Jan 01, 2017
By Debra North, RN, BScN

Promoting direct human contact

Educator Debra North insists her students learn to recognize the value of physical assessment skills

For several years, I have taught nursing skills in registered nurse and registered practical nurse programs in labs, acute care hospitals, rehab units and nursing homes. One of my biggest challenges as an educator has been to convince students of the importance of collecting and analyzing head-to-toe data at the bedside.

Most of my students have cellphones to which they are wedded. The level of attachment has increased over the years as phones have become more complex. In fact, it seems students don’t believe they can survive an hour of the day without being on one. At our college, nursing students are not permitted to bring phones onto clinical units. I believe, however, that having spent so much of their time relating to electronics rather than people has reduced their ability to recognize how much can be learned from direct human contact.

Many of the students think that an oximeter reading provides the most reliable respiratory assessment. Similarly, they eagerly rely on digital blood pressure monitors for blood pressure and pulse but have difficulty accepting that assessing heart rhythm must be done manually.

I start off each semester by explaining that although these and other machines are there to assist nurses, machines cannot replace them. I outline the limits of each one, reminding them that machines do break down. I describe what constitutes a full patient assessment and explain that obtaining readings from medical equipment is only one part of data collection. However, I generally find that students believe machines are infallible, and therefore they are more confident about the results they obtain from them. They don’t see the need to learn how to do head-to-toe assessments because they believe that these give results that are less reliable. I patiently reiterate that machines are limited in the amount of data they provide and don’t pick up the changes that nurses can identify. Those first few weeks of the semester are frustrating because it takes so much time to convince them.

Once they are on clinical units, they encounter patients who have cold hands or are wearing nail polish, which can give a false low oximeter reading. When students get this result, they generally become anxious and frantically look to me to start the patient on oxygen. Asking them about any symptoms of respiratory distress — Is the patient short of breath? Does he have dusky-coloured lips? — is met with blank stares. In fact, they sometimes forget to actually look at the patient.

They become even more nervous at the bedside, when I start talking with the patient to collect respiratory data; they want me to start the person on oxygen immediately. Afterward, when we meet to discuss the assessment, they begin to understand the need to collect more data and consider all the factors that could give a false reading.

I have learned that students are more likely to show willingness to learn physical assessment skills after someone in the class gets an inaccurate oximeter reading. To ensure they have that experience, I will sometimes have to arrange for them to take vital signs on a patient who I know has cold hands. I do what I have to do!

My goal is to help my students recognize that physical assessment skills are an irreplaceable part of the nursing role and to motivate them to try to excel in these skills. I want them to graduate with the knowledge that it is their skills as nurses, rather than the medical equipment they use, that will save lives.

Debra North, RN, BScN, is a clinical instructor at Centennial College in Scarborough, Ont.

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