Factors Influencing Nurse Interns’ Competence in Physical Assessment for Adult Patients

Abstract

Context: Physical assessment is essential to the overall health assessment, constituting the nursing process's first phase. The physical assessment competence of nurse interns has been observed as insufficient in evaluating and solving patients' health problems in the clinical environment. This insufficiency has negatively influenced their ability to make better clinical decisions for patients, thus contributing to poor quality of patient care.

Aim: To investigate factors influencing nurse interns' competence in physical assessment for adult patients.

Methods: Cross-sectional analytical research design guided the conduct of the study. The sample comprised 117 nurse interns in health facilities in the Western region of Kenya. Data collection was done using a self-administered questionnaire and health assessment observation checklist. The study was done in level 5 and 6 referral hospitals in the Western region of Kenya, covering the former Western, Nyanza, and Rift-valley provinces. These comprised Kericho, Nakuru, Kitale, Kakamega, Bungoma, and Kisii County Referral hospitals; Jaramogi Oginga Odinga and Moi Teaching and Referral Hospitals.

Results: The overall assessment showed that 35% (n=41) of nurse interns were competent in physical assessment with a score of 90% and above in physical assessment skills, while 65% (n=76) were not competent. Factors that were statistically associated with higher competence scores (≥ 90%) included the year of completion between 2016 – 2019 (OR: 3.1; 95% CI [1.1-8.5]; p=0.02), longer internship period between 9–12 months (OR: 0.2; 95% CI [0.1-0.5]; p=0.0002), more than seven months previous clinical experience before internship (OR: 0.4; 95% CI [0.2-1.0]; p=0.05), self-confidence in performing physical assessment accurately (OR: 4.5; 95% CI [1.9-10.5]; p=0.003) and motivation to learn more and perform physical assessment (OR: 0.4; 95% CI [0.2-1.0]; p= 0.042).

Conclusion: Nurse interns' competence in physical assessment skills is low, as shown by around one-third of study participants achieving a 90% and above score. Key factors that influence physical assessment competence are the year of completion, a longer period of internship, previous clinical experience before internship, self-confidence in performing physical assessment accurately, and motivation of nurse interns to learn more and perform physical assessment. The study recommends that nurse training institutions emphasize theoretical and practical sessions of physical assessment skills to enhance the competence and confidence of student nurses in physical assessment before the internship.