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

Dalton, M, Harrison, J, Malin, A and Leavey, C (2018) Factors that influence nurses' assessment of patient acuity and response to acute deterioration. British Journal of Nursing, 27 (4). ISSN 0966-0461

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Abstract

BACKGROUND: nurses play a crucial role in the early recognition and management of the deteriorating patient. They are responsible for the care they provide to their patients, part of which is the monitoring of vital signs (blood pressure, pulse, respiratory rate and temperature), which are fundamental in the surveillance of deterioration. The aim of this study was to discover what factors influence how nurses assess patient acuity and their response to acute deterioration. METHODS: a generic qualitative approach was used. Some 10 nurses working in an acute NHS trust were interviewed using a semi- structured approach, with equal representation from medical and surgical inpatient wards. RESULTS: the main themes identified were collegial relationships, intuition, and interpretation of the MEWS system (Modified Early Warning Score). Collegial relationships with the medical staff had some influence on the nurses' assessment, as they tended to accept the medical peers' assessment as absolute, rather than their own assessment. It was also highlighted that nurses relied on the numerical escalation of the MEWS system to identify the deteriorating patient, instead of their own clinical judgement of the situation. Interestingly, the nurses found no difficulty in escalating the patient's care to medical staff when the patient presented with a high MEWS score. The difficulty arose when the MEWS score was low-the participants found it challenging to authenticate their findings. CONCLUSION: this study has identified several confounding factors that influence the ways in which nurses assess patient acuity and their response to acute deterioration. The information provides a crucial step forward in identifying strategies to develop further training.

Item Type: Article
Additional Information: This document is the Accepted Manuscript version of a Published Work that appeared in final form in British Journal of Nursing copyright © MA Healthcare, after peer review and technical editing by the publisher. To access the final edited and published work see http://dx.doi.org/10.12968/bjon.2018.27.4.212
Uncontrolled Keywords: 1110 Nursing
Subjects: R Medicine > RT Nursing
Divisions: School of Nursing & Allied Health
Publisher: Mark Allen Healthcare
Related URLs:
Date Deposited: 06 Apr 2018 11:15
Last Modified: 06 Apr 2018 11:15
DOI or Identification number: 10.12968/bjon.2018.27.4.212
URI: http://researchonline.ljmu.ac.uk/id/eprint/8425

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