Nursing physical assessment for patient safety in general wards: Reaching consensus on core skills

Douglas, Clint, Booker, Catriona, Fox, Robyn, Windsor, Carol A., Osborne, Sonya, & Gardner, Glenn E. (2016) Nursing physical assessment for patient safety in general wards: Reaching consensus on core skills. Journal of Clinical Nursing, 25(13-14), pp. 1890-1900.

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Aims and objectives

  • To determine consensus across acute care specialty areas on core physical assessment skills necessary for early recognition of changes in patient status in general wards.


  • Current approaches to physical assessment are inconsistent and have not evolved to meet increased patient and system demands. New models of nursing assessment are needed in general wards that ensure a proactive and patient safety approach.


  • A modified Delphi study.


  • Focus group interviews with 150 acute care registered nurses (RNs) at a large tertiary referral hospital generated a framework of core skills that were developed into a web-based survey. We then sought consensus with a panel of 35 senior acute care RNs following a classical Delphi approach over three rounds. Consensus was predefined as at least 80% agreement for each skill across specialty areas.


  • Content analysis of focus group transcripts identified 40 discrete core physical assessment skills. In the Delphi rounds, 16 of these were consensus validated as core skills and were conceptually aligned with the primary survey: (Airway) Assess airway patency; (Breathing) Measure respiratory rate, Evaluate work of breathing, Measure oxygen saturation; (Circulation) Palpate pulse rate and rhythm, Measure blood pressure by auscultation, Assess urine output; (Disability) Assess level of consciousness, Evaluate speech, Assess for pain; (Exposure) Measure body temperature, Inspect skin integrity, Inspect and palpate skin for signs of pressure injury, Observe any wounds, dressings, drains and invasive lines, Observe ability to transfer and mobilise, Assess bowel movements.


  • Among a large and diverse group of experienced acute care RNs consensus was achieved on a structured core physical assessment to detect early changes in patient status.

Relevance to clinical practice

  • Although further research is needed to refine the model, clinical application should promote systematic assessment and clinical reasoning at the bedside.

Impact and interest:

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ID Code: 91625
Item Type: Journal Article
Refereed: Yes
Keywords: Clinical deterioration, Delphi method, early recognition, general wards, nursing assessment, nurse surveillance, patient assessment, patient observations, patient safety, physical assessment skills
DOI: 10.1111/jocn.13201
ISSN: 1365-2702
Subjects: Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > NURSING (111000)
Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > NURSING (111000) > Clinical Nursing - Secondary (Acute Care) (111003)
Divisions: Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Current > Schools > School of Nursing
Copyright Owner: Copyright 2016 John Wiley & Sons Ltd.
Deposited On: 05 Jan 2016 23:45
Last Modified: 24 Jun 2016 09:59

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