Patient Deterioration In Nursing

One of the pivotal roles of a nurse is the ability to recognise patient deterioration. The skill of identifying crucial elements of deterioration and acting appropriately is fundamental for positive patient outcome. A vital skill performed primarily by nurses is the act of respiratory rate measurement. This skill is performed in addition to five other physiological parameters, which form a basis for a scoring system. The scoring systems commonly used are known as NEWS (National Early Warning Score) and EWS (Early Warning Score). As many adverse events are preceded by a period of time where by the patient exhibits physiological dysfunction, there is often time to correct abnormalities. This has significance for nurses, as they are responsible

An audit of patient records completed in 2005, revealed a low incidence of respiratory rate recording. An initial audit completed revealed that only 7% of 341 patients had a respiratory rate recording (Butler-Williams 2005). Due to this worrying outcome, the priority was to implement appropriate training to raise respiratory rate significance. Due to the audit being completed hospital wide and with no prior warning, it is an accurate indicator of an overall attitude of practice towards the recording of respiratory rate. Various studies have been conducted in order to gain an understanding as to why this precious sign is so often ignored. Jacqueline Hogan explored the paucity of patient monitoring on acute wards, completing qualitative research using focus groups in 2004. Four major themes were identified, firstly the issue of the nursing workload. Many participants acknowledged the expansion of the nurse’s role and with this added responsibility, the need for delegation of activities such as patient observations. Observations are often delegated to junior staff members such as healthcare assistants and student nurses. Although many nurses admitted to delegating this vital activity, 73% of nurses did not consider healthcare assistants possessed the required knowledge to interpret observational results. With this lack of knowledge comes the absence of appreciation for the completion of such vital signs, and

The aim of the report was to illustrate why deterioration incidents happen. Focus groups and semi-structured interviews were conducted with nurses and doctors from acute trusts across England and Wales. Concerns were found within written communication on patient observation charts. Rather than results being plotted, users were writing in numbers creating information in a disjointed manner. This has implications for identifying trends and makes it difficult to notice deviation. Issues involving prioritisation due to nursing workload were also emphasised. Many nurses felt that patient comfort was often prioritised as oppose to completing observations. Although comfort is a fundamental attribute to patient satisfaction, the need for appreciation and respect for vital sign monitoring should be promoted over all tasks in order to identify deterioration promptly. A general lack of confidence and respect was held for all patient observations, being viewed as merely a task that needs to be