Significance Physical Examination PDF

Running head: SIGNIFICANCE OF PHYSICAL EXAMINATION
Significance Physical Examination
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Introduction
Advanced Nurse Practitioners (ANP) are registered nursing personnel who work
independently and in corporation with family-centered professionals to provide family-based
care, trauma, and emergency care. Advanced nurse practitioners play a significant role in their
contribution to the Australian healthcare system (Forbes & Watt, 2015). Given their autonomous
nature of service and the relatively wide scope of the family patient support, this category of
nursing staff offers multiple health-related amenities that spin around the family as a unit; from
disease prevalence inhibition to emergency care and life support across the lifecycle (Forbes &
Watt, 2015). Due to the complexity of their daily undertakings, these professionals are trained to
carry out diagnostic procedures and offer management to complicated medical situations both
physically and cognitively. One explicit role in execution of their mandate is carrying out
physical examination as part of their principal assessment and radical diagnosis stages. The aim
of this assignment is to discuss the physical examination as a nursing exercise, its pertinence to
the safety and health of the patient, issues influencing the application of this procedure in
contemporary advanced nursing practice as well as the experts view on this diagnostic practice.
Background
Also known as wellness check, physical examination refers to primary routine tests a
primary care provider (PCP) performs on a patient in order to gain a clear understanding of the
patient’s overall health condition (Blair & Jansen, 2015). The PCP may be a doctor, a physician
assistant, or a nurse. One doesn’t have to be sick to seek this kind of service. During this
examination, one may ask questions regarding his or her health and discuss any problems or

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changes that he or she may have noticed with the PCP. Depending on one’s age, family
background or medical history, the examining medic may recommend further testing.
The Significance of Physical Examination
A physical examination helps the healthcare giver determine the general health status of
the patient before developing an intervention plan. It also provides an opportunity for the patient
to talk about any symptoms or pains him or she may be experiencing. Physical examination is
important in that it helps the doctor check for possibility of emerging ailments whose symptoms
may not have become noticeable, identify any other issues that may be of concern to the patient
in future, update or recommend necessary immunizations and help the patient maintain a healthy
lifestyles such as routine exercises and appropriate diet (Harmon et al, 2015).
Physical Examination as a Clinical Practice
Is physical examination a clinical role? Absolutely yes. Physical examination is purely a
clinical role as all the activities, knowledge and background principles all conform to the basic
characteristics of clinical practice. These characteristics include; the concept of practice in
philosophy, practice in psychology, practice in education and practice in knowledge which are
all aspects of human life (LeBlond, 2015). According to the Australian nursing and midwifery
board, one can only apply for a registered nurse certificate upon completion of a government-
approved program of study in the same field. Such programs are approved by the Australia
health practitioners regulatory agency; a body charged with the mandate of governing all the
fifteen national boards responsible for developing practice standards and regulating the medical
practitioners. These boards include the Dental Board of Australia (DBA), Occupational Therapy
Board of Australia (OTBA), Nursing and Midwifery Board of Australia (NMBA), Medical

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Board of Australia (MBA) among others. Thus once a course has been approved by the Nursing
and midwifery board and endorsed by the AHPRA, it is considered suitable for adoption in the
syllabus. One of the compulsory units in the nursing syllabus is the physical examination
practice.
Qualifications
The Nursing and Midwifery Board of Australia, for instance, outlines the various
competencies that qualify an individual to be registered as a nurse or an advanced nursing
practitioner. Examples of these requirements include but not limited to undertaking a detailed
and complex mental and or physical health examination of patients with multifarious healthcare
needs in critical situations, Accurate and concise interpretation of different assessments so as to
come up with a plan and execute it and the ability of an individual to competently and
confidently make an evidence-based and ethical intervention under critical and complex
situations. One must also be able to prescribe medication for a patient and help them manage
their medicines. It is worth noting that item number one on the list of competencies for a
registered nurse is the physical examination aspect. This shows just how the physical
examination is vital exercise in nursing practice.
Issues Influencing the Application of Physical Examination
Marxist philosophy considers a practice to be all social objective and to play a role in
transforming, exploring a reforming the world (Forbes & Watt, 2015). By conducting a physical
examination, the practitioner has a broad objective of transforming the patient's current state of
health into a better condition. Studies of practice ability in clinical psychology have focused on
practical intelligence. Neisser was among the scholars who first came up with the idea of

