Chapter 31 – Psychomotor Skills for Nurses

It is not enough for nurses to have knowledge, but be able to perform certain psychomotor skills to help with patient care. The following are just some of the common psychomotor skills that nurses must be able to perform competently and confidently in home health:

VITAL SIGNS/LAB:

• Taking Vital Signs which include:
• Blood pressure measurement with a sphygmomanometer
• Taking heart rate per minute
• Taking respiratory rate
• Temperature checks and being able to convert Celcius to Farhenheit
• Pain assessment using PQRST or OLDCART
• Glucometer use to measure blood glucose levels via finger stick (more recently knowledge of how to use Freestyle Libre for continuous blood sugar monitoring)
• Insulin administration and teaching
• Diabetic foot care
• Venipuncture for labs
• IV insertion and management

RESPIRATORY:

• Oxygen use
• Nebulizer use
• Tracheostomy care
• Mechanical ventilator care
• Apnea monitoring (CPAP/BIPAP)
• Pharyngeal suction
• Inhaler use
• Incentive spirometry

CARDIO:

• Nitroglycerine use
• CPR/BLS

NUERO –

• LOC assessment
• Cranial Nerves assessment
• Pupillary dilation assessment (PERRLA)
• Aphasia care
• Seizure precaution,
• Mini mental status exam (MMSE)

GI:

• NG tube insertion and care
• Ostomy care and irrigation
• Gastrostomy Tube (GT) care and feedings
• Jackson Pratt (JP) drain care and feedings
• Impaction removal
• Eenema administration
• Ileostomy care
• Nasopharyngeal and oropharyngeal suctioning

SKIN:

• Sterile dressing change (ie PICC dressings, MIDLINE dressings, Central lines, etc)
• Wet to dry dressing
• Decubitus/pressure ulcer care
• Wound vac
• Hemovac

GU:

• Foley insertion and care
• Suprapubic cystostomy care
• Urostomy care, condom catheter care
• In-and-out catheter
• Catheter irrigation

MUSCLE:

• TED hose
• TKA care
• Total hip replacement care
• Cast assessment and care
• Hoyer lift use

MED ADMIN:

• Various routes of administration:
• Oral
• Rectal
• Intramuscular (IM)
• Subcutaneous (SQ, SubQ)
• Peripheral Intravenous (IV)
• Hickman broviac (central lines)
• Port-a-caths
• PICC lines
• TPN
• Enteral feedings
• Chemotherapy
• IV pumps
• Ear, eye, nose drops
• Suppositories

Tip: For a good video reference, go to MedBridge.com (requires a yearly subscription) for a great database of video of psychomotor skills and explanations for home health nurses. MedBridge.com is a highly recommended resources for various skills that nurses need to competently care for patients.

Practice Makes Perfect

There are factors that affect nurses’ psychomotor skills and the ways in which they can improve them. This includes knowledge gap, barriers to learning, and lack of basic resources in the clinical environment. After looking at these factors, we can begin to formulate a plan for improving nurses’ psychomotor skills. Repetition is the mother of learning, and the more the nurse repeats these skills in various circumstances, the better and faster they will perform these skills.

Methods of teaching

To teach nurses the essential skills needed for patient care, a variety of methods are used. Demonstrations and simulations are two common ways to teach patients the skills they will need. These approaches are both effective for teaching problem-solving skills and independent thinking. Simulations can also be beneficial for teaching complex information because they help patients relate the information to their own experiences. Lastly, one-on-one discussions are another effective method of teaching psychomotor skills.

One method that has gained popularity for teaching nurse psychomotor skills is video. There are now studies examining the effectiveness of video as a teaching method. Using videos to teach students can help student nurses to develop their clinical skills, according to a recent systematic review. The review searched PubMed, CINAHL, MEDLINE, and EMBASE to identify articles related to the use of video in nursing education. The researchers found that student nurses improved clinical performance when they were exposed to video.

In another case, a patient’s poor health literacy prevented him from reading a handout about myocardial infarction. The nurse identified this patient as having poor functional and health literacy. She could impart better teaching to the patient by using the term “heart attack” instead of “myocardial infarction.” A nurse could also use the word “heart attack” instead of “myocardia infarction,” and extend the time of the teaching session with regular breaks. In addition, she could assign elaborate reading materials to improve the patient’s comprehension.

Barriers to learning

During nursing education, the focus is on developing clinician competency. Developing skills in this area requires knowledge of basic science and performance principles, as well as specific dexterity and strength. Learning these skills requires deliberate practice on real people. However, barriers to nursing students’ learning of psychomotor skills often hinder their progress. In this article, we will examine some common obstacles. Learners of nursing skills must be aware of these obstacles.

In addition, lack of social support may inhibit motivation and limit practice of new skills. Social and cultural differences may also serve as barriers. On the nurse’s end, time constraints and multiple competing demands may hinder the educational process. The role of the professional nurse is not prioritized in the nursing field due to staffing issues and perceptions of educational efforts. A nurse’s lack of self-confidence in the ability to teach patients new skills can also be a barrier.

