From ward-based critical care to educational curriculum 2: a focussed ethnographic case study

Cutler, Lee R.

doi:10.1016/s0964339702000319

Cited by 20 publications

(40 citation statements)

References 13 publications

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“…Nurses initiate interventions, such as the administration of oxygen, suctioning, positioning of a patient and preparing intravenous fluids, before appropriate help arrives to prevent the progression of life‐threatening complications (Considine & Botti 2004; Donohue & Endacott 2010). Cutler (2002) reported that the difficulty in getting doctors to review patients often required experienced nurses to act first and report to the doctor later. Also, experienced nurses who are able to make appropriate clinical judgments often act beyond the medical direction and give advice to junior doctors on procedural matters.…”

Section: Resultsmentioning

confidence: 99%

A review of educational strategies to improve nurses' roles in recognizing and responding to deteriorating patients

Liaw

Scherpbier²,

Klainin‐Yobas

et al. 2011

International Nursing Review

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The review has highlighted important aspects of patient safety in clinical deterioration that could be further addressed by educational strategies targeting the role of ward nurses. These strategies include: utilizing clinical decision-making models to develop nurses' decision making skills; developing a standardized tool for systematic nursing assessment and management of clinical deterioration; incorporating training in clinical deterioration as a core competence of pre-registered nursing education; providing vital signs training to nursing assistants; and conducting more rigorous studies to evaluate the effectiveness of the educational programmes.

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Section: Resultsmentioning

confidence: 99%

A review of educational strategies to improve nurses' roles in recognizing and responding to deteriorating patients

Liaw

Scherpbier²,

Klainin‐Yobas

et al. 2011

International Nursing Review

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“…The association between vital sign parameters (fast pulse rate and low systolic BP) and mortality [13]–[15] challenges traditional assumptions that mortality outcomes and determinants of survival fall solely within the domain of medical care, and provides further evidence that these outcomes are ‘nursing sensitive’ [13]. Nurses’ concerns about caring for critically ill patients on general wards are that patients are having increasingly more complex surgery, increasing their dependence and morbidity, which, in the face of understaffing, results in increased workload and suboptimal quality of care, leaving less time to apply learning in practice [16], [17].…”

Section: Introductionmentioning

confidence: 97%

Record Review to Explore the Adequacy of Post-Operative Vital Signs Monitoring Using a Local Modified Early Warning Score (Mews) Chart to Evaluate Outcomes

2014

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Objectives1) To explore the adequacy of: vital signs’ recordings (respiratory and heart rate, oxygen saturation, systolic blood pressure (BP), temperature, level of consciousness and urine output) in the first 8 post-operative hours; responses to clinical deterioration. 2) To identify factors associated with death on the ward between transfer from the theatre recovery suite and the seventh day after operation.DesignRetrospective review of records of 11 patients who died plus four controls for each case.ParticipantsWe reviewed clinical records of 55 patients who met inclusion criteria (general anaesthetic, age >13, complete records) from six surgical wards in a teaching hospital between 1 May and 31 July 2009.MethodsIn the absence of guidelines for routine post-operative vital signs’ monitoring, nurses’ standard practice graphical plots of recordings were recoded into MEWS formats (0 = normal, 1–3 upper or lower limit) and their responses to clinical deterioration were interpreted using MEWS reporting algorithms.ResultsNo patients’ records contained recordings for all seven parameters displayed on the MEWS. There was no evidence of response to: 22/36 (61.1%) abnormal vital signs for patients who died that would have triggered an escalated MEWS reporting algorithm; 81/87 (93.1%) for controls. Death was associated with age, ≥61 years (OR 14.2, 3.0–68.0); ≥2 pre-existing co-morbidities (OR 75.3, 3.7–1527.4); high/low systolic BP on admission (OR 7.2, 1.5–34.2); tachycardia (≥111–129 bpm) (OR 6.6, 1.4–30.0) and low systolic BP (≤81–100 mmHg), as defined by the MEWS (OR 8.0, 1.9–33.1).ConclusionsGuidelines for post-operative vital signs’ monitoring and reporting need to be established. The MEWS provides a useful scoring system for interpreting clinical deterioration and guiding intervention. Exploration of the ability of the Cape Town MEWS chart plus reporting algorithm to expedite recognition of signs of clinical and physiological deterioration and securing more skilled assistance is essential.

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“…(2004) highlight the range of models available, discussing some that are focussed on education (e.g. Cutler 2002a, Richardson et al. 2004), others on follow‐up (e.g.…”

Section: Introductionmentioning

confidence: 99%

“…2004). While some studies have discussed the needs of ward nurses in caring for critically ill patients and identified outreach services as an appropriate intervention (Whittaker & Ball 2000, Cutler 2002a), there are fewer studies that actually evaluate perceptions of outreach held by these consumers. Richardson et al.…”

Section: Introductionmentioning

confidence: 99%

The impact of an ICU liaison nurse: a case study of ward nurses’ perceptions

Chaboyer¹,

Gillespie²,

Foster³

et al. 2005

Journal of Clinical Nursing

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From ward-based critical care to educational curriculum 2: a focussed ethnographic case study

Cited by 20 publications

References 13 publications

A review of educational strategies to improve nurses' roles in recognizing and responding to deteriorating patients

A review of educational strategies to improve nurses' roles in recognizing and responding to deteriorating patients

Record Review to Explore the Adequacy of Post-Operative Vital Signs Monitoring Using a Local Modified Early Warning Score (Mews) Chart to Evaluate Outcomes

The impact of an ICU liaison nurse: a case study of ward nurses’ perceptions

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