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practical intelligence. He suggested that practical intelligence corresponds to academic
intelligence. Physical examination is taught in an academic setting and gradually shifted to real
life environment both in theory and practice. It, therefore, goes without saying that knowledge
utilization is the key connotation of clinical-based practice of which physical examination is part
of (Reiman et al., 2015). Although knowledge may be relative, the aspect of practical knowledge
is strongly emphasized in all clinical practices. Health caregivers employ practical knowledge to
solve real-life problems. Since physical examination encompasses the ability to transform
knowledge into practice, use of practical knowledge to assess the patient's condition and
combines both physical and psychological aspects of both the practitioner and the patient, then it
can distinctively be regarded as a clinical procedure (Malanga & Mautner, 2016).
Clinical appraisal by Family care experts depends upon suitable gathering and
translation of pertinent emotional and biophysical information from the patient. The physical
evaluation gives essential target data by utilization of four primary systems in particular; review,
percussion, palpation, and auscultation. During the inspection, the nurse reviews each of the
patient’s body systems by use of smell, vision or hearing. The PCP tries to identify any
deviations or abnormal conditions with regard to the patient’s sounds, colour, texture, odours
symmetry, and movement. Palpation is the utilization of the medic’s hand to touch the patient
(Malanga & Mautner, 2016). The touch is done with the exertion of different degrees of pressure.
Thus there are two major types of palpation namely the light palpation that assesses skin
elasticity, tenderness, masses, texture, moisture pulsations, and temperature and deep palpation is
done to feel the shape, symmetry, and tenderness of internal body organs. During palpation,
tender areas should be done last.

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During a percussion, the attending nurse taps her fingers sharply and quickly against
parts of the attendee’s body to help locate or identify organs, organ borders, shape, and position
or if it is solid fluid. There is direct and indirect percussion. Lastly, auscultation requires the
primary care provider to listen for heart, lung and bowel sounds using a stethoscope. While
auscultating, the examiner uses the diaphragm to detect high-pitched sounds from body organs
such as the heart’s first and second sounds. He then firmly holds the diaphragm against the
patient’s skin, exerts enough pressure which later leaves a shallow depression on the skin
afterward (Hegedus et al.,2018). A bell is used to single out low-pitched sounds. To pick them
up, the examining clinical nurse places the bell on the surface of the patient’s skin and presses it
firmly enough to form a seal. The PCP then tries to identify the characteristics of each sound
produced, one at a time. This review helps a caregiver to achieve an in-depth understanding of
the attendee’s medical history, the current state of health and thus an essential exercise that forms
the rationale for selecting certain diagnostic processes, testing and the treatment that follows.
This process ensures that patients do not have to undergo unnecessary costly diagnostic testing
procedures (Hermansen et al., 2017).
It is still worrying that , in spite of the evident need to conduct this exercise, studies
physical examination is still being disregarded by both seasoned and armature professionals in
the advanced nursing fraternity. Findings indicate that with the high patient to nurse ratio, most
of the nurses find the workload so overwhelming that they do not have enough time to physically
examine the patient. They argue that doing so will amount to a lot of time being consumed at the
expense of other patients’ treatment (Ball et al, 2014). Due to negligence, some practitioners
deliberately chose to skip physical examination and head straight to other medical tests. This is
unprofessional conduct is common in a number of private health facilities where the

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management works in cohort with nurses to raise more revenue by referring patients to expensive
diagnostic tests and treatment (Rubio-Ochoa et al., 2016 p.35-37). Another factor influencing the
use of physical evaluation in primary diagnostics is the incipient laziness among the new breed
of nursing professionals who tend to over-rely on machines to do everything for them.
Technology is widely used in medical diagnostics and easily avails all the details an examiner
wishes to know about a patient. As a result, most nurses and other practitioners tend over-rely on
technology without first playing their role (Dunphy et al., 2015). Training also plays a significant
role in how the PCP executes her roles. If the kind of training a medic received did not
emphasise on a given aspect or procedure, then it is unlikely that the practitioner will give it the
importance it deserves. Porter (2017) however comes to the defense of medics arguing that some
patients are highly uncooperative and unwilling to have the medic touch their body parts leave
alone questioning them. He goes ahead to cite some cases where patients lodging faulty
accusations to medics of sexually harassing them while in their normal procedure of service.
Since the patient’s rights have to be obeyed, these medics chose to recommend advanced
diagnostic procedures for solutions that would have been achieved through physical examination.
Unknown to many, this is emerging trend of skipping physical examination is a costly
error through which many patients’ lives are lost (Hippensteel et al., 2018). Many resident
doctors and advanced nurses have deliberately ignored the vitality of physical examination and
they no longer conduct it at all. In unavoidable circumstances that compel them to do it, they
delegate this key task to beginners. Ball et al ( 2014) accuses them of not even following up to
know what their juniors identified. Consequently, critical clues about the patients’ health
continue to elude the medics, putting the patients’ lives at risk (Ball et al, 2014). It is a worrying
trend as the same unprofessional practice is gradually being passed on to the incoming breed of

