Physical Examination Methods: Training Your Students

Physical examinations are one of healthcare’s most powerful tools. They’re fast, informative, and inexpensive. But not all physical examinations are created equal.

According to the American Journal of Medicine, 76% of cases resulting in missed or delayed diagnoses were due to inadequate physical examinations. Physical examination methods decrease the probability of misdiagnosis and improve patient safety. So in order to bridge the theory-practice gap in nursing, it’s imperative to educate nursing students on physical examination methods: inspection, palpation, percussion, and auscultation.

76% of cases resulting in missed or delayed diagnoses were due to inadequate physical examinations Click To Tweet

Want to better prepare your nursing students to perform physical exams? Download our head-to-toe assessment checklist.

Physical Examination Methods

Physical examination methods follow a sequence, beginning with a general inspection that increases in detail. The following overview from the third edition of Health Assessment and Physical Examination thoroughly describes the four physical examination methods and what each entails.

Inspection

Performed first, inspection is the most repeated of the four physical examination methods. Teaching students about inspection emphasizes using sight and smell to check specific areas for normal color, shape, and consistency.

Sight

Make sure that your students arrange clothing accordingly and use adequate lighting to fully observe the body parts they are inspecting.

Smell

Because certain infections give off a stench, smell is vital to inspection. You may simulate smell by using a scent-laden cheese (as done in this study) to give students real-life experience with smell inspection.

Get out the cheese to help nursing students identify wounds (as done in this study by Wound Management and Prevention). Click To Tweet

Palpation

Palpation is the act of touching a patient to feel for abnormalities anywhere in the body. There are two different types: light and deep palpation.

Light Palpation

As the name suggests, light palpation is soft and gentle. Nurses may find information on skin texture and moisture, masses, fluid, muscle guarding, and superficial tenderness by using light palpation.

Deep Palpation

Deep palpation explores the body’s internal structures to a depth of 4-5 centimeters. This technique can inform nurses about the position of organs and masses, as well as their size, shape, mobility, consistency, and areas of discomfort.

Have students role play using different scenarios to train them to palpate effectively. Encourage short fingernails and warm hands to boost patient comfort during palpation.

Percussion

Percussion includes tapping one’s hands on a patient’s body to produce sound vibrations. The sounds made can confirm the presence of air, fluid, and solids, along with organ size, shape, and position. Percussion can be practiced almost anywhere to analyze the intensity, duration, pitch, frequency, quality, and location of sound.

Here are a few at-home percussion practice ideas for your nursing students to try:

Percuss two glasses—one filled with water, the other empty. Compare the sounds.

Percuss the wall of a room and listen for the change in tones when a studboard is reached.

Percuss your thigh. Puff your cheeks and percuss them. Compare the sounds.

Auscultation

The final method is auscultation, which is listening to the heart, lungs, neck, or abdomen to gather information. There are two types of auscultation: direct and indirect.

Direct Auscultation

Listening with the unaided ear. This may include listening to the patient from a distance or right on the patient’s skin.

Indirect Auscultation

Using amplification or a mechanical device, such as a stethoscope. An acoustic stethoscope does not amplify the body sounds but blocks out environmental sounds.

Practice is an important part of becoming skilled at anything, including auscultation. Click To Tweet

John Finley stated, “Hearing is a sense, but listening is a skill that can be improved.” Studies show remarkable improvement in the accuracy of heart murmur assessments through repetition. Help your students master auscultation through repeated practice. Students may pair off and practice on each other, switching back and forth.  

Additional Resources

Training nursing students to perform health assessments through physical examination methods will better prepare them for the workforce. But teaching effective physical assessment is no small task.

That’s why we’ve created a rubric that outlines the thirty most common skills performed in a physical examination. This checklist will help nursing students focus on the basics, equipping them to learn more specialized skills as they advance.

Grab your free copy of the Head-to-Toe Assessment Checklist and prepare your students to use their knowledge of physical examination methods to conduct health assessments.

Interested in more tips for nursing educators? Check out 6 Ways to Teach Nursing Skills Faster.

Sources

Verghese, et al. “Inadequacies of Physical Examination as a Cause of Medical Errors and Adverse Events: A Collection of Vignettes.” The American Journal of Medicine.

Asif, et al. “Importance of Thorough Physical Examination: A Lost Art.” Cureus.

“Tired of the Theory-Practice Gap in Nursing?” GoReact.

Estes. “Physical Assessment.” Health Assessment & Physical Examination: 3rd Edition

Roberson, Neil, Bryant. “Improving Wound Care Simulation with the Addition of Odor.” Wound Management and Prevention.

Finley, et al. Teaching Heart Auscultation to Health Professionals.