What factors influence ward nurses’ recognition of and response to patient deterioration? An integrative review of the literature

Massey, Debbie; Chaboyer, Wendy; Anderson, Vinah

doi:10.1002/nop2.53

Cited by 173 publications

(139 citation statements)

References 66 publications

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“…In general, nurses abilities to recognize and respond to patient's deterioration are of great value to reduce AEs, and with EWS‐S, a framework is given, which enables to respond appropriately and promptly when CDET of patients occurs . However, up to our knowledge, little is known about attitudes towards EWS‐S among different groups of health care workers.…”

Section: Discussionmentioning

confidence: 99%

Chief physicians' attitudes towards early warning score systems in Switzerland: Results of a cross‐sectional survey

Richard

Frank

Schwappach

2017

Evaluation Clinical Practice

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Section: Discussionmentioning

confidence: 99%

Chief physicians' attitudes towards early warning score systems in Switzerland: Results of a cross‐sectional survey

Richard

Frank

Schwappach

2017

Evaluation Clinical Practice

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“…[24] Confidence is a common theme in studies that have examined novice RNs' ability to learn skills required for safe patient care. [25][26][27][28] However, few studies focus on novice RN confidence and training strategies in the hospital setting. Investigations of hospital training strategies are needed to build the knowledge base for improving novice RN confidence for the application of clinical skills used towards safe patient care.…”

Section: Introductionmentioning

confidence: 99%

Effective patient safety education for novice RNs: A systematic review

Niemeyer¹

2017

JNEP

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Background and objective: The need is great for identifying effective evidence-based strategies that focus on increasing novice RN confidence for the application of skills used to care for patients safely. The purpose of this systematic review is to explore effective continuing education strategies that target novice RNs' professional development, enhance clinical confidence, and focus on patient safety. Results: This systematic review identified 12 articles that describe effective training strategies aimed at improving novice RNs' clinical practice confidence and skill. A thematic analysis of the data was used to systematically gain knowledge about strategies used to educate novice RNs working in the hospital setting. The majority of strategies employed a number of different types of simulation and reported varying degrees of success for improving novice RN ability to care for patients safely. Simulation, virtual reality, preceptored clinical experiences, and interdisciplinary experiences were found to be effective education strategies enhancing novice RN's skill for providing safe care. Didactic instruction had positive results, but was not as effective as simulation for novice RNs learning safe patient care. Finally, written instruction was not as effective as simulation, and hard copy supplements provided no added value to novice RNs learning safe patient care. Conclusions: Findings from this review are foundational to address calls from the Institute of Medicine (IOM) and the National League for Nursing (NLN) to reform and support post-graduate nursing education. The development of novel education and training targeting novice RNs in the hospital setting is essential, but more research is needed to enhance safe patient care.

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“…Similarly, the interventions (primarily educational) proposed to address the problem of ALF have tended to focus on the behaviours related to patient monitoring and assessment (Liaw et al, ; Smith, Osgood, & Crane, ). In comparison, there is paucity of studies that have reported the actions of staff when they are escalating care and what influences their escalation behaviour (Massey, Chaboyer, & Aitken, ; Massey, Chaboyer, & Anderson, ; Smith & Aitken, ). The results of this documentary analysis reflect the wider body of evidence, with a higher proportion of statements related to monitoring behaviour compared to escalation behaviour.…”

Section: Discussionmentioning

confidence: 99%

How actionable are staff behaviours specified in policy documents? A document analysis of protocols for managing deteriorating patients

Smith

Sekhon

Francis

et al. 2019

Journal of Clinical Nursing

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Background To optimise care of deteriorating patients, healthcare organisations have implemented rapid response systems including an “afferent” and “efferent” limb. Afferent limb behaviours include monitoring vital signs and escalating care. To strengthen afferent limb behaviour and reduce adverse patient outcomes, the National Early Warning Score was implemented in the UK. There are no published reports of how National Early Warning Score guidance has translated into trust‐level deteriorating patient policy and whether these documents provide clear, actionable statements guiding staff. Aim To identify how deteriorating patient policy documents provide “actionable” behavioural instruction for staff, responsible for actioning the afferent limb of the rapid response system. Design A structured content analysis of a national guideline and local policies using a behaviour specification framework. Methods Local deteriorating patient policies were obtained. Statements of behaviour were extracted from policies; coded using a behaviour specification framework: Target, Action, Context, Timing and Actor and scored for specificity (1 = present, nonspecific; 2 = present, specific). Frequencies and proportions of statements containing elements of the Target, Action, Context, Timing and Actor framework were summarised descriptively. Reporting was guided by the COREQ checklist. Results There were more statements related to monitoring than escalation behaviour (65% vs 35%). Despite high levels of clear specification of the action (94%) and the target of the behaviour (74%), context, timing and actor were poorly specified (37%, 37% and 33%). Conclusion Delay in escalating deteriorating patients is associated with adverse outcomes. Some delay could be addressed by writing local protocols with greater behavioural specificity, to facilitate actionability. Relevance to clinical practice Numerous clinical staff are required for an effective response to patient deterioration. To mitigate role confusion, local policy writers should provide clear specification of the actor. As the behaviours are time‐sensitive, clear specification of the time frame may increase actionability of policy statements for clinical staff.

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What factors influence ward nurses’ recognition of and response to patient deterioration? An integrative review of the literature

Cited by 173 publications

References 66 publications

Chief physicians' attitudes towards early warning score systems in Switzerland: Results of a cross‐sectional survey

Chief physicians' attitudes towards early warning score systems in Switzerland: Results of a cross‐sectional survey

Effective patient safety education for novice RNs: A systematic review

How actionable are staff behaviours specified in policy documents? A document analysis of protocols for managing deteriorating patients

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