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practitioners. The negligence of this procedure is apparent not just in the field but right from the
lecture room. Educators somehow lay little emphasis on the aptness of this procedure on ground
that it consumes a lot of time. In fact Andrew Scanlon et al (2014), is perturbed at how the
healthcare fraternity is easily moving away from the very practices that form the foundation of
its existence.
Expert’s View on Physical Examination
The contention that physical diagnosis could be dying off among the medical
practitioners is indeed very true and a valid assertion argues LeBlond (2015). To substantiate
this, the author of the reviewed article cited a number of scientific studies involving human basic
examinations. Surprisingly, in many cases, in cases where the physicians were expected to
analyze a given health condition without the application of technology, the results were below
the expectations. A research conducted at the Duke University Medical Center in the year 1992
revealed a worsening situation in medical facilities. It was astonishing to find out that more than
half of the resident nurses could not identify an aortic regurgitation or a mitral regurgitation. In
another similar study involving both the students and residents, participants were asked to listen
and identify various recorded heart sounds from patients. Only twenty percent of the sounds
were correctly identified. Is this not a disaster in a waiting? Relying solely on technology is
disastrous since just like human, technology too has its flaws. A combination of humans and
machines in carrying out physical examination would be a perfect scenario (Lange et al., 2015 p.
402-404).
Marx et al (2016) warns that the society could be trading on a catastrophic path if the
resulst of the recent studies are anything to believe. Medics will continue to helplessly watch
their patients die when they had an earlier chance of saving their lives. Physical diagnosis is an

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age long practice that was and should be done daily in practice. Although it is not perfect it could
work better with technology (Bryant‐Lukosius et al., 2016 p.203).
Dr Sandeep Jauhar, is a holder of PhD in Experimental physics from Berkley university
and a practicing cardiologist. Since 2015, Janhuar has been writing for the New York Times in
the opinions column. In one of his opinions, ‘The Demise of Physical Examination’, Dr Sandeep
looks at the repercussions of medical malpractice or ignorance among nurses. The cardiologist
accordingly thinks about whether physical finding still has any centrality to therapeutic experts
and on the off chance that it does, he is annoyed at the degree to which this apparently vital life
sparing methodology has been underestimated among specialists and attendants. Janhuar is
concerned that this propensity is influencing numerous traditional specialists to build up an
inclination that the fundamental routine methods that ought to be at the fingertips of extremely
social insurance supplier will before long be overlooked (Williams et al., 2016 p. 118).
The restorative society that could be getting things done as normal while then again
loosing lives in light of essential intimations that escaped their exceptionally physical perception
(Rabelo‐Silva et al., 2017 p.380). This paper subsequently asserts that as a professional, one's
main obligation is to spare and secure life to the best of his capacity. All cases exhibited to a
doctor are extraordinary and as one of a kind as every patient. It is along these lines imperative to
take adequate time with every patient lead a physical examination while focusing on each detail
as that disregarded sign could be the thin line between the life and passing of the patient
(Strender et al., 2017).
Conclusion
In conclusion, the pertinence of physical as one of the roles of advanced nursing
consultants cannot be underscored. It is a key procedure in determining the way forward for a

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patient with regard to subsequent diagnostics and treatment procedures. As evidenced, the steps
and processes involved are simple and affordable to a patient as the only resource they require is
time and perhaps a few equipment. Unfortunately this patient assessment is being overlooked on
grounds of high patient to nurse ratio, care giver negligence, improper training, uncooperative
patients, the tendency of primary care providers to over-rely on technology and greed perpetrated
by some private medical practitioners. The author recommends the combination of both physical
examination and use of machines in carrying out medical diagnosis for patients. While some
reasons for skipping physical examination may sound convincing, they do no warrant avoiding
this important procedure in patient assessment. This paper calls upon the practicing individuals
to serve keeping in mind that a patient is not just an unwell body but rather a life to conserve.

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