The consequences of using advanced physical assessment skills in medical and surgical nursing: A hermeneutic pragmatic study.

AIMS AND OBJECTIVES: The aim of this study was to explore the consequences of the nurse's use of advanced assessment skills on medical and surgical wards.

BACKGROUND: Appropriate, accurate, and timely assessment by nurses is the cornerstone of maintaining patient safety in hospitals. The inclusion of "advanced" physical assessment skills such as auscultation, palpation, and percussion is thought to better prepare nurses for complex patient presentations within a wide range of clinical situations.

DESIGN: This qualitative study used a hermeneutic pragmatic approach.

METHOD: Unstructured interviews were conducted with five experienced medical and surgical nurses to obtain 13 detailed narratives of assessment practice. Narratives were analyzed using Van Manen's six-step approach to identify the consequences of the nurse's use of advanced assessment skills.

RESULTS: The consequences of using advanced assessment skills include looking for more, challenging interpretations, and perseverance. The use of advanced assessment skills directs what the nurse looks for, what she sees, interpretation of the findings, and her response. It is the interpretation of what is seen, heard, or felt within the full context of the patient situation, which is the advanced skill.

CONCLUSION: Advanced assessment skill is the means to an accurate interpretation of the clinical situation and contributes to appropriate diagnosis and medical management in complex patient situations.

RELEVANCE TO CLINICAL PRACTICE: The nurse's use of advanced assessment skills enables her to contribute to diagnostic reasoning within the acute medical and surgical setting.