Abstract
Multiple perspectives of Community Nurse Practitioner’s use of medical physical assessment skills in primary care; a qualitative study of current practice in the UK. Aim To explore the use of medical physical assessment skills (PAS) by community nurse practitioners in primary care in the UK Background: Physical assessment skills are commonly practiced by community nurse practitioners in primary care. These skills are used to support GPs to deliver a wide range of services in primary care. There is no evidence on how physical assessment skills are used by community nurse practitioners in primary care Methods: A qualitative interpretative embedded case study design. Results: Participants reported that community nurse practitioners used medical PAS in integrated ways, by bringing together their clinical expertise, leadership, education and liaison skills to work across professional boundaries, to deliver a range of services. Specialist nurses caring for patient with one or more chronic long-term condition use these skills within the constructs of a person-centred framework, which is relationship focussed, holistic and collaborative. Nurse practitioners use physical assessment skills to work as generalists and make independent diagnostic decisions. Competence, capability and performance are necessary to make complex decisions. Failure of community nurse practitioners to take responsibility for assessment decisions creates inter-professional tensions and conflict. Conclusions: Medical physical assessment skills are successfully being used by community nurse practitioners to deliver a wide range of services in primary care. These skills improve competence, capability and performance for advanced nursing practice roles. Physical assessment skills education and training at universities needs to be validated by allied health professional bodies for advanced practice roles. Relevance to clinical practice: • Physical assessment education and training prepares nurses with higher levels of theoretical assessment knowledge and skills that are fit for purpose. • GPs believe that education and training of physical assessment skills are vital for nurses to manage the burden of assessment work in primary care. • Common sets of assessment practices between disciplines have better outcomes for patients • Registered nurses require a standard of competence which allows them to perform physical assessment skills to the same level as doctors. • Competence and performance are best achieved when working with patients and experienced clinicians. Key words: medical physical assessment skills, community nurse practitioners, cross boundary working, diagnostic skills.