Woolfe Loftus Nicholas, Smith Duncan, Aitken Leanne M
City St George's, University of London, London, UK.
St Bartholomew's Hospital, London, UK.
J Clin Nurs. 2025 Apr;34(4):1250-1263. doi: 10.1111/jocn.17500. Epub 2025 Jan 24.
Despite the high acuity of coronary care unit (CCU) patients and their risk of deterioration, little is known about how nurses assess them.
Increase understanding of the scope of nurses' assessments of deteriorating CCU patients.
Online mixed methods survey.
The mRAPIDS (modified Rescuing a Patient in Deteriorating Situations) tool was used to measure assessment scope in responses to a patient vignette with a higher mRAPID score signalling broader scope (maximum score 24). Reflections on day-to-day practice were collected concurrently and thematically analysed. Themes were integrated with scores using a joint display table and organised into domains. Comparing 'fit' between data showed expansion (overlap with broader nonoverlapping findings) and disconcordance (contradictory findings).
Thirty-four nurses responded, and scope of assessment was found to be narrow (median mRAPIDS 5). Two domains were identified that helped explain this finding 'the act of assessment' and 'education and experience'. Participants emphasised the importance of education and experience, neither increased assessment scope.
This study showed that participant assessments were generally narrower than widely accepted best practice (ABCDE assessment).
Participant assessments did not reflect gold standard A-E assessment, which may partly reflect a need for assessment frameworks that are more compatible with real-world practice. Further research is required to understand the role of healthcare assistants in the care of deteriorating CCU patients. Clinical judgement is important, but not yet well understood in rapid response systems.
This study offers preliminary understanding of nurses' assessments of deteriorating patients in CCUs.
American Psychological Association, Mixed Methods Standards.
Reviewed protocol, aided result interpretation and shared ideas for future research.
尽管冠心病监护病房（CCU）患者病情严重且有病情恶化风险，但对于护士如何对他们进行评估却知之甚少。
加深对护士对病情恶化的CCU患者评估范围的理解。
在线混合方法调查。
使用mRAPIDS（改良的在病情恶化情况下抢救患者）工具来衡量对患者病例描述的评估范围，mRAPIDS得分越高表明评估范围越广（最高分24分）。同时收集对日常实践的思考并进行主题分析。使用联合展示表将主题与得分整合，并组织成不同领域。比较数据之间的“契合度”显示有扩展（与更广泛的非重叠结果有重叠）和不一致（相互矛盾的结果）。
34名护士做出回应，发现评估范围较窄（mRAPIDS中位数为5）。确定了两个有助于解释这一发现的领域，即“评估行为”和“教育与经验”。参与者强调了教育和经验的重要性，但两者均未扩大评估范围。
本研究表明，参与者的评估通常比广泛接受的最佳实践（ABCDE评估）更窄。
参与者的评估未反映黄金标准的A-E评估，这可能部分反映出需要更符合实际临床实践的评估框架。需要进一步研究以了解医疗辅助人员在护理病情恶化的CCU患者中的作用。临床判断很重要，但在快速反应系统中尚未得到很好的理解。
本研究初步了解了护士对CCU中病情恶化患者的评估情况。
美国心理学会，混合方法标准。
审查方案，协助结果解释并分享未来研究的想法。
