Bingham Gordon, Fossum Mariann, Hughes Leanne, Digby Robin, Bucknall Tracey
Alfred Health, Melbourne, Vic., Australia.
Centre for Caring Research - Southern Norway, Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway.
J Adv Nurs. 2020 Aug;76(8):2171-2181. doi: 10.1111/jan.14433. Epub 2020 Jun 4.
To describe nurses' decision-making, experiences and perceptions of escalating deteriorating patients to the treating medical team using urgent clinical review criteria.
A qualitative design comprising individual in-depth interviews with nurses from a major Australian metropolitan tertiary teaching hospital.
A purposive sample of 30 Registered Nurses from nine surgical and medical wards were interviewed in April 2018 using semi-structured interviews. An inductive thematic analysis was conducted.
Identified themes included: detecting the deterioration; countering the problem; getting a response; and challenges faced in the process of escalation. Nurses reported an important awareness, sense of responsibility, and critical thinking to ensure the safe management and escalation of deteriorating patients. However, barriers to escalation necessitated individual workarounds and organizational structures to mitigate patient risk.
This study supports the importance of communication between clinical teams and recognizes that it is crucial to enable a fail-safe experience for patients and families. Recognition of disciplinary contributions to patients' goals of care is required to better understand and address the prevalence of deteriorating patients. Our study is among the first to explore the actual experience of nurses who articulate balancing uncertainty and managing complex team dynamics on wards for patients experiencing deteriorating health status. The information may assist in determining team training strategies and structures to facilitate patient management during deterioration.
This is among the first study to investigate barriers influencing decision-making of RNs prior to escalation using qualitative methods. This study provides a foundation to inform and develop policies and strategies aimed at ensuring escalation occurs for deteriorating patients.
描述护士依据紧急临床评估标准，将病情恶化患者的情况告知治疗医疗团队时的决策过程、经历和看法。
采用质性研究设计，对澳大利亚一家大型都市三级教学医院的护士进行个人深度访谈。
2018年4月，采用半结构化访谈对来自9个外科和内科病房的30名注册护士进行了目的抽样访谈。进行了归纳主题分析。
确定的主题包括：发现病情恶化；应对问题；获得回应；以及病情升级过程中面临的挑战。护士们报告称，他们具备重要的意识、责任感和批判性思维，以确保对病情恶化患者进行安全管理和病情升级。然而，病情升级的障碍需要个人采取变通方法和组织结构来降低患者风险。
本研究支持临床团队之间沟通的重要性，并认识到为患者及其家属提供万无一失的体验至关重要。需要认识到各学科对患者护理目标的贡献，以便更好地理解和应对病情恶化患者的普遍情况。我们的研究是首批探索护士实际经历的研究之一，这些护士阐述了在病房中平衡不确定性和管理复杂团队动态以应对健康状况恶化患者的情况。这些信息可能有助于确定团队培训策略和结构，以促进病情恶化期间的患者管理。
这是首批使用定性方法调查病情升级前影响注册护士决策的障碍的研究之一。本研究为制定旨在确保病情恶化患者得到病情升级处理的政策和策略提供了依据。
