School of Nursing and Midwifery and Centre for Quality and Patient Safety Research, Deakin University, c/- Deakin University, Geelong, Victoria 3125, Australia.
School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Locked Bag 4, Maroochydore DC, Queensland, 4558, Australia.
Nurse Educ Today. 2018 Aug;67:77-82. doi: 10.1016/j.nedt.2018.05.009. Epub 2018 May 19.
Critical care nurses have been involved in Rapid Response Teams since their inception, particularly in medically led RRTs, known as Medical Emergency Teams. It is assumed that critical care skills are required to escalate care for the deteriorating ward patient. However, evidence to support critical care nurses' involvement in METs is anecdotal. Currently, little is known about the educational requirements for nurses involved in RRT or METs.
We aimed to identify and describe what nurses involved in a MET consider the most vital areas of knowledge and skill when delivering care to the deteriorating ward patient.
An exploratory descriptive design was used and data was collected at a session of the Australian and New Zealand Intensive Care Society Rapid Response Team (ANZICS-RRT) Conference held at The Gold Coast, Australia in July 2015. All conference delegates were eligible to take part. Conference delegates totalled 293; 194 nurses, 89 doctors and 10 allied health professionals. Data collection took place in three phases, over a 90-minute period. First, demographic data were collected from all participants at the start of data collection. These data were collected using paper-based surveys. Second, extended response surveys; that is, paper-based surveys that asked open-ended questions to elicit free text responses, were used to collect participants' individual responses to the question: "What are the specific theoretical knowledge, skills and behavioural attributes required in a curricula to prepare nurses to be high functioning members of a MET?" Demographic, educational and work characteristics were descriptively analysed using SPSS (version 22). Participants perceptions of what knowledge, skills and attributes are required for nurses to recognise and respond to clinical deterioration were thematically analysed.
Participants were predominantly female (88.3%, n = 91) with 54.4% (n = 56) holding a Bachelor of Nursing. Participants had a median of 20 years (IQR 16) experience as RNs, and a median of 14 years (IQR 13) experience in critical care. Participants formed part of METs frequently, with nearly half the cohort seeing clinically deteriorating patients more than once per day (37.9%, n = 33) or daily (10%, n = 9). Thematic analysis of survey responses revealed four main themes desired in Rapid Response Team Curricula: Clinical Deterioration Theory, Clinical Deterioration Skills, Rapid Response System Governance, and Professionalism and Teamwork.
We suggest that a curriculum that educates nurses on the specific requirements of assessing, managing and evaluating all aspects of clinical deterioration is now required.
自快速反应团队（RRT）成立以来，重症监护护士就一直参与其中，尤其是在以医学为主导的 RRT 中，被称为医疗急救团队（MET）。人们认为，重症监护护士需要具备一定的技能才能为病情恶化的病房患者提供更高水平的护理。然而，目前尚缺乏有关参与 RRT 或 MET 的护士的教育要求的证据。
我们旨在确定并描述参与 MET 的护士在为病情恶化的病房患者提供护理时，认为最关键的知识和技能领域。
本研究采用探索性描述性设计，于 2015 年 7 月在澳大利亚黄金海岸举行的澳大利亚和新西兰重症监护学会快速反应团队（ANZICS-RRT）会议上收集数据。所有会议代表均有资格参加。会议代表总计 293 人，包括 194 名护士、89 名医生和 10 名联合卫生专业人员。数据收集分三个阶段在 90 分钟内完成。首先，在数据收集开始时，从所有参与者那里收集人口统计学数据，这些数据是通过纸质调查问卷收集的。其次，使用扩展响应调查（即纸质调查问卷，提出开放式问题以征集自由文本回复）收集参与者对以下问题的个人回复：“在一个课程中，需要哪些特定的理论知识、技能和行为属性来培养护士成为医疗急救团队的高效成员？”使用 SPSS（版本 22）对人口统计学、教育和工作特征进行描述性分析。使用主题分析法对护士识别和应对临床恶化所需的知识、技能和属性进行分析。
参与者主要为女性（88.3%，n=91），其中 54.4%（n=56）持有护理学学士学位。参与者作为注册护士的中位工作年限为 20 年（IQR 16），作为重症监护护士的中位工作年限为 14 年（IQR 13）。参与者经常参与 MET，近一半的参与者每天看到病情恶化的患者超过一次（37.9%，n=33）或每天（10%，n=9）。对调查回复的主题分析揭示了快速反应团队课程中需要的四个主要主题：临床恶化理论、临床恶化技能、快速反应系统治理以及专业精神和团队合作。
我们建议现在需要一门教育护士评估、管理和评估临床恶化各个方面的具体要求的课程。
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