The primacy of vital signs – Acute care nurses’ and midwives’ use of physical assessment skills: A cross sectional study

Osborne, Sonya, Douglas, Clint, Reid, Carol, Jones, Lee, & Gardner, Glenn (2015) The primacy of vital signs – Acute care nurses’ and midwives’ use of physical assessment skills: A cross sectional study. International Journal of Nursing Studies, 52(5), pp. 951-962.

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Registered nurses and midwives play an essential role in detecting patients at risk of deterioration through ongoing assessment and action in response to changing health status. Yet, evidence suggests that clinical deterioration frequently goes unnoticed in hospitalised patients. While much attention has been paid to early warning and rapid response systems, little research has examined factors related to physical assessment skills.


To determine a minimum data set of core skills used during nursing assessment of hospitalised patients and identify nurse and workplace predictors of the use of physical assessment to detect patient deterioration.


The study used a single-centre, cross-sectional survey design.


The study included 434 registered nurses and midwives (Grades 5-7) involved in clinical care of patients on acute care wards, including medicine, surgery, oncology, mental health and maternity service areas, at a 929-bed tertiary referral teaching hospital in Southeast Queensland, Australia.


We conducted a hospital-wide survey of registered nurses and midwives using the 133-item Physical Assessment Skills Inventory and the 58-item Barriers to Registered Nurses’ Use of Physical Assessment scale. Median frequency for each physical assessment skill was calculated to determine core skills. To explore predictors of core skill utilisation, backward stepwise general linear modelling was conducted. Means and regression coefficients are reported with 95% confidence intervals. A p value < .05 was considered significant for all analyses.


Core skills used by most nurses every time they worked included assessment of temperature, oxygen saturation, blood pressure, breathing effort, skin, wound and mental status. Reliance on others and technology (F = 35.77, p < .001), lack of confidence (F = 5.52, p = .02), work area (F = 3.79, p = .002), and clinical role (F = 44.24, p < .001) were significant predictors of the extent of physical assessment skill use.


The increasing acuity of the acute care patient plausibly warrants more than vital signs assessment; however, our study confirms nurses’ physical assessment core skill set is mainly comprised of vital signs. The focus on these endpoints of deterioration as dictated by early warning and rapid response systems may divert attention from and devalue comprehensive nursing assessment that could detect subtle changes in health status earlier in the patient's hospitalisation.

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13 citations in Scopus
12 citations in Web of Science®
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ID Code: 81611
Item Type: Journal Article
Refereed: Yes
Keywords: acute care, health assessment, clinical deterioration, barriers to physical assessment, hospital rapid response team, nursing assessment, nursing observation, physical examination, vital signs
DOI: 10.1016/j.ijnurstu.2015.01.014
ISSN: 0020-7489
Subjects: Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > NURSING (111000) > Nursing not elsewhere classified (111099)
Divisions: Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Copyright Owner: Copyright 2015 Elsevier Ltd.
Copyright Statement: NOTICE: this is the author’s version of a work that was accepted for publication in International Journal of Nursing Studies. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in International Journal of Nursing Studies, Volume 52, Issue 5, (May 2015), DOI: 10.1016/j.ijnurstu.2015.01.014
Deposited On: 04 Feb 2015 23:04
Last Modified: 24 Jun 2017 19:36

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