All About Advanced Assessment

“The course equips nurses to develop complex clinical reasoning skills and to formulate a management plan within the multidisciplinary team.”

Registered Nurse Jess explains what the Advanced Assessment module is, who can apply, what it involves, how you are assessed if you complete it, and the opportunities that can come from it.

What Is ‘Advanced Assessment’?

The Advanced Physical Assessment module is a course for healthcare professionals who want to gain additional knowledge and skills to enhance their clinical practice.

Usually run through a university, the course helps clinicians to systematically assess the body, and to understand the pathophysiology of long-term diseases such as heart failure or COPD. It covers conditions which are grouped under respiratory, cardiovascular, neurology, musculoskeletal and gastrointestinal.

The course equips nurses and allied healthcare professionals to develop complex clinical reasoning skills and to formulate an appropriate management plan within the multidisciplinary team.

Who Can Apply?

If you are a nurse or allied healthcare professional, usually with at least 2 years of clinical experience, you might be eligible. When applying for the course, you’ll have to demonstrate that you have the support of your workplace. This means you’ll need someone to support you and act as your clinical assessor. They need to be an experienced clinician with advanced assessment skills and knowledge.

The course also requires you to attend university teaching sessions on a weekly or fortnightly basis, so this is something to discuss with your employer before applying.

Investigate

Perhaps you want to expand your knowledge and current skill set and avoid stagnating in your current role. If so, this course may be for you! Advanced assessment skills allow you more autonomy and flexibility in how you work, and they can markedly develop your clinical judgment.

Advanced assessment and diagnostic reasoning are similar to the game of a detective. Except that instead of trying to solve a crime, you’re trying to discover the cause of your patient’s symptoms to form a ‘differential diagnosis’. This is where you provide a series of alternate explanations for the cause of their presenting complaint.

To find the culprit, you first need to identify what’s going on for your patient. What symptoms are they experiencing?

To do this, you take a history of their presenting complaint. You’ll need to ask questions such as “when did their symptom/s start?”, “how severe is the symptom right now?” and any associated symptoms. You need to be able to recognise red flags which indicate your patient’s symptoms may be serious.

You’ll need to ask them about their past medical history, any recent surgery and whether they have recently travelled. If your patient takes medication, then you’ll review any recent changes, and whether this may be contributing to their symptoms, as well as taking note of any allergies.

Taking a social history is also really important, such as whether your patient smokes, drinks, their occupational history and any recent stressors or life events that may be impacting their health. Since we’re integrated beings, it’s important to understand if they’re experiencing any emotional and psychological trauma.

You can also ask them about their family history of illness, to see if there are any genetic factors that might be involved.

Assess

Then you start your investigation by undertaking a physical assessment. This includes skills such as auscultation, inspection, percussion, and palpation. During the course you’ll learn about anatomy and physiology, and how to recognise the common abnormalities that occur within the systems of the body.

The main systems are respiratory, cardiovascular, abdominal, neurological, and musculoskeletal. You’ll learn some of the following skills:

Respiratory: chest auscultation, percussion, checking hands for signs of clubbing (changes in the shape of the fingernails); inspecting face and hands for cyanosis (bluish discoloration of the skin), anaemia, or shortness of breath; checking for equal expansion of the chest and the placement of the trachea; palpating lymph nodes; assessing vocal resonance.

Cardiovascular: heart auscultation to identify any abnormal heart sounds and murmurs; palpating brachial and radial pulses (arteries in the arms and wrists); recognising lower limb oedema; assessing for raised jugular venous pressure (a vein located in the right side of the neck); recognising signs of poor circulation.

Abdominal: palpation of the lower abdomen, liver, spleen, and kidneys; auscultation for bowel sounds and aortic bruits (whooshing sound of blood through a narrowed artery); percussion of the abdomen to identify fluid build-up such as ascites; special tests such as rebound tenderness (experiencing pain upon release of applied pressure).

Neurological: a series of tests for the 12 cranial nerves and upper and lower neurological tests such as: assessing limb power and tone; testing for reflexes; testing for sensation; inspecting the body for visual signs of neurological abnormalities.

Musculoskeletal: examination of range of movement; assessing muscle strength and tone; palpation of bones, joints, muscle and soft tissue; general observation of the patient’s legs, gait, posture, balance, and sitting and standing.

Diagnose

Next, you’ll need to make some further enquiries to help inform your diagnosis. These are common tests such as vital signs, blood tests, urinalysis, ECGs, X-rays, and ultrasounds. You’ll use the results of these tests, combined with your knowledge of anatomy and physiology, and your history-taking, to form your differential diagnosis.

For example, a differential diagnosis for community-acquired pneumonia may include ‘an infective exacerbation of COPD’, or ‘congestive heart failure’, or ‘bronchiectasis’. You need to provide evidence of how you reached your conclusions and demonstrate how you communicated with other healthcare professionals to assimilate your findings into a reasonable explanation.

The course is a helpful tool to develop your critical reasoning skills and it teaches you to avoid making assumptions too readily.

Treat

Finally, you’ll create a treatment plan tailored to the needs of your patient. This might include referring them to other services for further investigations or asking their GP to prescribe a course of antibiotics. It should always include some form of safety-netting, to ensure that your patient is followed up appropriately and to prevent unnecessary deterioration.

The management plan might be short-term, in the case of an easily treatable infection unrelated to any serious underlying complaint. Or it may be a long-term healthcare plan, which involves advanced care planning and regular communication with different healthcare professionals.

The course equips nurses to develop complex clinical reasoning skills and to formulate a management plan within the multidisciplinary team.

How Is It Taught And Assessed?

The course involves a mixture of theory, virtual learning, and skills practice. The seminars are taught by an experienced clinician, who is often still in clinical practice. The face-to-face sessions give you the opportunity to practice the skills you are learning, with the peer support of your class.

Assessment is an OSCE, where you will be given a clinical scenario and asked to demonstrate assessment skills during a simulation. You’ll build a portfolio of various assessments, overseen by your mentor, which you will be expected to complete within your current clinical role.

You may also be asked to write a critically reflective essay about a patient you have seen in practice.

How Much Does It Cost?

Fees range from approximately £1667 to £2920. Depending on your workplace arrangements, you may be able to receive an external scholarship, or be funded by your employer.

Sometimes, you’ll be asked to complete the course for a specific role, such as in hospital avoidance teams or an advanced nurse practitioner post, where nurses are expected to operate with a higher level of knowledge, skill, and autonomy.

What Opportunities Does It Give You?

The Advanced Physical Assessment course can be undertaken as a Level 6 or Level 7 module, depending on the course provider. Level 7 is a 30-credit module, which can be used towards a Master’s degree such as Advanced Clinical Practitioner, or a postgraduate qualification. 

How To Find Out More

Expanding your knowledge and assessment skills significantly improves your clinical practice, because it gives you a strong foundation. Think of it like a building: if you understand the groundwork and structure, then you can establish where the problem originates far more clearly than if you were encountering it at first glance.

You gain a better perspective, and a framework, which will help you critically assess each situation.

You can find out more by researching university courses in Advanced Physical Assessment.