Motor Skill Learning Theory for Abdominal Palpation in Nursing

This report discusses how motor skill learning theory can help nurses adopt and implement the theoretical and practical concept of abdominal palpitation during pregnancy. It includes a literature review of the chosen clinical skill, steps for part practice, whole practice, blocked practice, random practice, mental practice, and augmented feedback, and concludes with the importance of abdominal palpation in successful normal delivery of the child and health of mother and baby.

0Running head: GRADUATE DIPLOMA IN NURSING
Graduate Diploma in Nursing
Name of the Student
Name of University
Author’s note

1
GRADUATE DIPLOMA IN NURSING
Table of Contents
Introduction......................................................................................................................................2
Literature review of chosen clinical skill.........................................................................................3
Clinical Project................................................................................................................................6
Conclusion.......................................................................................................................................9
References......................................................................................................................................10
Appendix........................................................................................................................................12
Appendix A................................................................................................................................12
Appendix B................................................................................................................................13
Appendix C................................................................................................................................14
Appendix D................................................................................................................................15

2
GRADUATE DIPLOMA IN NURSING
Introduction
Every woman hopes for a normal pregnancy so that she can cradle and nurse her baby. In
order to have normal pregnancy and healthy childbirth, women require comprehensive antenatal
care in order to ensure a normal physiological process (Devi, Khandelwal & Das, 2016).
Antenatal care mainly deals with education counselling, screening and treatment of the expecting
mother in order to promote well-being of both the mother and foetus. However, as per the reports
published by The Australian Institute of Health and Welfare (2017), the maternal mortality rate
in Australia during the year 2012 to 2014 is 6.8 out of 100,000 women. Though that is the lowest
maternal mortality rate in the world but the common cause highlighted for the death includes
abdominal bleeding and non-obstetric and non-obstetric bleeding. This shows that the antenatal
care activity is extremely poor in Australia. The main reasons that hamper the comprehensive
use of the antenatal care is haemorrhage, eclampsis, infection, spontaneous abortion and
obstructed labour. Other issues which create hindrance in successful antenatal care are lack of
preparedness and knowledge about the importance of the reproductive health in the community,
family and healthcare provider (Finlayson & Downe, 2013). Pacagnellaet al. (2014)further
highlighted that reason behind the poor antenatal care. The main reasons highlighted by
Pacagnella et al. (2014) include lack of knowledge of the healthcare provides about the concept
of labour and obstetric complications. Moreover, a high percentage of healthcare providers
indulge in harmful practice of fundal pressure during the process of vaginal delivery. Only a
negligible amount of health care providers indulge in the active management of the third stage of
labour in all kind of deliveries (Chandra-Mouli et al., 2013).

3
GRADUATE DIPLOMA IN NURSING
One of the important yet successful ways of delivering antenatal care is the
implementation of the abdominal palpation. Abdominal palpation is a kind of examination that is
performed during each antenatal appointment starting from 24th week of pregnancy till 36th week
of pregnancy in order to estimate the foetal size and foetal presentation (Nishikawa &
Sakakibara, 2013). Nishikawa and Sakakibara (2013) is of the opinion that abdominal palpation
which is performed upon hospital admission is a form of four manoeuvre technique (Leopold’s
maneuvers)that helps in the identifications of limbs, size and position of foetus in-utero. It is also
used as a medium to access the length, frequency and strength of uterine contraction and to
gauge the uterine involution postnatally (Nishikawa & Sakakibara, 2013).
Nurses are an important part of abdominal palpation during pregnancy and proper nursing
education and skill development is crucial in delivering high-quality nursing care. However, gap
in the theory and practise continues to be a prevailing problem of nurses and midwifery
education (Birks et al., 2013). Birks et al. (2013) identified that the nurses and midwives though
nurture positive attitudes towards abdominal palpation, lacks adequate knowledge towards
executing the procedure successfully. So the following report aim towards analysing how the
implementation of the motor skill learning theory can help the nurses to successfully adopt and
implement the theoretical and practical concept of abdominal palpitation during pregnancy.
Literature review of chosen clinical skill
According to Nishikawa and Sakakibara (2013), the main aim of the abdominal palpation
is observation of the signs of pregnancy, estimation of gestation, proper assessment of the fetal
growth, fetal position, presentation and engagement and detection of any deviation from the
normal. Abdominal palpation in conducted in highly aseptic condition under utmost privacy and

