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PUBH 202 Health Promotion Question: The written assignment is based on students undertaking a critical analysis of the role of the Advanced Nurse Practitioner (ANP) or Clinical Nurse Specialist (CNS). Students are required to discuss the application of the role they have chosen to their workplace. This assignment will provide students with the opportunity to explore and gain further theoretical understanding of the chosen role. Students are required to discuss the registration standards in Australia and the practice domains. Answer: 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 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 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 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.  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 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 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 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 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. References Andrew Scanlon, D. N. P., Denise Hibbert, R. G. N., Freda DeKeyser Ganz PhD, R. N., Linda East PhD, R. N., & Debbie Fraser MN, R. N. (2014). Addressing issues impacting advanced nursing practice worldwide. Online Journal of Issues in Nursing, 19(2), 1. Ball, J. W., Drains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2014). Seidel’s guide to physical examination. Elsevier Health Sciences. Blair, K. A., & Jansen, M. P. (Eds.). (2015). advanced practice nursing: Core concepts for professional role development. Springer Publishing Company. Bryant?Lukosius, D., Spichiger, E., Martin, J., Stoll, H., Kellerhals, S. D., Fliedner, M., & Schwendimann, R. (2016). Framework for evaluating the impact of advanced practice nursing roles. Journal of Nursing Scholarship, 48(2), 201-209. Dunphy, L. M., Winland-Brown, J., Porter, B., & Thomas, D. (2015). Primary care: Art and science of advanced practice nursing. FA Davis. Forbes, H., & Watt, E. (2015). Jarvis’s Physical Examination and Health Assessment. Elsevier Health Sciences. Harmon, K. G., Zigman, M., & Drezner, J. A. (2015). The effectiveness of screening history, physical exam, and ECG to detect potentially lethal cardiac disorders in athletes: a systematic review/meta-analysis. Journal of electrocardiology, 48(3), 329-338. Hegedus, E. J., Goode, A. P., Cook, C. E., Michener, L., Myer, C. A., Myer, D. M., & Wright, A. A. (2018). Which physical examination tests provide clinicians with the most value when examining the shoulder? Update of a systematic review with meta-analysis of individual tests. Br J Sports Med, 46(14), 964-978. Hermansen, C., Poulsen, H. S., Jensen, J., Langfeldt, B., Steenskov, V., Frederiksen, P., & Jensen, O. M. (2017). Diagnostic reliability of combined physical examination, mammography, and fine?needle puncture (“triple?test”) in breast tumors: A prospective study. Cancer, 60(8), 1866-1871. Hippensteel, K. J., Brophy, R., Smith, M. V., & Wright, R. W. (2018). A Comprehensive Review of Physical Examination Tests of the Cervical Spine, Scapula, and Rotator Cuff. The Journal of the American Academy of Orthopaedic Surgeons. Lange, T., Freiberg, A., Dröge, P., Lützner, J., Schmitt, J., & Kopkow, C. (2015). The reliability of physical examination tests for the diagnosis of anterior cruciate ligament rupture–a systematic review. Manual therapy, 20(3), 402-411. LeBlond, R. F. (2015). DeGowin’s diagnostic examination. McGraw-Hill Medical. Malanga, G. A., & Mautner, K. (2016). Musculoskeletal Physical Examination E-Book: An Evidence-Based Approach. Elsevier Health Sciences. Marx, R. G., Bombardier, C., & Wright, J. G. (2016). What do we know about the reliability and validity of physical examination tests used to examine the upper extremity?. The Journal of hand surgery, 24(1), 185-193. Porter, D. (2017). Law and ethics in complementary medicine-a handbook for practitioners in Australia and New Zealand [Book Review]. Australian Journal of Acupuncture and Chinese Medicine, 11(1), 31. Rabelo?Silva, E. R., Dantas Cavalcanti, A. C., Ramos Goulart Caldas, M. C., Lucena, A. D. F., Almeida, M. D. A., Linch, G. F. D. C., … & Müller?Staub, M. (2017). Advanced Nursing Process quality: Comparing the International Classification for Nursing Practice (ICNP) with the NANDA?International (NANDA?I) and Nursing Interventions Classification (NIC). Journal of clinical nursing, 26(3-4), 379-387. Reiman, M. P., Goode, A. P., Cook, C. E., Hölmich, P., & Thorborg, K. (2015). Diagnostic accuracy of clinical tests for the diagnosis of hip femoroacetabular impingement/labral tear: a systematic review with meta-analysis. Br J Sports Med, 49(12), 811-811. Rubio-Ochoa, J., Benítez-Martínez, J., Lluch, E., Santacruz-Zaragozá, S., Gómez-Contreras, P., & Cook, C. E. (2016). Physical examination tests for screening and diagnosis of cervicogenic headache: A systematic review. Manual therapy, 21, 35-40. Strender, L. E., Sjöblom, A., Sundell, K., Ludwig, R., & Taube, A. (2017). Interexaminer reliability in physical examination of patients with low back pain. Spine, 22(7), 814-820. Williams, J. K., Katapodi, M. C., Starkweather, A., Badzek, L., Cashion, A. K., Coleman, B., … & Hickey, K. T. (2016). Advanced nursing practice and research contributions to precision medicine. Nursing outlook, 64(2), 117-123.

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