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Rivera J, Malone S, Puerto-Torres M, Prewitt K, Counts L, Wiphatphumiprates P, Sakaan F, Al Zebin Z, Arias AV, Bhattacharyya P, Gunasekera S, Johnson S, Kambugu J, Kaye EC, Mandrell B, Mack J, McArthur J, Mendez A, Morrissey L, Sharara-Chami R, Snaman J, Sniderman E, Luke DA, Graetz DE, Agulnik A. CritCom: assessment of quality of interdisciplinary communication around deterioration in pediatric oncologic patients. Front Oncol 2023; 13:1207578. [PMID: 37886167 PMCID: PMC10598383 DOI: 10.3389/fonc.2023.1207578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 09/22/2023] [Indexed: 10/28/2023] Open
Abstract
Background High-quality clinical care requires excellent interdisciplinary communication, especially during emergencies, and no tools exist to evaluate communication in critical care. We describe the development of a pragmatic tool focusing on interdisciplinary communication during patient deterioration (CritCom). Methods The preliminary CritCom tool was developed after a literature review and consultation with a multidisciplinary panel of global experts in communication, pediatric oncology, and critical care to review the domains and establish content validity iteratively. Face and linguistic validity were established through cognitive interviews, translation, and linguistic synthesis. We conducted a pilot study among an international group of clinicians to establish reliability and usability. Results After reviewing 105 potential survey items, we identified 52 items across seven domains. These were refined through cognitive interviews with 36 clinicians from 15 countries. CritCom was piloted with 433 clinicians (58% nurses, 36% physicians, and 6% other) from 42 hospitals in 22 countries. Psychometric testing guided the refinement of the items for the final tool. CritCom comprised six domains with five items each (30 total). The final tool has excellent reliability (Cronbach's alpha 0.81-0.86), usability (93% agree or strongly agree that the tool is easy to use), and similar performance between English and Spanish tools. Confirmatory factor analysis was used to establish the final 6-domain structure. Conclusions CritCom is a reliable and pragmatic bilingual tool to assess the quality of interdisciplinary communication around patient deterioration for children in diverse resource levels globally. Critcom results can be used to design and evaluate interventions to improve team communication.
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Affiliation(s)
- Jocelyn Rivera
- Pediatric Emergency Department, Hospital Infantil Teletón de Oncología (HITO), Querétaro, Mexico
| | - Sara Malone
- Washington University in St. Louis, Brown School, St. Louis, MO, United States
| | - Maria Puerto-Torres
- Division of Critical Care Medicine, Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Kim Prewitt
- Washington University in St. Louis, Brown School, St. Louis, MO, United States
| | - Lara Counts
- Washington University in St. Louis, Brown School, St. Louis, MO, United States
| | - Parima Wiphatphumiprates
- Division of Critical Care Medicine, Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Firas Sakaan
- Division of Critical Care Medicine, Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Zebin Al Zebin
- Pediatric Hematology and Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Anita V. Arias
- Division of Critical Care Medicine, Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | | | - Sanjeeva Gunasekera
- Department of Pediatric Oncology National Cancer Institute, Maharagama, Sri Lanka
| | - Sherry Johnson
- Division of Critical Care Medicine, Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Joyce Kambugu
- Pediatric Oncology, Uganda Cancer Institute, Kampala, Uganda
| | - Erica C. Kaye
- Division of Critical Care Medicine, Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Belinda Mandrell
- Division of Critical Care Medicine, Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Jennifer Mack
- Department of Hematology and Oncology, Dana-Farber Cancer Institute and Boston Children’s Hospital, Boston, MA, United States
| | - Jennifer McArthur
- Division of Critical Care Medicine, Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Alejandra Mendez
- Pediatric Intensive Care Unit, Unidad Nacional de Oncología pediátrica (UNOP), Guatemala City, Guatemala
| | - Lisa Morrissey
- Department of Hematology and Oncology, Dana-Farber Cancer Institute and Boston Children’s Hospital, Boston, MA, United States
| | - Rana Sharara-Chami
- Pediatric Critical Care Medicine, American University of Beirut, Beirut, Lebanon
| | - Jennifer Snaman
- Department of Hematology and Oncology, Dana-Farber Cancer Institute and Boston Children’s Hospital, Boston, MA, United States
| | - Elizabeth Sniderman
- Northern Alberta Children’s Cancer Program, Stollery Children’s Hospital, Edmonton, AB, Canada
| | - Douglas A. Luke
- Washington University in St. Louis, Brown School, St. Louis, MO, United States
| | - Dylan E. Graetz
- Division of Critical Care Medicine, Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Asya Agulnik
- Division of Critical Care Medicine, Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, United States
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Demir Kösem D, Bektaş M, Gawronski O. Psychometric properties of the Turkish version of the vital signs monitoring on pediatric wards scale (Ped-V scale). J Pediatr Nurs 2023:S0882-5963(23)00102-1. [PMID: 37142493 DOI: 10.1016/j.pedn.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/06/2023]
Abstract
PURPOSE The aim of this study should be to adopt the Turkish version of the vital signs monitoring on pediatric wards scale (Ped-V scale). DESIGN AND METHOD This methodological study was carried out with 331 pediatric nurses aged 18-65 between September 2022 and November 2022. The data were collected using an online questionnaire including a Descriptive Information Form and the Ped-V scale. Before starting the implementation of the study, the language adaptation of the scale was made, then expert opinion was taken and a pilot application was made. Then the main sampling was applied and evaluated. Explanatory and confirmatory factor analysis, Cronbach's alpha, and item-total score analysis were used for data analysis. RESULTS It was determined that the scale consisted of 30 items and four sub-dimensions and that four sub-dimensions explained 42.91% of the total variance. Both exploratory and confirmatory factor analyses indicated that all factor loads were >0.30. According to the confirmatory factor analysis, all of the fit indices were >0.80, and the RMSEA was <0.080. Cronbach's alpha was determined as 0.88 for the total scale and >0.60 for all sub-dimensions. CONCLUSION As a result of the analyses, it was determined that the Ped-V scale was a valid and reliable measurement tool for the Turkish sample. PRACTICE IMPLICATIONS Using the Ped-V scale, it can help to determine the attitudes of nurses working in pediatric clinics toward monitoring vital signs and to plan in-service training if there is a problem.
