By Lara Cooper RN, MSN-Ed
CPTC Nursing Instructor

Physical assessment skills are amongst the first skills taught in any nursing program. Keen observation skills are essential for learning physical assessment, yet these skills are difficult to teach even in the clinical setting and are often overlooked during curriculum development process. Nursing faculty assumes students will know how to look; students just need to learn what to look for. That assumption is faulty, and many educators are beginning to pay closer attention to the development of observation skills in both medical and nursing fields. Many educators are looking for creative ways, such as observing paintings and photographs to teach observation skills. Some nursing programs, as well as medical school programs, are taking students to the art museum to improve observational skills (Frei, Alvarez, & Alexander, 2008).

Most of the students in nursing programs work very hard and are able to obtain good grades in the classroom. The students can transfer the knowledge gained in the classroom to the laboratory and are able to perform a careful Head-to-Toe assessment on a fellow student. Yet, most students are struggling in the clinical setting. In the clinical setting, students are able to complete an assessment on a patient and fill out the appropriate form, but often miss fine details only observable in real patients. Many students have no difficulties locating and counting apical pulse or obtaining a blood pressure, but often fail to observe the quality of the skin of a patient on prednisone, or the facial expression of a patient in pain. At first, the inability to locate certain assessments observations could be perceived as a lack of interest in the patient. However, the root of the problem might be quite different; students are not observing the patients closely enough to notice such fine details. Students need to be taught not only what to observe, but also how to observe and pay attention to small details in the patients’ facial expressions, skin variations, or breathing patterns. Simply telling them in class to pay attention to skin variations does not translate into the competency of how to actually “look” at the patients (Shapiro, Rucker & Beck, 2006).

Clover Park Licensed Practical Nursing students attend a field trip to Tacoma Art Museum where they spend time with museum educators trained to teach observation skills and empathy.  Initially, students struggle to understand the connection between nursing and visual arts.

Once in the museum, however, looking and discussing the art with the docent, their attitudes and interest levels change. The powerful and complex world of visual arts draws them in. Museum educators train students to focus on the colors, brush strokes, and other details in the paintings that they did not observe at first glance. They learn to look beyond the visible and are encouraged to ponder the meaning of the painting, the message in the canvas.

Soon, students understand that nursing and visual arts have a lot in common.  One needs to look at all the fine details, approach each patient like they do a painting, as a work of art.  They must understand what is hidden, what is not said, and look closely for the fine details that eluded their eyes at first. They learn that when we react to a painting without trying to understand, it limits their experience of the arts. The same is true of our patients. When we rush, judge, overlook; we miss the opportunity to connect with our patients, and more importantly, we miss important clinical cues. After just one short experience, students emerge with more appreciation for an accurate physical exam – paying attention to details as well as seeing the “the whole person”.

NOTE: Funding for student participants has been provided through the CPTC Emerging Needs Fund.