Does anyone still teach percussion in assessment?

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Hi, I've taught beginning ADN students physical assessment for several terms now. We had not been teaching percussion. I learned percussion many years ago in my direct-entry BSN program, but rarely rarely used it. I don't think I ever used it as a staff nurse, except to assess for bladder fullness (and we have bladder scanners now).

So I have three related questions-

Do staff RN's use assessment (is it used in current practice settings)?

If you are in a position to teach or evaluate nursing students' assessment skills, do you expect them to be able to percuss?

Do we need to teach ADN students percussion as an assessment technique?

Thank you :)

Specializes in Clinical Adjunct.

Hi There,

    I'm a clinical adjunct, baccalaureate prepared. I am also an MSN practitioner student. I nor my colleagues teach our ADN (technically prepared) RN students percussion. I think a BSN (professionally prepared) RN student may be more proficient, while understanding the proper way to perform it, as many doctors/APRNs don't perform it correctly. If not done on a quasi-routine basis, the 'ear' for this type of assessment is lost. I think that's some of the reason why it's underutilized, along with the diagnostics we have (a lot more expensive than percussion, I might add).

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Percussion is a nostalgic curiosity that was used when there was little else available for diagnosis/assessment of anatomic cavitary pathology. Now with ultrasound and CT and MRI it's obsolete. If it changes treatment or diagnostic course it would be a novel, one off event, ie, no one would/should get or not get a CT (or any test) based on what percussion adds to their physical exam. Worth noting? Maybe. Major factor in medical decision making? IMO, no. Unless you're 75 years old and have been taking care of patients for 50 of them. 

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Percussion is a basic low-tech skill which every nurse should know, just like running IV fluids by counting drops per minute, or taking manual vital signs.

Your student is ill equipped if they are unable to assess a patient in a disaster or emergency situation.

All you have to do is teach the basic skill and let them master on their own time.

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We go over it in my ADN program, but do not teach for proficiency.  I also teach as an adjunct in a BSN program. Same deal.  I tell the students it is good to understand the concept.  I have never seen it used on any nursing units I have worked on.  My doctor will percuss, but he is an older doc (I told him NEVER retire!). 

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On 4/27/2022 at 3:59 PM, feelix said:

Percussion is a basic low-tech skill which every nurse should know, just like running IV fluids by counting drops per minute, or taking manual vital signs.

Your student is ill equipped if they are unable to assess a patient in a disaster or emergency situation.

All you have to do is teach the basic skill and let them master on their own time.

Calculating drops per minute was a math exercise to graduate. No one ever gave precise volumes or unit/time doses accurately using gravity flow. At the very best, the rate would change as the volume of fluid in the bag changed. At the end of the day a total IVF requirement would be made up in a bolus if it was deficient or discontinued if too far ahead. I eye ball drugs like a gram of vancomycin in 250 ml to go over about 45 mins or even phenylepherine on a microdrip and titrate to blood pressure (in the OR). The idea is just to know what the totals over a particular time period should be. 

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Specializes in Emergency Medicine.

I have been a nurse for 10 years, and I didn’t learn percussion until NP school. It’s considered an advanced assessment skill. 

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Specializes in ER.

I rarely see MDs percuss and never see nurses percuss. Everything is imaging now. That's fine except what if for some reason that is not available? You are in a remote area, power is down etc. Doctors and nurses used to use labs and imaging to confirm what they already know from clinical assessment, now they use them to diagnose.

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Specializes in ER.
On 2/22/2022 at 6:39 PM, offlabel said:

Percussion is a nostalgic curiosity that was used when there was little else available for diagnosis/assessment of anatomic cavitary pathology. Now with ultrasound and CT and MRI it's obsolete. If it changes treatment or diagnostic course it would be a novel, one off event, ie, no one would/should get or not get a CT (or any test) based on what percussion adds to their physical exam. Worth noting? Maybe. Major factor in medical decision making? IMO, no. Unless you're 75 years old and have been taking care of patients for 50 of them. 

I disagree that it is nostalgic. Relying on imaging for diagnostics does not make a good clinician. Imaging and labs should be used to confirm what you already know. They shouldn't be used blindly as diagnostics. Percussing is a useful skill for deciphering solid masses from fluid, estimating size of liver etc. What if the power goes down? In a remote area? Pt refuses CT. 

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Specializes in oncology.
On 5/5/2022 at 8:14 PM, offlabel said:

At the end of the day a total IVF requirement would be made up in a bolus if it was deficient or discontinued if too far ahead.

My nursing experience started in (70s) the days when pumps where only used for TPN. Otherwise we did calculate drips.  It was what it was.  No I never heard anyone bolusing to catch up or discontinuing if too far ahead/ 

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On 5/5/2022 at 6:14 PM, offlabel said:

Calculating drops per minute was a math exercise to graduate. No one ever gave precise volumes or unit/time doses accurately using gravity flow. At the very best, the rate would change as the volume of fluid in the bag changed. At the end of the day a total IVF requirement would be made up in a bolus if it was deficient or discontinued if too far ahead. I eye ball drugs like a gram of vancomycin in 250 ml to go over about 45 mins or even phenylepherine on a microdrip and titrate to blood pressure (in the OR). The idea is just to know what the totals over a particular time period should be. 

Critical thinking would beg the question, why is counting drops a requirement to pass? I am not going to give away the answer.

We are so disabled by technology we cannot even think any more.

I learned IV skills as an EMT. EMTs  usually don't take pumps with them into the ditch or while extricating someone from a collapsed building. I know of a terror attack situation where medical interns had to hang IV bags with Kurlex to save lives due to mass casualty numbers. It makes me shudder to think how we would survive something like that without knowing there is something like a drip set and drops per minute.

Insurance does not pay for redundant testing. What can be dealt at basic level need need not be subjected to radiation and interdisciplinary involvement.

Is anyone teaching tube placement by auscultation  any more or are we now x-raying every NG tube too?

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On 2/22/2022 at 11:46 AM, EducatorIAm said:

Hi There,

    I'm a clinical adjunct, baccalaureate prepared. I am also an MSN practitioner student. I nor my colleagues teach our ADN (technically prepared) RN students percussion. I think a BSN (professionally prepared) RN student may be more proficient, while understanding the proper way to perform it, as many doctors/APRNs don't perform it correctly. If not done on a quasi-routine basis, the 'ear' for this type of assessment is lost. I think that's some of the reason why it's underutilized, along with the diagnostics we have (a lot more expensive than percussion, I might add).

My understanding was all RNs are professionally prepared. The practical / vocational nurses are technicians.

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On 12/21/2016 at 11:08 AM, SHGR said:

Hi Caffeine, thanks for posting.

I have two follow-up questions for you- Are you an ADN or BSN? In what specialty do you use percussion?

I have my BScN (and an MScN), LOL. I teach and I work in a high acute area, and yes... I still use percussion (it's a basic skill all nurses should have). Do you have current clinical practice? Or, are you strictly just working as an "educator"?

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