University of Louisville School of Medicine, Louisville, KY, USA.
Am J Nurs. 2011 May;111(5):22-9; quiz 30-1. doi: 10.1097/01.NAJ.0000398045.00299.64.
Medical emergency teams (METs) have been shown to contribute to a decrease in in-hospital cardiac arrests, unplanned ICU admissions, and overall hospital mortality rates. But their use is relatively new and our understanding of them is incomplete; in particular, the role of the non-ICU staff nurse during a MET call has received scant attention. To better understand the role of such nurses, and possibly to increase the effectiveness of these teams, we sought to determine the nursing staff's familiarity with and perceptions of the MET at one hospital.
After examining survey formats used in previous studies of nurses' perceptions of and attitudes toward METs, a 30-item survey was developed, consisting of 13 demographic and background items and 17 items based on a 5-point Likert agreement scale. In August 2008, the survey was distributed to the 388 nurses at Allegheny General Hospital in Pittsburgh, Pennsylvania, for whom the MET is a possible resource-that is, non-ICU staff nurses working outside critical care units or the ED. Responses were anonymous and voluntary. Data were entered and analyzed using Microsoft Excel software.
One hundred and thirty-one surveys (34%) were returned. Nearly all of the respondents (97%) were familiar with the MET, and a majority (72%) had participated in a MET call. Initiating the call (77%) and relaying the patient's history (84%) were the most common actions. A majority of respondents agreed or strongly agreed that use of the MET improved patient care (92%) and nurses' working conditions (83%). But only 41% agreed or strongly agreed that they were comfortable with their role as a member of the MET, and 39% reported neutral feelings about this. Just 41% agreed or strongly agreed that they felt prepared to administer nursing care during a MET call. A majority (52%) agreed or strongly agreed that an increase in experience corresponded to an increase in preparedness, but only 28% agreed or strongly agreed that their MET education had prepared them for their role. Nearly a third (31%) reported that they'd been hesitant to call a MET, citing physician discouragement as the most common reason.
Nurses felt that the MET improved both patient care and their working conditions, something that other studies have found may contribute to nurse retention and recruitment. But the role of the non-ICU staff nurse during a MET call remains unclear; nurses were neutral about their level of understanding of and comfort with their roles as members of the MET. More specific guidelines and further education may help the non-ICU staff nurse feel more valued as a team member and better prepared to administer nursing care during a MET call. Intimidation by other team members proved not to be a significant factor in nurse participation on the team, but the data may not have accurately described the unique relationship between the non-ICU staff nurse and the responding ICU nurses. Some non-ICU staff nurses were hesitant to call the team, for reasons that included physician discouragement; this could seriously undermine the effectiveness of the MET and indicates that better interprofessional education is needed.
bedside nurse, medical emergency team, non-ICU staff nurse, nurse attitudes, patient crisis, patient safety, rapid response system, survey.
医疗急救团队（MET）的应用已被证明有助于降低院内心脏骤停、非计划转入 ICU 和总体医院死亡率。但它们的使用相对较新，我们对它们的了解还不完整；特别是，在 MET 呼叫期间，非 ICU 医护人员的角色几乎没有受到关注。为了更好地了解这些护士的作用，并可能提高这些团队的效率，我们试图确定一家医院的护理人员对 MET 的熟悉程度和看法。
在检查了先前研究护士对 MET 的看法和态度的调查格式后，我们开发了一个包含 30 个项目的调查，其中包括 13 个人口统计学和背景项目，以及基于 5 点李克特同意量表的 17 个项目。2008 年 8 月，该调查分发给宾夕法尼亚州匹兹堡阿勒格尼总医院的 388 名护士，对于这些护士来说，MET 是一种可能的资源，即非 ICU 医护人员在重症监护病房或急诊科以外的地方工作。回复是匿名和自愿的。使用 Microsoft Excel 软件输入和分析数据。
有 131 份（34%）调查问卷被退回。几乎所有的受访者（97%）都熟悉 MET，大多数（72%）都参与过 MET 呼叫。发起呼叫（77%）和传递患者病史（84%）是最常见的行动。大多数受访者同意或强烈同意使用 MET 可以改善患者护理（92%）和护士的工作条件（83%）。但只有 41%的人同意或强烈认为他们对自己作为 MET 成员的角色感到满意，39%的人对此持中立态度。只有 41%的人同意或强烈认为他们对在 MET 呼叫期间提供护理有信心。大多数（52%）人同意或强烈认为经验的增加对应着准备程度的提高，但只有 28%的人同意或强烈认为他们的 MET 教育为他们的角色做好了准备。近三分之一（31%）的人表示他们曾犹豫不决地呼叫 MET，因为医生的劝阻是最常见的原因。
护士们认为 MET 改善了患者护理和他们的工作条件，这是其他研究发现的可能有助于护士保留和招聘的因素。但在 MET 呼叫期间，非 ICU 医护人员的角色仍不清楚；护士对自己作为 MET 成员的理解程度和舒适度持中立态度。更具体的指导方针和进一步的教育可能会帮助非 ICU 医护人员感到自己作为团队成员更有价值，并在 MET 呼叫期间更好地准备提供护理。其他团队成员的恐吓并不是护士参与团队的一个重要因素，但数据可能无法准确描述非 ICU 医护人员和响应的 ICU 护士之间的独特关系。一些非 ICU 医护人员因为医生的劝阻而犹豫不决地呼叫团队，这可能会严重影响 MET 的效果，并表明需要更好的跨专业教育。
床边护士、医疗急救团队、非 ICU 医护人员、护士态度、患者危机、患者安全、快速反应系统、调查。
