The increase in diagnostic tools in the medical field has led to the want for validation of the need for physical assessment from medical providers. Observed conditions often lead to other tools that lead to a diagnosis, so it could be presumed that the physical assessment lacks the importance that it did prior to these increases in technology and other-than-physical assessment tools. Labs, x-ray, and even telemedicine have provided astounding abilities to doctors, admittedly decreasing the need in many cases for physical assessment. However, physical assessment in other integral medical circumstances has led to pivotal diagnoses that have saved lives or bettered health outcomes.
A pivotal finding determined by physical assessment leads to a change in diagnosis and a change in clinical management. One in four patients has pivotal physical findings according to one study (Reilly, 2003). This statement alone indicates a need for physical assessment, and most healthcare facilities and nursing schools teach the importance of physical assessment, however there are still barriers to getting assessments performed. A 2007 study found that out of 123 items used to physically assess patients, 30 were routinely performed. The rest were rarely performed or not performed at all (Douglas, Osborne, Reid, Batch, Hollingdrake, Gardner, & Members of the RBWH Patient Assessment Research Council, 2014).
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"Value of Physical Assessment".
Hospitals have early warning systems to detect a patient’s deterioration, but it requires a nurse’s ability to identify deterioration through observation and assessment (Douglas et al., 2014). As this does not happen as frequently or thoroughly as it should, the early warning systems are less effective, which decreases the health outcomes for the patient. Barriers to physical assessment by nurses include lack of confidence, perception that it was not a nurse’s responsibility, and lack of support by peers. Nurses also cite a lack of time required to perform the assessment. Physical assessments were also only used when a nurse suspected a problem (Douglas et al., 2014).
There is evidence that those who are acutely ill receive suboptimal care because of inadequate assessment (Douglas et al., 2014). Evidence-based medicine requires thorough physical assessment to gain the objective information needed in clinical decision-making rather than the information thought to have been relevant (Reilly, 2003). Lack of time or inadequate training or knowledge is not an attitude that should gain support for limited physical assessments, as the missing elements may contain the information needed to better the outcome for the patient.
The importance of medical research, informatics, and advanced technology cannot be overstated. It increases the accuracy of diagnoses and allows for healthcare delivery in areas that suffer barriers to care such as disparate countries and rural areas. The availability of telemedicine is invaluable, and it decreases the cost of medical care in almost every incident. However, it does not replace the tried and true practices of physical assessment at this time. The physical assessment is still the backbone of the medical exam and the standard of care. Nurses must consider this value when considering whether or not their time is best spent completing a thorough exam in order to properly provide clinical management with his or her healthcare team. Support of this practice by managers and nursing peer groups could also increase the perceived value of this skill and enhance the culture of the organization.
A quarter of pivotal findings come from physical assessment. The nurses performing physical assessments will achieve greater health outcomes for their patients if they recognize the impact of it and avoid barriers such as time constraints when making clinical management decisions until there is evidence that physical assessments are not integral to a diagnosis.
