Patient bedside observations: what could be simpler?

Buist, Michael; Stevens, Stella

doi:10.1136/bmjqs-2013-002143

Cited by 9 publications

(6 citation statements)

References 9 publications

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“…This was a small, qualitative study in a single centre study, so it is not possible to generalise. Nonetheless it meets the need for an exploratory qualitative, in‐depth study of why vital sign observations are taken less at night, as highlighted by Buist and Stevens (). As these findings chime with existing qualitative and quantitative research, this suggests some of our conceptual findings may be transferable (Lincoln & Guba, ) to nursing practice at night more generally.…”

Section: Study Limitationsmentioning

confidence: 99%

“…However, there is no research evidence exploring how nursing staff navigate these dilemmas in their routine work at night. Qualitative research is needed to explore why vital sign observations reduce at night (Buist & Stevens, ). This study aimed to explore why adherence to early warning score protocol‐led observation schedules is poorer at night by analysing nurses’ accounts of decision‐making about taking vital sign at night.…”

Section: Introductionmentioning

confidence: 99%

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A fundamental conflict of care: Nurses’ accounts of balancing patients' sleep with taking vital sign observations at night

Hope

Recio‐Saucedo

Fogg

et al. 2018

Journal of Clinical Nursing

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Aims and objectivesTo explore why adherence to vital sign observations scheduled by an early warning score protocol reduces at night.BackgroundRegular vital sign observations can reduce avoidable deterioration in hospital. early warning score protocols set the frequency of these observations by the severity of a patient's condition. Vital sign observations are taken less frequently at night, even with an early warning score in place, but no literature has explored why.DesignA qualitative interpretative design informed this study.MethodsSeventeen semi‐structured interviews with nursing staff working on wards with varying levels of adherence to scheduled vital sign observations. A thematic analysis approach was used.ResultsAt night, nursing teams found it difficult to balance the competing care goals of supporting sleep with taking vital sign observations. The night‐time frequency of these observations was determined by clinical judgement, ward‐level expectations of observation timing and the risk of disturbing other patients. Patients with COPD or dementia could be under‐monitored, while patients nearing the end of life could be over‐monitored.ConclusionIn this study, we found an early warning score algorithm focused on deterioration prevention did not account for long‐term management or palliative care trajectories. Nurses were therefore less inclined to wake such patients to take vital sign observations at night. However, the perception of widespread exceptions and lack of evidence regarding optimum frequency risks delegitimising the early warning score approach. This may pose a risk to patient safety, particularly patients with dementia or chronic conditions.Relevance to clinical practiceNurses should document exceptions and discuss these with the wider team. Hospitals should monitor why vital sign observations are missed at night, identify which groups are under‐monitored and provide guidance on prioritising competing expectations. early warning score protocols should take account of different care trajectories.

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Section: Study Limitationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A fundamental conflict of care: Nurses’ accounts of balancing patients' sleep with taking vital sign observations at night

Hope

Recio‐Saucedo

Fogg

et al. 2018

Journal of Clinical Nursing

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“…The underlying reasons for the reduced frequency of measurement of vital signs on general wards at night are unclear and require exploration (Buist & Stevens, ). Staffing at night is usually lower than during daytime shifts, with increased patient:staff ratios.…”

Section: Introductionmentioning

confidence: 99%

Relationships between healthcare staff characteristics and the conduct of vital signs observations at night: Results of a survey and factor analysis

et al. 2018

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AimTo explore the association of healthcare staff with factors relevant to completing observations at night.DesignOnline survey conducted with registered nurses, midwives, healthcare support staff and student nurses who had worked at least one night shift in a National Health Service hospital in England.MethodsExploratory factor analysis and mixed effects regression model adjusting for role, number of night shifts worked, experience and shift patterns.ResultsSurvey items were summarized into four factors: (a) workload and resources; (b) prioritization; (c) safety culture; (d) responsibility and control. Staff experience and role were associated with conducting surveillance tasks. Nurses with greater experience associated workload and resources with capacity to complete work at night. Responses of student nurses and midwives showed higher propensity to follow the protocol for conducting observations. Respondents working night shifts either exclusively or occasionally perceived that professional knowledge rather than protocol guided care tasks during night shifts.

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“…Bedside patient assessment by registered nurses (RNs) in acute care settings has never been more important for keeping patients safe or more vulnerable as core nursing business (Buist & Stevens ). Despite the dramatic increase in patient acuity and complexity on general acute wards over the past few decades, traditional nursing assessment models and practices have remained relatively unchanged (Cardona‐Morrell et al .…”

Section: Introductionmentioning

confidence: 99%

Nursing physical assessment for patient safety in general wards: reaching consensus on core skills

Douglas

Booker

Fox

et al. 2016

Journal of Clinical Nursing

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Patient bedside observations: what could be simpler?

Cited by 9 publications

References 9 publications

A fundamental conflict of care: Nurses’ accounts of balancing patients' sleep with taking vital sign observations at night

A fundamental conflict of care: Nurses’ accounts of balancing patients' sleep with taking vital sign observations at night

Relationships between healthcare staff characteristics and the conduct of vital signs observations at night: Results of a survey and factor analysis

Nursing physical assessment for patient safety in general wards: reaching consensus on core skills

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