Julie-Anne Considine

Hospital in the Home nurses' recognition and response to clinical deterioration

AIMS AND OBJECTIVESnTo obtain an understanding of how Hospital in the Home (HITH) nurses recognise and respond to clinical deterioration in patients receiving care at home or in their usual place of residence.nnnBACKGROUNDnRecognising and responding to clinical deterioration is an international safety priority and a key nursing responsibility. Despite an increase in care delivery in home environments, how HITH nurses recognise and respond to clinical deterioration is not yet fully understood.nnnDESIGNnA prospective, descriptive exploratory design was used. A survey containing questions related to participant characteristics and 10 patient scenarios was used to collect data from 47 nurses employed in the HITH units of three major health services in Melbourne, Australia. The 10 scenarios reflected typical HITH patients and included medical history and clinical assessment findings (respiratory rate, oxygen saturation, heart rate, blood pressure, temperature, conscious state and pain score).nnnRESULTSnThe three major findings from this study were that: (i) nurse and patient characteristics influenced HITH nurses assessment decisions; (ii) the cues used by HITH nurses to recognise clinical deterioration varied according to the clinical context; and (iii) although HITH nurses work in an autonomous role, they engage in collaborative practice when responding to clinical deterioration.nnnCONCLUSIONnHospital in the Home nurses play a fundamental role in patient assessment, and the context in which they recognise and respond to deterioration is markedly different to that of hospital nurses.nnnRELEVANCE TO CLINICAL PRACTICEnThe assessment, measurement and interpretation of clinical data are a nursing responsibility that is crucial to early recognition and response to clinical deterioration. The capacity of HITH services to care for increasing numbers of patients in their home environment, and to promptly recognise and respond to clinical deterioration should it occur, is fundamental to safety within the healthcare system. Hospital in the Home nurses are integral to a sustainable healthcare system that is responsive to dynamic changes in public health policies, and meets the healthcare needs of the community.

Nurses' role in recognising and responding to clinical deterioration in surgical patients

AIM AND OBJECTIVESnTo explore nurse role in recognising and responding to deteriorating post-operative patients.nnnBACKGROUNDnClinical deterioration is a significant problem in acute care settings. Nurses play a vital role in post-operative patient monitoring; however, there is limited understanding of the nurses role in recognising and responding to clinical deterioration in surgical patients.nnnMETHODSnThis qualitative exploratory study was conducted at a metropolitan teaching hospital in Melbourne, Australia. Data were collected through focus groups from 1 September to 31 October 2014. Four focus groups of 2-5 surgical nurses (nxa0=xa014) were conducted to explore the nurses perception of their role in managing deterioration over the first 72xa0hr postoperatively. Qualitative data were recorded, transcribed and key themes identified.nnnRESULTSnNurses demonstrated a high level of awareness of their role in recognising and responding to early signs of deterioration. The themes that arose from the focus group interviews were struggling with blood pressure, and we know our patient is sick. The nurses were confident about the clinical indicators of deterioration and the appropriate channels to use to escalate care. Using track and trigger observation charts enabled nurses to identify deteriorating patients prior to the patient fulfilling rapid response system escalation criteria.nnnCONCLUSIONSnThese findings highlight the importance of a collective team approach to preventing, recognising and responding to clinical deterioration across the whole patient journey. Initiatives to ensure accurate written and verbal communication between medical and nursing staff warrants further assessment.nnnRELEVANCE TO CLINICAL PRACTICEnNurses working in acute surgical wards are highly engaged in the process of recognising and responding to clinical deterioration in post-operative patients. Many nurses reported being able to anticipate deterioration occurring but are required by current organisational frameworks to escalate care to rapid response systems. How nurses anticipate and manage deterioration prior to the patient fulfilling rapid response system criteria warrants further investigation.

Longer time to transfer from the emergency department after bed request is associated with worse outcomes: FOUR HOUR TARGET, TIME TO BED REQUEST AND MORTALITY

To determine the relationships between: (i) total ED length of stay (EDLOS) and in‐hospital mortality, ward clinical deterioration; and (ii) between time of bed request, ward transfer and in‐hospital mortality, with a particular focus on patients transferred just prior to a 4 h EDLOS.

Using observation to collect data in emergency research

Research questions require specific data collection techniques to appropriately explore and understand the phenomena of interest. Observation as a term features commonly in the literature as a way to describe both the design of a study and methods deployed within procedures. Observation as a data collection method is a mode of inquiry to systematically collect information about different settings and groups. However, the objective of observation in data collection is to better understand the phenomena of interest situated in context. Specifically, observation data collection can improve understanding of practice, processes, knowledge, beliefs, and attitudes embedded in clinical work and social interactions. This pragmatic paper will assist emergency nurses and other clinicians to understand how observation can be used as a data collection method within clinical practice.