ISSN 2475-529X

Research Article Journal of Nursing & Healthcare

Do Nurses Really need Physics? (Analysis of the Results of a Written Test)
Zuzana Balázsiová*
Corresponding author
*

Zuzana Balázsiová, university lecturer, Institute of Medical Physics,

Faculty of Medicine, Comenius University, Bratislava, Slovak Biophysics, Informatics and Telemedicine, Faculty of Medicine, Comenius
Republic. University, Sasinkova 2, 813 72 Bratislava, Slovakia, e-mail: zuzana.
[email protected]

Submitted: 18 Sep 2017; Accepted: 26 Sep 2017; Published: 30 Sep 2017

Abstract
The aim of the work was to assess the physics literacy of 266 practising registered nurses-studying for a master’s
degree in nursing; a written test was used to determine whether they were able to apply the knowledge of physics
that they had acquired in their studies to solve model problems in nursing practice. The results indicated that: 1.
The nurses’ physics and technical literacy was insufficient and, in our view, does not meet the needs of the present
time, in which health care establishments are making increasing use of instruments and equipment. 2. Errors were
identified in the solutions to practical nursing problems that could have had a negative effect on patients’ condition
in real practice.

Student nurses’ knowledge of physics could be improved by changing the way in which biophysics is taught in the
nursing curriculum.

Keywords: Biophysics in nursing. Retention of biophysics knowledge. Characteristics of the test

Nurses’ physics and technology literacy. The test was intended to determine how much knowledge of
biophysics the nurses retained and their ability to apply this knowledge
Introduction in healthcare practice. It included material on biophysics that is taught
The current education system in Slovakia is based on the Bologna in the first year of a bachelor’s degree in nursing. In eleven tasks it
Declaration, which recommended that nurses study in higher covered three thematic areas where physics is relevant for nursing
education to at least bachelor’s level [1]. In EEC documents, practice:
biophysics is defined as one of the basic scientific subjects for the 1. Medication delivery-questions focussed on: 1. reading from a
theoretical and technical higher education of nurses responsible calibrated scale to determine the correct delivery of medication;
for general care [2]. Based on the profile for a graduate of the 2. how the physical properties of medications (tonicity, surface
nursing study programme and cited EEC directive, biophysics is tension of a solution) may affect their dosage and delivery.
an obligatory pre-clinical subject that is a pre-requisite for nearly 2. Detection of vital signs-questions focussed on: 1. the effect of
all clinical subjects [2, 3]. Even so, it is a common belief amongst physical factors and methods of measurement on the accuracy
nursing students that biophysics courses are too difficult and of the result, 2. the ability of nurses to assess the accuracy of
unnecessary. Students are often unaware of the subject’s importance measured values.
and they are not always able and willing to accept the reasons for its 3. Knowledge of the location of a person’s centre of gravity, which
inclusion in the curriculum. This work uses an analysis of a written is of vital importance for the correct and safe manipulation of
test to assess nurses’ physics and technical literacy. patients by nurses.