Many nurses are unaware of the importance of patient education. Often, they do not perceive education to improve patient care and therefore, fail to learn these skills. Further, nurses often do not feel interested in this aspect of nursing education. Further, the noneffective exposure to this environment may contribute to students’ dropout. Some nurses have even left the profession because of this. Insufficiency of time and money may also contribute to nursing students’ poor education.

Knowledge gap

Most nurses agree that they do not receive adequate practice while studying and that this lack of practice is the reason why they feel unsure of their abilities to apply their newly acquired knowledge. Fortunately, research on the knowledge-practice gap suggests that the best way to endow students with these skills is through on-the-job training. By observing the nurse perform a task, the educator can gauge whether further learning is needed.

The gap between theoretical knowledge and actual practice is one of the greatest challenges in nursing education. The knowledge and skills acquired in education programs are incomparable to what the novice nurse needs to perform her job effectively. According to Bendall (1976), novice nurses are unable to recontextualize the formalized knowledge they acquire in school. Moreover, the lack of collaboration between nursing schools and clinical settings is one of the main obstacles to overcoming this gap.

While it may seem obvious, the process of assessment is often the first step in instructional design. Yet this step is the one most likely to be overlooked, despite its importance. Nurses often jump into teaching without taking time to evaluate the determinants of their learning. Ineffective assessment may result in the nurse teaching the same patients with the same health conditions. The information provided may not be individualized or based on adequate educational assessment.

Lack of basic resources in the clinical setting

A lack of basic resources for nurses in the clinical setting can result in many issues, including the potential for needlestick injuries and the need to separate ICU patients from non-ICU patients. This clinical setting also include home health agencies, as most home health agencies lack the basic resources in training and educating their current or new nurse hires.

Many registered nurses are concerned with the deteriorating state of health care in our country, but these issues often go unnoticed. Many changes in the health care system have been made without proper evaluation and oversight from regulatory agencies. This lack of basic resources for nurses in the clinical setting affects everyone, including patients and staff.

Lack of basic resources for nurses in the clinical environment can also result in a disruption of care environments, as well as emotional tensions. It is important to understand the differences between developed and developing countries in order to be able to apply research findings in other settings. Regardless of the context, the findings of this study are consistent with other studies that address nursing shortages. In particular, it’s important to note that there are several factors that contribute to the lack of basic resources for nurses.

Besides inadequate staffing, other factors impact nurses’ perceptions of the quality of nursing care. Insufficient staffing levels and imbalanced workloads are major factors in burnout, dissatisfaction, and turnover. Appropriate physical resources are another factor that affects nurse satisfaction. This includes adequate physical structures and equipment. These are important components of an optimal practice environment. And while it may seem trivial, these factors can make a huge difference in patient care.

Emotions during the learning process

Emotional wellbeing and competence development of nursing students are explored through the lens of peer and teacher support. It shows that both types of support have direct and indirect impacts on students’ emotional states. The findings suggest that teacher and peer support is highly influential on nursing students’ perceptions of learning and competence. Although nurse education research is limited, this study will contribute to nursing education by providing empirical support for nurse students’ emotional well-being.

Self-conscious emotions can produce negative feelings and lead to self-consciousness. Many nurses report feeling guilty in situations where they could have assisted, and when they are not in a position to do so. They also feel vulnerable when unable to take action. For example, home health nurses highlight the lack of teamwork, which impairs individual effort and the relationship among team members. In these instances, nurses may feel guilty and resign because their contribution was not valued.

The study also showed that learners’ emotional wellbeing significantly improved after the course. While negative emotions were less common, positive emotions tended to increase. A significant decrease in negative emotions was seen in the students who reported ill humor, anxiety, and stress. Despite these results, nurses should continue to seek support for their mental health from their peers to improve their learning experience. And it would be better to support them and make them feel comfortable.

Need for more time to practice

Psychomotor skills are important in the delivery of healthcare, but the learning environment can affect the acquisition of these skills. In nursing education, students rarely get enough time to practice skills in the skills laboratory or clinical environment. Psychomotor skills are learned by repetition, and therefore, time must be allocated to drilling practical skills and demonstrating their complexity. Students who spend more time practicing psychomotor skills in the laboratory are more likely to transfer these skills to the clinical setting.

In addition to being a difficult task to complete, students also felt that they were not spending enough time on clinical placements to fully master their skills. Despite this, some faculty members suggested that more time is needed for students to practice these skills. One example is that nurses should allow students more time to develop their skills in order to improve their clinical performance. This will help them become better nurses. Using videos during clinical placements can be helpful in this regard.

This change has global implications for HPE. In addition, COVID-19 has implications for tertiary education, continuing in-service education, and ongoing professional development. While the recent pandemic has prevented the delivery of a great deal of F2F training, it doesn’t excuse the need for more time to practice psychomotor skills.