In a simulation situation during my clinical skills assessment focusing on the Gastrointestinal system, I was assigned to do a physical examination of my patient. My group consisted of four members and all of us were assigned to carry out a task for the assessment. The task assigned was as follows 1 member was acting as a patient, one as an assessor, an observer, and a timer. All members of the group were allowed to carry out the physical assessment. After viewing all candidates my peer suggested me to review my palpation techniques. According to my peer group, I should have warmed my hand before palpating my patient. In addition to it, I should have palpated the less painful areas first to more painful areas in order to have a better overview of the affected organs.During the procedure, I was very nervous as the members of the group were watching on me how I’m doing. I was unsure about my own act despite I know the way and techniques of how to carry out the procedure. In our country that is in Mauritius we nurses do not normally get the opportunity to carry out a physical assessment. For instance, at my workplace, only the physician is allowed to carry the physical examination on the patient. Inside my mind, many things were going on I was stressed out and a bit unsure.After the procedure, I was relieved that I manage to carry it out and my peers have given me some positive as well as some negative feedback. The good part is that I was able to differentiate when to use finger pads during light palpation and when to use the palm of the hand during deep palpation. However, the negative parts were that I should have warmed my hand prior to palpating my patient. In addition, I should have palpated the less painful areas first to more painful areas. At first, I felt disagree and unsatisfied with my peer’s comments as according to me palpating the affected area is first recommended. This is so as it will give us a quick insight into the underlying problem. Upon thinking about the incident that happened somehow I felt unsure and doubtful about the steps I have taken. After reflecting on the incident I found that my peer members had a point; painful areas should have been palpated at last and warm hands should have been used prior to starting which I did not pay attention at all. I was still confused and was thinking about the rationale behind it.Upon evaluating the incident I realized that my patient was uncomfortable during the procedure as my hands were too cold. Moreover, my patient was very nervous, irritated and uncooperative as I palpated the most painful areas at first which I should have done at last. Studies have shown that using warm hands to palpate prevent the abdominal muscles to contract and by doing this the patient’s confidence is obtained, and the patient realizes that he/ she is not going to be hurt, the patient tends to relax the abdominal muscles (Hamilton Bailey, 1954). Warm hands further promote relaxation (Patricia Ann Potter, 2005). While doing palpation warm hands should be used instead of cold as cold hands are uncomfortable for the patient causing abdominal tensing (Josephine M. Sana, 1982).Furthermore, studies have shown in all patients with abdominal pain, palpation should begin away from the painful area and gradually move toward palpation over the most painful spot (Robert H. Seller, 2011). It is indicated to palpate tender areas last because they could cause the patient to become tense and impede the assessment (Anne Griffin Perry, 2019). If a patient’s pain is severe, do not palpate, tenderness or pain to palpation may suggest abdominal injury (Frances Donovan Monahan, 2010). If pain is emanating from one particular region, that area should be palpated last to detect involuntary guarding and muscular rigidity which rarely reveals any additional findings such as a mass on physical examination (Mark Feldman, 2010). If you start by touching the painful area, the abdomen may become tense making it difficult to palpate (Bhangu, 2006).Base on the incident that happened I concluded that in order to prevent such circumstances from arising I need to warm my hands by simply rubbing it as advised by my peer members. Or as cited by (Pilliterri, 1995) to wash hands in warm water, if necessary, to avoid abdominal muscle contraction and tightness caused by cold hand. Moreover to attain a good abdominal assessment avoid touching tender or painful areas until last and reassure patients of your intention, in order to detect tenderness and superficial masses (Janet Weber, 2003). As added by my peer’s group palpating painful areas last will lead to my patient cooperation during the assessment.Upon pondering about the situation another measure I thought about is to check the patient facial expressions when I palpate him/her. This can help me to know how the patient is feeling. Over and above that I can warm by hands in a mid while by asking the patient to point the area most painful. Hence I try to palpate that area at last. These actions will help me to establish a good relationship with the patient and gain her/his trust by making her/him feel comfortable during the assessment.
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