Method How the test was marked

Respondents’ characteristics The test was marked using a binary score (correct answer-1
The research sample was 266 nurses in part time study for a master’s point, incorrect answer-0 points). The pass mark for the test was
degree in nursing at three Slovak universities. The average age of set at 60% of answers correct. The results were processed using
the respondents was (33.62±8.68) years. The youngest respondent descriptive statistics (average points scored per respondent,
was 23 and the oldest was 57. The majority worked in various standard deviation, median, mode). Differences in level of
hospital departments. The average length of nursing experience knowledge between respondents within the group were evaluated
was (13.47±9.53) years. using the coefficient of variation (CV). A qualitative analysis was
also conducted of the numbers of individual responses and the
The students took the test at the end of the first or the start of respondents’ most common errors.
second year of the master’s stage of their studies.
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Results The percentage of all respondents who were able to read the
Respondents gave correct answers to an average of (6.7±1.6) of correct value and then convert it to the required physical units
questions where a correct answer could depend on knowledge (from ml to dm3) was just 20.68%. Just over two fifths (41.35%)
of physics; in percentage terms, it was (61.00±14.45)% There of the nurses read the calibrated scale correctly but made a mistake
were 2 respondents who scored 100% correct, and 1 respondent in converting millilitres to cubic decimetres. Another 31.5% of
who scored 0%. The median number of points was 7. The largest nurses read the volume of liquid incorrectly from the calibrated
number of respondents scored 6 points, which means 6 correct measuring cylinder. The task was omitted by 6.02% of nurses.
answers out of 11.
2. Detection of vital signs
The value of the coefficient of variation showed that there were Question 1. When measuring blood pressure, a general principle
no statistically significant differences within the population of is:
respondents (CV = 0.237). a) The larger the circumference of a patient’s shoulder, the wider
a cuff should be
Qualitative analysis of the test b) The larger the circumference of a patient’s shoulder, the
1. Medication delivery narrower a cuff should be
Question 1. Two bottles of equal size contain 95 ml of solvent and c) The result of measurement is not affected by the width of the
5 ml of the medicament-active substance. Bottle I has water as cuff
a solvent and bottle II has alcohol. Both bottles have a standard The question was answered correctly by 72.18% of nurses. The answer
dropping closure. What rules apply to dosage? that as the circumference of the shoulder increased, the width of the
a) The same number drops are needed from bottle I and bottle II cuff should be reduced was chosen by 0.38% of respondents (1 nurse)
for a dose of the medicament and 27.07% of respondents claimed that the result of measurement
b) A different number of drops may be needed from bottle I and did not depend on the width of the sphygmomanometric cuff. No
bottle II for a dose of the medicament response was given by 0.38% of nurses.
c) The dosage depends on the type of dropping closure
It was found that 44.74% of nurses claimed that if two types of Question 2. Statement I: A nurse takes a pulse by lightly pressing
medication contained the same quantity of the medicament and three fingers on the inside of the patient’s left wrist
differed only in the type of solvent, the dose required the same Statement II: A nurse takes a pulse by lightly pressing the thumb
number of drops. The correct answer - that the dosage may be on the inside of the patient’s left wrist
different, was given by just 39.10% of nurses. 11.65% of the a) The results of measurement as described in I and II must be
nurses said that dosage depended only on the type of dropping the same
closure and 4.51% did not answer. b) The results of measurement as described in I and II may be
different
Question 2. Medication can be delivered intravenously without c) The results of measuring the pulse do not depend on how the
endangering the patient’s health in a pulse is taken.
a) hypertonic solution The correct answer was chosen by 70.68% of nurses - measuring the
b) hypotonic solution pulse using the thumb or fingers can give different results. The answer
c) isotonic solution that the measurements must be the same was chosen by 9.77% of
The correct answer was given by 89.95% of nurses - to avoid the nurses and 17.67% thought that the result did not depend on the
risk to a patient a medication is delivered intravenously in an method of measurement. No answer was given by 1.88% of nurses.
isotonic solution. A hypertonic solution was chosen by 4.51% of
respondents and a hypotonic solution by 3.01%. No response was Question 3. A nurse counts 11 pulses on a patient’s cervical artery
given by 2.63% of nurses. in 10 seconds. What is the patient’s pulse rate, assuming that they
have a regular pulse?
Question 3. Which claim is true? The correct pulse rate was given in the correct form, with the
a) The lower an infusion bottle is hung, the slower an infusion right number and the right physical unit, by 42.48% of the nurses.
solution flows The right number but the wrong physical unit or no physical unit
b) The higher an infusion bottle is hung, the slower an infusion was given by 44.74% of respondents. The wrong number and the
solution flows wrong physical unit were given by 4.51% of the nurses and 5.64%
c) The flow speed of an infusion solution depends only on its of nurses did not complete the task.
physical characteristics
The correct answer - that the flow speed of an infusion solution Question 4. Use the patient’s temperature chart (shown in an
is directly proportionate to the height of the infusion bottle above illustration in the test) to determine the difference between their
the ground - was given by 77.44% of nurses. The claim that the highest and lowest daily body temperatures on the second day of
speed of an infusion flow decreases as the infusion bottle is raised hospitalisation.
higher was chosen by 4.14% of nurses while 17.29% said that flow
speed depended only on the physical characteristics of the infusion The correct answer was given by 31.20% of the nurses. The wrong
solution. No answer was given by 1.13% of nurses. number but the right physical unit were given by 30.83%. Both
the wrong number and the wrong unit were given by 13.53% of
Question 4. What volume is the volume of the liquid (in dm3) in the nurses. No answer was given in 16.92% of cases.
measuring cylinder? (the test included a picture of a measuring
cylinder) Question 5. At first sight a stethoscope appears to be in good

