NURSE INTERNS’ COMPETENCE IN PHYSICAL ASSESSMENT FOR ADULT PATIENTS IN HEALTH FACILITIES IN WESTERN REGION OF KENYA

Abstract

Physical assessment is an essential part of the overall health assessment which constitutes the first phase of nursing process. Physical assessment competence of nurse interns has been observed as insufficient in evaluation and solving patients’ health problems in the clinical environment. This has negatively influenced their ability to make better clinical decisions, thus contributing to poor quality of patient care. The aim of this study was to investigate nurse interns’ competence in physical assessment for adult patients in Western region of Kenya. A cross-sectional research design using mixed methods of data collection was used with the target population being nurse interns in health facilities in Western region of Kenya. A sample size of 117 interns was used. A self-administered questionnaire was used to collect data on physical assessment knowledge and factors influencing physical assessment competence of nurse interns while an observation checklist was used to assess their physical assessment skills. Key informant interview was used to obtain information from nurse managers on factors influencing physical assessment competence of nurse interns. Quantitative data was analyzed using SPSS, version 26 using both descriptive and inferential data analysis techniques while qualitative data was analyzed thematically guided by the study objectives. For inferential statistics, multiple regression was applied, with a p value of ≤ 0.05considered as statistically significant. Adjusted Odds Ratio (AOR) was used to test the strength of association between independent and dependent variables. The findings of the study revealed that 62% (n=72) of nurse interns were knowledgeable on physical assessment. They had knowledge in taking vital signs (≥90%, n=106), preparation for physical assessment (≥85%, n=99), inspection (89.7%, n=105) and palpation (88%, n=103). 35% (n=41) of the interns performed very well in physical assessment skills. ≥90% (n=106) of them performed very well in measurement of vital signs, assessment of the airway and inspection of body systems. The study revealed that 35% (n=41) of the interns were competent as they scored 90% in both knowledge and physical assessment skills. Factors that were statistically associated with higher competence scores (≥ 90%) were year of completion of 2016 – 2019 (OR: 3.1; 95% CI [1.1, 8.5]; p = 0.02), internship period of 9 – 12 months (OR: 0.2; 95% CI [0.1, 0.5]; p = 0.0002),>7 months previous clinical experience prior to internship (OR: 0.4; 95% CI [0.2, 1.0]; p = 0.05), self-confidence (OR: 4.5; 95% CI [1.9, 10.5]; p = 0.003) and motivation (OR: 0.4; 95% CI [0.2, 1.0]; p = 0.042). In conclusion, nurse interns' competence in physical assessment is low, as shown by around one third of study participants achieving a score of 90% and above in both knowledge and physical assessment skill performance. Key factors that influence physical assessment competence are year of completion, a longer period of internship, previous clinical experience before internship, self confidence in performing physical assessment accurately, motivation of nurse interns to learn more and perform physical assessment and regulatory body factors. This study therefore recommends the Schools of Nursing to put more emphasis on theoretical teaching of physical assessment and provide adequate supervision for student nurses during clinical practicum to enable them develop their physical assessment skills before internship. The study also recommends hospitals to train nurse mentors to provide ongoing professional development opportunities and mentorship programmes for nurse interns. This will improve their motivation and confidence, thus enhancing their competence in physical assessment.