4
GRADUATE DIPLOMA IN NURSING
comfort. The main process of the abdominal palpation is initiated via fundal palpation in order to
assess if the fetal growth is consistent with the gestational age. In order to do this the distance
between the symphysis pubis and fundus (SFH) is measured in cm via the use of disposable tape.
The tape is required to be place longitudinally along the abdomen starting from symphysis pubis.
The change in the symphysis-fundal height should be measured and recorded starting from 24th
week of gestation and this data should be used to plot customised growth chart and if any
deviation from the normal is being observed then proper actions must be taken (Nishikawa &
Sakakibara, 2013). Fundal palpation is also used to determine uterine contractions which is
helpful to the gauge the time to start pain relief. Lateral palpation is used to determine the fetal
position (oblique, longitudinal or transverse). It is done via the use of both the hand on the either
side of the uterus via stroking the hand movements down the length of the uterus. Pelvic
palpation is used to determine the fetal presentation and the degree of flexion. Here the fingers
are directed downwards and inwards and is more preferred than the Pawlik’s manoeuvre
(Macaluso & McNamara, 2012). Abdominal palpation is also used to access the fetal heart rate
and maternal pulse (Macaluso & McNamara, 2012). Apart from clinical significance, abdominal
palpation also had psychological significance. For example, Nishikawa and Sakakibara (2013)
highlighted that the abdominal palpation of Leopold’s Maneuvers is used to enhance maternal
awareness about the feral position, attachment with mother and fetus and frequency of mother
talking with the fetus. The survey conducted by Birks et al. (2013) over the Australian nurses
highlighted that there are at least 43 skills which are learnt by the nurses during their internship
session but are never performed during the professional life. 37 skills are skills are used
occasionally, 28 skills are used frequently and only 13 skills are used regularly. In this skills
training and practice and survey, the abdominal palpation of the pregnancy women falls under

5
GRADUATE DIPLOMA IN NURSING
the category of skills which are practiced only occasionally. The main reason highlighted by
Birks et al. (2013) behind the occasional employment of the skill includes blurring roles between
the doctors and the nurses. For example, in a busy ward, a nurse might lack adequate time to
perform palpation, auscultation and percussion thinking that the medical team will also be
conducting the same checkups as the part of their role. This lack of performance decreases the
level of expertise and thereby increasing the chances of error or lack of precision in conducting
the abdominal palpation in pregnant women. Moreover, Birks et al. (2013) lack of prolong
practice generates lack of confidence, which prevents them to perform the task even if the
situation demands. Thus in order to increase the precision and confidence, proper practice and
execution of the procedure is important.

6
GRADUATE DIPLOMA IN NURSING
Figure: Skills practiced by the nurses
(Source: Birks et al., 2013)

7
GRADUATE DIPLOMA IN NURSING
Clinical Project
In order to train the nurses in abdominal palpation in pregnant women, motor skill
learning theory can be applied. According to the motor learning principles help in proper
learning of the procedural skills among the nurses. The learning of the procedural or clinical
skills under the banners of the motor learning texts has different parts including part practice or
whole practice, blocked practice or random practice, mental practice and augmented feedback
(concurrent feedbacks or terminal feedback) (Sattelmayer et al., 2016).
Part practice or whole practice means sub-dividing the procedure into numerous
fundamental movement segments. After obtaining precision in the isolated parts, the learner is
required to proceed to practice the parts in altogether. In whole practice, the entire practice is
either taught in a serial order or as a whole entity (Sattelmayer et al., 2016). So in case of
abdominal palpation, the nurses must be trained in parts starting from setting up the aseptic
condition along with a private atmosphere and then learning to perform the hand and finger
strokes over the abdomen and finally via training with the plotting of the graphs. Learning in
parts will help the nurses to attain precision over the entire technique in a gradually (Zwicker &
Harris, 2009).
Steps Actions
1 Setting up a private atmosphere
2 Maintenance of aseptic condition
3 Hands movements
4 Finger movements
5 Recording the change on the basis of measurement (diagram provided in appendix A)
6 Plotting the graph (customised growth chart)

8
GRADUATE DIPLOMA IN NURSING
Table: Step by step action in part practice
Source: Created by author
In random practice, numerous components of the procedural skills are taught in under a
single session but in a random order. On contrary, in blocked practice demands skills to be
practiced under closed blocks followed by progression to the next preceding skills after the
previous task has been accomplished under predefined amount of practice. Random practice
deals with gradual increase in the level of difficulty (Sattelmayer et al., 2016). Sattelmayer et al.
(2016) is of the opinion that this can have negative effects on the overall performance as the
pressure increases. Thus in order to decrease the pressure and increase the performance,
intensive motor planning operations must be undertaken which will help in better retrieval of
memory on subsequent transfer tests (Kantak & Winstein, 2012). Thus the planning of the
random practice should be done in a pictorial representation of the data or the practice procedure
as this will help in memory retention and thereby aiding the nurses to perform random tasks
having a clear view of the overall anatomical features (Please refer to appendix B) (Zwicker &
Harris, 2009). Kantak and Winstein (2012) are of the opinion that the random practice or block
practice is best suited after the execution of the whole practice.
Mental practice is defined as a method of the learning without physically performing it.
Metal practice is associated with the concept of the mental rehearsal which involves exercises
like thinking about the procedure. So the nurses must be aided with proper inforgraphic
representation of the entire procedure of abdominal palpation during their recess hours. This will