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condition (bell, diaphragm, transfer system) but you do not hear dosages. It is likely that the cause of this finding was the fact that
anything on auscultation. Give a reason. nursing studies emphasise nursing procedures and the correct
No answer was given by 24.81% of nurses. Regardless of the performance of actions. Applications of principles from physics
proposed phenomenon, 60.15% of nurses gave 1 reason, 12.41% such as the properties of liquid medications are not mentioned in
gave 2 reasons and just 2.63% of nurses gave 3 reasons. In their higher years, and if so then only on the margins.
explanations of the phenomenon, 34.21% of nurses mentioned
a “blocked” stethoscope, 13.5% of nurses mentioned an error in The measurement of blood pressure and the acquisition of information
the method of examination and 30.08% of nurses mentioned the from a patient’s temperature chart are basic nursing activities in all
patient’s health condition. hospital departments. Even so, it was found that nurses have deficits
in their knowledge of the correct way to measure blood pressure
3. Patient positioning and their ability to make active use of a patient’s body temperature
Question 1. Where is a person’s centre of gravity? records. The literature also includes example of clinical nurses
a) outside their body having a low level of knowledge of the use of a pulse oximeter, the
b) in the vicinity of the chest reliability of the use of alarms and identification of factors that could
c) in the vicinity of the pelvis and the abdomen affect the results of examination [8].
The correct location of the centre of gravity in a patient’s body was
given by 87.97% of nurses. A location in the vicinity of the chest Stethoscopes are used routinely in nearly all healthcare
was chosen by 9.02% of nurses and a location outside the body by establishments. Even so, the task focussing on their function
1.13%. No answer was given by 1.88% of nurses. and physical principles was completed in the required quality
(specification of the physical basis) by less than half the
Question 2. After an operation on their appendix, it is easier for a respondents. Nearly a quarter of respondents gave no answer
patient to get out of bed if they start on their to this question. This shows that nurses have a deficit in their
a) stomach knowledge of physics and the instruments that are commonly
b) back used in nursing practice. There is work from the last century that
c) side warned that nurses often first encountered the instruments needed
A total of 87.97% of the nurses knew that it is easier for a patient for their work when went into working departments at the end of
who has had an operation in their abdominal cavity to get up from their studies and that they had to learn to use them by themselves
a position on their side. Starting from a position on the belly was using “trial and error” methods [9]. Pfeil, Zuzelo and Paclová have
chosen by 1.13% of nurses and 9.02% suggested starting from on also described gaps in nurses’ technical literacy [10-12]. When
their back. The task was not completed by 1.88% of nurses. new nurses begin working with instruments and medical devices,
they are not adequately familiar with their instructions and they
Discussion often have problems with technical skills [13].
On completion of the analysis of the results achieved by practising
nurses also participating in a part-time master’s degree programme The low number of possible solutions that the respondents in the
in nursing who were tested on nursing problems whose solution present research - on average each nurse gave only 1.2 reasons-
could involve the application of knowledge of (bio) physics, it was may indicate deficiencies in nurses’ ability to make a flexible
found that the average score was 61%, which was just above the set and comprehensive response to problems in practice. There was
pass mark. There were no significant differences between nurses only one case in which a respondent proposed solutions related
in the level of knowledge (CV = 0.237). This may be related to the the measurement technique, an error in the stethoscope and the
fact that all the tasks focussed on activities that nurses perform in patient’s health condition. Although the problem of nurse’s low
most healthcare establishments. In our view, the nurses achieved ability to solve nursing problems on graduation has been described
their results mainly by applying knowledge from nursing. The previously [9,14], our findings show that it remains an issue of
weak results in the test may be the result of a negative relationship high importance in the present.
to (bio) physics and inadequate education on physics at secondary
school [4-6]. Our teaching experience suggests that if the students The problems that the present work has identified could be mitigated
applied elementary knowledge of physics in solving problems they by changing the method used to teach biophysics in the nursing
could get better results not just in theoretical questions but also in curriculum. It should not involve just the passive transmission of
their nursing practice. information. It should be based on solving nursing problems that
could serve as a basis for explaining (bio) physical principles. The
A lack of skill in physics was identified in the questions related physics concepts needed in nursing practice should be explained
to reading from a calibrated scale and using the correct physical using elementary ideas and a minimum of mathematics [4,15].
units. With reference to the current mobility options for nurses, a Healthcare practice should incorporate training on technology and
good habit of recording the results of an examination in the correct technical skills into nurses’ continuing education [13].
form with the correct physical unit is particularly important when
working as a nurse in countries that use different physical units Conclusion
from SI units (in Great Britain, for example) [4]. The concept of nursing now includes the use of instruments,
which nurses need to be able to control without errors in order to
Current medicines policy in Slovakia prefers the use of cheaper, prevent harm to patients’ health. This requires a certain level of
generic medications [7]. We were therefore disturbed by the knowledge in physics and technical skills. The present research
finding that only a third of respondents knew that medications with has found that nurses do not have adequate knowledge of physics,
the same active substance in different solvents could have different the theory of measurement and the instruments that they use in

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Copyright: ©2017 Zuzana Balázsiová. This is an open-access article

distributed under the terms of the Creative Commons Attribution License,
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