resources structure, and establishing the physical characteristics of different sections evaluation framework, emphasis on continued care education, the development of assessment techniques is very important.2. Initially established the physical assessment framework for nurses working in internal departmentApplication of Delphi method Advisory 18 nursing education, nursing management and clinical nurse specialist, the framework includes six areas:general condition, skin and mucosa, head, chest, abdomen, extremities and spine, neuromuscular, a total of 2 indicators. Assessment framework in place for clinical assessment of medical nurses in the direction of the body, but also for the future of the physical characteristics of a specialist assessment techniques laid the foundation.