9
GRADUATE DIPLOMA IN NURSING
help them to relate with their learned practice in a relaxed mood (Schmidt & Lee, 2013) (please
refer to appendix C).
Augmented feedback is defined as the procedure about providing information about the
overall performance. This feedback will help in the evaluation of the proposed implementation.
This augmented feedback will be based on a set of questions (please refer to appendix D) which
will help to review the current status of the nurses in the domain of exposure to the skills. On the
basis of the score of the coding scale, proper training session (random practice or whole practice
can be designed). Moreover, augmented feedback will also be used to measure the outcome of
the motor skills learning theory and thereby helping to determine the factors which are
influencing the performance and thereby setting the practice procedure accordingly (Sattelmayer
et al., 2016).Further evaluation of the proposed implementation will be determined by driving a
comparative analysis of learning vs. the performance and this will be done under the control
supervision of healthcare physicians of the maternity ward (Sattelmayer et al., 2016).
Conclusion
Thus from the above discussion it can be concluded that the abdominal palpation is a
driving aspect behind the successful normal delivery of the child and health of mother and the
baby. However, the nurses due to high work-pressure and lack of proper training fail to
undertaken a comprehensive abdominal palpation. So in order to increase the level of practice
and precision of performing abdominal palpation among the nursing professionals motor skill
learning theory can be applied. Under the motor skill learning theory, the nurses will be provided
training on the basis of whole practice, blocked practice or random practice, mental practice.

10
GRADUATE DIPLOMA IN NURSING
Finally augmented feedbacks will be used in order to evaluate the success of the proposed
implementation.

11
GRADUATE DIPLOMA IN NURSING
References
Australian Institute of Health and Welfare (2017). Maternal deaths in Australia 2012–2014.
Access date: 7th June 2018. Retrieved from: https://www.aihw.gov.au/reports/mothers-
babies/maternal-deaths-in-australia-2012-2014/contents/table-of-contents
Birks, M., Cant, R., James, A., Chung, C., & Davis, J. (2013). The use of physical assessment
skills by registered nurses in Australia: Issues for nursing education. Collegian, 20(1),
27-33.
Chandra-Mouli, V., Camacho, A. V., & Michaud, P. A. (2013). WHO guidelines on preventing
early pregnancy and poor reproductive outcomes among adolescents in developing
countries. Journal of Adolescent Health, 52(5), 517-522.
Devi, B., Khandelwal, B., & Das, M. (2016). Factors Associated with Nursing Students’ Level of
Knowledge Regarding Abdominal Palpation at Gangtok, Sikkim. International Journal
of Health Sciences and Research (IJHSR), 6(10), 162-173.
Finlayson, K., & Downe, S. (2013). Why do women not use antenatal services in low-and
middle-income countries? A meta-synthesis of qualitative studies. PLoS medicine, 10(1),
e1001373.
Kantak, S. S., & Winstein, C. J. (2012). Learning–performance distinction and memory
processes for motor skills: A focused review and perspective. Behavioural brain
research, 228(1), 219-231.

12
GRADUATE DIPLOMA IN NURSING
Macaluso, C. R., & McNamara, R. M. (2012). Evaluation and management of acute abdominal
pain in the emergency department. International journal of general medicine, 5, 789.
Nishikawa, M., & Sakakibara, H. (2013). Effect of nursing intervention program using
abdominal palpation of Leopold’s maneuvers on maternal-fetal attachment. Reproductive
health, 10(1), 12.
Pacagnella, R. C., Cecatti, J. G., Parpinelli, M. A., Sousa, M. H., Haddad, S. M., Costa, M. L., ...
& Pattinson, R. C. (2014). Delays in receiving obstetric care and poor maternal
outcomes: results from a national multicentre cross-sectional study. BMC pregnancy and
childbirth, 14(1), 159.
Sattelmayer, M., Elsig, S., Hilfiker, R., & Baer, G. (2016). A systematic review and meta-
analysis of selected motor learning principles in physiotherapy and medical
education. BMC medical education, 16(1), 15.
Schmidt, R., & Lee, T. (2013). Motor Learning and performance, 5E with web study guide: from
principles to application. Human Kinetics.
Zwicker, J. G., & Harris, S. R. (2009). A reflection on motor learning theory in pediatric
occupational therapy practice. Canadian Journal of Occupational Therapy, 76(1), 29-37.

13
GRADUATE DIPLOMA IN NURSING
Appendix
Appendix A
Figure: Fundal height measurement

14
GRADUATE DIPLOMA IN NURSING
Appendix B
Figure: Abdominal palpation week-wise measurement

15
GRADUATE DIPLOMA IN NURSING
Appendix C
Figure: Infographics for abdominal palpation

16
GRADUATE DIPLOMA IN NURSING
Appendix D
Interview question to access the success of the training