Dalton Mark, Harrison John, Malin Anitra, Leavey Conan
Advanced Nurse Practitioner, Royal Liverpool and Broadgreen Hospital Trust, Final year PhD student/Visiting Senior Lecturer, Liverpool John Moores University.
Senior Lecturer In Mental Health Nursing, Faculty of Education, Health and Community, Liverpool John Moores University.
Br J Nurs. 2018 Feb 22;27(4):212-218. doi: 10.12968/bjon.2018.27.4.212.
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.
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.
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.
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.
护士在早期识别和处理病情恶化的患者方面发挥着关键作用。他们负责为患者提供护理，其中一部分是监测生命体征（血压、脉搏、呼吸频率和体温），这些对于监测病情恶化至关重要。本研究的目的是发现哪些因素会影响护士评估患者病情严重程度以及他们对急性病情恶化的反应。
采用一般定性研究方法。使用半结构化方法对在一家急性国民保健服务信托机构工作的约10名护士进行了访谈，医疗和外科住院病房的护士人数均等。
确定的主要主题是同事关系、直觉以及改良早期预警评分（MEWS）系统的解读。与医务人员的同事关系对护士的评估有一定影响，因为他们倾向于将同行医生的评估视为绝对正确，而非自己的评估。研究还强调，护士依赖MEWS系统的数值升级来识别病情恶化的患者，而不是依靠自己对病情的临床判断。有趣的是，当患者MEWS评分较高时，护士在将患者护理升级至医务人员方面没有困难。但当MEWS评分较低时，问题就出现了——参与者发现难以证实自己的判断。
本研究确定了几个影响护士评估患者病情严重程度以及他们对急性病情恶化反应方式的混杂因素。这些信息为确定进一步开展培训的策略迈出了关键一步。
