Janis Sikora, MSN, RN; Jane Dansevich, MSN, MS; Laura Daniel, PhD; Donamarie N-Wilfong, DNP, RN West Penn Allegheny Health System, Pittsburgh, PA

The Effects of a Head-to-Toe Physical Assessment Simulation Course on First Term Nursing Students’ and on Home Health Nurses’ Comfort Levels

Methods

Results

Discussion

Introduction Accurate data collection is crucial when performing Head-to-Toe assessments because these measurements

lay the foundation for clients’ comprehensive care plans. Performing this essential skill and integrating the data, may make some novice nursing students feel uncomfortable, which would interfere with precise data collection. Therefore, in an effort to ease students’ anxieties and to raise their confidence prior to clinical experiences, a training course was developed, complete with video and simulation technology. The primary purpose was to guide first term nursing students through the nursing process. This program was hypothesized to help student nurses feel more comfortable performing Head-to-Toe assessments by providing them with an opportunity to refine their physical examination skills.

Forty first year nursing students participated in a one-day simulation course. This training session began with a survey that asked them to rate how comfortable or uncomfortable they felt in performing each part of the Head-to-Toe assessments including vital signs, lung, cardiac, skin, eyes, ears, nose, mouth, neurological and abdominal, as well as performing the assessments overall as a whole. Students were asked to quantify their feelings on 7-point Likert scales that ranged from “Extremely Uncomfortable” to “Extremely Comfortable.” Then the students watched a 30-minute video that demonstrated how to properly perform the Head-to-Toe assessments. After viewing the video, students then performed assessments on simulators. At the conclusion of the course, students were guided through a debriefing session where they were encouraged to use their critical thinking skills to reflect on their strengths and weaknesses. Following the debriefing session, students were again asked to complete the comfort surveys. The pre/postcourse survey data was analyzed with descriptive statistics and Wilcoxon Signed Rank Tests, with alpha equal to 0.05.

Students’ mode comfort levels increased for every part of the Head-to-Toe assessments except for the cardiac and skin items, where the modes remained the same before and after training. The item modes that increased the most (by two) belonged to the ears, nervous system, mouth and abdominal assessments. Inferential statistical results showed that the simulation training elicited a statistically significant change in students’ comfort levels for all individual aspects of the Head-to-Toe assessment as well as overall , Z = -4.859, p < .01 (see Table 1).

Upon achieving these positive results, the study was replicated with a group of experienced nurses (n = 47) to determine if the educational program would be beneficial to employed home health nurses. After the training, the majority of mode comfort levels (72.7%) increased among the staff nurses. The simulation training also elicited statistically significant changes in home health care nurses’ comfort levels for all of the individual aspects of the Head-to-Toe assessment, except for vital signs and neurological assessments (see Table 2).

Evidence showed that the simulation course had a positive effect on student nurses’ self-reported feelings of comfort both for the individual parts of the physical assessment and for the assessment as a whole. Staff nurses also benefited from this educational program and also showed increased confidence levels in most areas. This course has great implications for nursing, as it provided student and staff nurses with a means to gain clinical confidence. Without experiencing feelings of anxiety, nurses are better equipped to make precise clinical decisions.

Table 1. Wilcoxon Signed Rank Tests: Student Nurses

Vital Lung Cardiac Skin Eyes Ears Nose Mouth Nerves Abdomen Z -2.668 -4.538 -3.961 -3.043 -3.325 -3.421 -3.440 -3.038 -3.550 -2.910 p-value 0.008 0.000 0.000 0.002 0.001 0.001 0.001 0.002 0.000 0.004

Table 2. Wilcoxon Signed Rank Tests: Home Health Nurses Vital Lung Cardiac Skin Eyes Ears Nose Mouth Nerves Abdomen

Z -1.732 -2.957 -3.180 -2.744 -2.422 -3.526 -3.535 -2.229 -1.908 -3.232

p-value 0.083 0.003 0.001 0.006 0.015 0.000 0.000 0.026 0.056 0.001