PurposeTo synthesize factors influencing the activation of the rapid response system (RRS) and reasons for suboptimal RRS activation by ward nurses and junior physicians.Data sourcesNine electronic databases were searched for articles published between January 1995 and January 2016 in addition to a hand-search of reference lists and relevant journals.Study selectionPublished primary studies conducted in adult general ward settings and involved the experiences and views of ward nurses and/or junior physicians in RRS activation were included.Data extractionData on design, methods and key findings were extracted and collated.Results of data synthesisThirty studies were included for the review. The process to RRS activation was influenced by the perceptions and clinical experiences of ward nurses and physicians, and facilitated by tools and technologies, including the sensitivity and specificity of the activation criteria, and monitoring technology. However, the task of enacting the RRS activations was challenged by seeking further justification, deliberating over reactions from the rapid response team and the impact of workload and staffing. Finally, adherence to the traditional model of escalation of care, support from colleagues and hospital leaders, and staff training were organizational factors that influence RRS activation.ConclusionThis review suggests that the factors influencing RRS activation originated from a combination of socio-cultural, organizational and technical aspects. Institutions that strive for improvements in the existing RRS or are considering to adopt the RRS should consider the complex interactions between people and the elements of technologies, tasks, environment and organization in healthcare settings.

Aim: To explore the different levels of nurses' perspectives in the delivery of patient education in postoperative care. Background: Patient education is a frequently reported missed nursing care and can lead to postoperative complications and hospital readmissions. Methods: Descriptive exploratory qualitative study involving eight focus groups with 35 nurses was conducted in an acute hospital. Interviews were audio-recorded and transcribed verbatim. Data were thematically analysed. Results: The analysis yielded three themes: 'Role ambiguity' between the levels of nurses concerning their roles in patient education; 'Not a priority nursing care' for patient education due to competing work demands and the missing workplace culture to teach; and 'Informal teaching' carried out conversationally during nursing care activities. Conclusion: This study augments the need to develop strategies, including informal teaching, to strengthen the delivery of patient education to avert missed nursing care. Implications for Nursing Management: Nurse managers and educators are instrumental in establishing role clarity between ward nurses and specialty care nurses for patient education, recognizing patient education as the next nurse-sensitive indicator in reflecting quality of care, fostering positive workplace cultures to teach and providing ward nurses with trainings on communication strategies to provide effective informal teaching at bedside.

No abstract

No abstract