Factors that influence nurses' assessment of patient acuity and response to acute deterioration

Dalton, M. M.; Harrison, John; Malin, Anitra; Leavey, Conan

doi:10.12968/bjon.2018.27.4.212

Cited by 35 publications

(61 citation statements)

References 40 publications

(24 reference statements)

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“…The nurses also said that they feared that doctors would emphasize measurements at the expense of nurses' observations and clinical judgements. These findings correspond with the findings of a recent study that suggested that when using a tool, nurses relied on the numerical escalation of the system to identify deteriorating patients rather than their own clinical judgement and consequently, the participants found it challenging to escalate care when a score was low (Dalton, Harrison, Malin, & Leavey, 2018).…”

Section: National Early Warning Score and Professional Competencesupporting

confidence: 88%

Introducing the National Early Warning Score – A qualitative study of hospital nurses’ perceptions and reactions

2019

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Aim The aim of this study was to explore hospital nurses’ perceptions and reactions to the National Early Warning Score during an introduction programme. Design A qualitative case study approach with participatory observations was used for this study. Methods In total, nine seminars and 23 simulation sessions attended by nurses were observed. An activity theory system analysis was applied to interpret the material. Results The findings revealed four tensions related to the working context: (a) tension between using a standardized tool and relying on clinical judgement (the tool could be either an aid or a barrier to patient assessment); (b) tension in the community of practice (the tool could be beneficial or increase stress and anxiety); (c) tension related to rules and compliance (the tool could be perceived as optional or compulsory); and (d) tension related to the division of labour (nurses feared more work).

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Section: National Early Warning Score and Professional Competencesupporting

confidence: 88%

Introducing the National Early Warning Score – A qualitative study of hospital nurses’ perceptions and reactions

2019

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“…Nurses acknowledged that their knowing the patient prompted them to act on their intuition. Intuition or a “gut feeling” has been a common theme in recognising the deterioration of a patient (Cioffi et al, ; Dalton et al, ; Donohue & Endacott, ; McDonnell et al ., 2012), and literature has suggested that nurses resist contacting doctors on intuition alone as they believe they must defend their assumptions (Dalton et al, ; Massey et al, ). This study demonstrated that once nurses were concerned about a patient's condition or acute illness severity, they undertook a patient assessment by completing the EWS and escalated care using their own clinical judgement and were not reliant on the EWS protocol.…”

Section: Discussionmentioning

confidence: 99%

“…Compliance and adherence to EWS are influenced by many factors, including nurses’ intuition, doctors’ response times, team collaboration, communication and ward environments (Dalton, Harrison, Malin, & Leavey, ; Odell, ; Petersen, Rasmussen, & Rydahl‐Hansen, ; Smith & Aitken, ). Moreover, weekends and nights have been identified as periods of non‐adherence in recording the EWS due to reduced staffing levels and nurses not wishing to disturb sleeping patients (Gordon & Beckett, ; Hands et al, ).…”

Section: Introductionmentioning

confidence: 99%

How do nurses use the early warning score in their practice? A case study from an acute medical unit

Foley

Dowling

2018

Journal of Clinical Nursing

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Aims and objectives:This study aimed to describe how nurses use the early warning score (EWS) in an acute medical ward and their compliance with the EWS and explore their views and experiences of the EWS. Background: early warning score systems have been implemented in response to upward trends in mortality rates. Nurses play a central role in the use of EWS systems. However, barriers to their use have been identified and include behavioural, cultural and organisational approaches to adherence. Improvement strategies including education and training and electronic devices have assisted in compliance with the system. Design:A holistic single descriptive case study design was used. Methods: Data triangulation was used including non-participant observation, semistructured interviews with nurses and document analysis. Nurses were observed using EWS and were subsequently interviewed. Data analysis was guided by systematic text condensation (STC), an approach underpinned by Giorgi's phenomenological method, where meaning units and themes are identified. The study adhered to the consolidated criteria for reporting qualitative research (COREQ) guidelines. Results: Three themes with associated meaning units were found. Protocol Adherence vs. Clinical Judgement addresses nurses' knowledge, skill and experience and patient assessment. Parameter Adjustment and Escalation included parameters not being adjusted or reviewed, junior doctors not being authorised to set parameters and escalation. The final theme Culture highlighted a task-driven approach and deficient communication processes. Conclusion: This study highlights the need for ongoing training, behavioural change and a cultural shift by healthcare professionals and organisations to ensure adherence with EWS escalation protocols. Relevance to clinical practice: Improvements in education and training into recognition, management and communication of a deteriorating patient are required. Also, a cultural shift is needed to improve compliance and adherence with EWS practice. The potential use of electronic data should be explored. K E Y W O R D S acute care, case study, deteriorating patient, early warning score S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section at the end of the article. How to cite this article: Foley C, Dowling M. How do nurses use the early warning score in their practice? A case study from an acute medical unit.

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“…However, in most instances, HCPs described relying on intuition and feeling a sense of concern to pinpoint signs of decline. Intuition is fundamental in clinical nursing (Dalton, Harrison, Malin, & Leavey, 2018), though clinical decision‐making is complex, and the process of clinical judgement involves more aspects (Tanner, 2006). The results indicated differences when a patient's situation was vague or critical.…”

Section: Discussionmentioning

confidence: 99%

Homecare professionals’ observation of deteriorating, frail older patients: A mixed‐methods study

Strømme

Aase

Tjoflåt

2020

Journal of Clinical Nursing

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Aim and objectives To develop knowledge about homecare professionals’ observational competence in early recognition of deterioration in frail older patients. Background The number of frail older patients in homecare has been rising, and these patients are at higher risk of deterioration and mortality. However, studies are scarce on homecare professionals’ recognition and response to clinical deterioration in homecare. Design This study applies an explorative, qualitative, mixed‐methods design. Methods The data were collected in two homecare districts in 2018 during 62 hr of participant observation, as well as from six focus group interviews. The data were subjected to qualitative content analyses. The Standards for Reporting Qualitative Research (SRQR) checklist was used to report the results. Results The data analyses revealed two main themes and five sub‐themes related to homecare professionals’ observational practices. The first main theme entailed patient‐situated assessment of changes in patients’ clinical condition, that is, the homecare professionals’ recognised changes in patients’ physical and mental conditions. The second theme was the organisational environment, in which planned, practical tasks and collaboration and collegial support were emphasised. Conclusions The homecare professionals in the two districts varied in their ability to recognise signs of patient deterioration. Their routines are described in detailed work plans, which seemed to affect assessment of their patients’ decline. Relevance for clinical practice The results can inform homecare services on how homecare professionals’ observational competence and an appropriate organisational system are essential in ensuring early detection of deterioration in frail older patients.

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Factors that influence nurses' assessment of patient acuity and response to acute deterioration

Cited by 35 publications

References 40 publications

Introducing the National Early Warning Score – A qualitative study of hospital nurses’ perceptions and reactions

Introducing the National Early Warning Score – A qualitative study of hospital nurses’ perceptions and reactions

How do nurses use the early warning score in their practice? A case study from an acute medical unit

Homecare professionals’ observation of deteriorating, frail older patients: A mixed‐methods study

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