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Affiliation(s)
- Dilek Demir Kösem
- Hakkari University Faculty of Health Sciences, Department of Nursing, Hakkari, Turkey.
| | - Murat Bektaş
- Dokuz Eylul University Faculty of Nursing, Inciraltı, Izmir, Turkey.
| | - Orsola Gawronski
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
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Preparing New Graduate Nurses for Patient Rescue: An Experimental Quantitative Study. J Nurses Prof Dev 2023; 39:E20-E24. [PMID: 35067633 DOI: 10.1097/nnd.0000000000000840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A patient deterioration educational program was offered to new graduate nurses. Pre and post self-confidence scores were compared, and competency performance was evaluated during a simulation. The results indicate that most of the participants successfully demonstrated simulation competencies, and there was a statistically significant improvement in self-confidence scores. Based on these findings, education on identifying and managing patient deterioration that includes a simulation experience may be beneficial.
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Ghaderi C, Esmaeili R, Ebadi A. Situation awareness in intensive care unit nurses: A qualitative directed content analysis. Front Public Health 2022; 10:999745. [PMID: 36311586 PMCID: PMC9614415 DOI: 10.3389/fpubh.2022.999745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/27/2022] [Indexed: 01/26/2023] Open
Abstract
Background Situation awareness (SA) is an essential cognitive construct to create positive patient safety outcomes. SA of the nurses in the intensive care unit (ICU), where conditions may change rapidly, is particularly important. The present study aimed to explain the perception and experience of SA in ICU nurses based on Endsley's SA model. Materials and methods This qualitative directed content analysis was conducted on nurses in six hospitals in Tehran, Iran, from December 2020 to July 2021. Twenty-seven ICU nurses were selected using purposive sampling. Data were collected by semi-structured interviews and field observations. The data were analyzed based on the Elo and Kyngas method modified by Assarroudi et al. COREQ checklist was used to report the research. Results The concept of SA in ICU nurses, based on Endsley's model, includes perception of patients' clinical cues, perception of the human environment, perception of the physical environment, and perception of the organizational environment as generic categories of the perception of the elements in the environment. SA in ICU nurses also includes the main categories of comprehension the current situation through a sense of salience and interpretation of cues and projection the future situation through the prediction of patient status into the near future and environmental foresight. Conclusion Findings have further developed the concept of SA in ICU nurses based on Endsley's SA model. The insights and knowledge gained from this study can be useful for future practice, education, and research on SA among ICU nurses.
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Affiliation(s)
- Chiman Ghaderi
- Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Roghayeh Esmaeili
- Department of Medical-Surgical, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran,*Correspondence: Roghayeh Esmaeili
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran,Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Carr D, Gormley GJ. 'Visiting uncertainty': an immersive primary care simulation to explore decision-making when there is clinical uncertainty. EDUCATION FOR PRIMARY CARE 2022; 33:237-243. [PMID: 35638919 DOI: 10.1080/14739879.2022.2070867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Doctors are required to be able to care for patients in a variety of settings, including the patient's home. Patients requiring urgent care in their own homes are at risk of acute deterioration. However, differentiating acute deterioration from self-limiting conditions in the primary care environment can be challenging, even for GPs who are experienced in managing clinical uncertainty and ambiguity. Preparedness for practice of foundation doctors is directly related to opportunities for experiential learning and medical students face many barriers to obtaining experience of acute care in clinical environments. Simulation has been used in healthcare education as an adjunct to experiential learning in clinical environments since the 1950s. At present, the utilisation of immersive simulation in primary care environments for medical students is uncommon even though many foundation doctors will work in primary care. This article describes how faculty at a UK medical school developed an immersive simulated home visit scenario on an 'Acute Care Course' for medical students during their Assistantship. Debriefing discussions between students, faculty, and simulated participants focused on the cognitive, emotional, and ethical impacts of uncertainty and how this influenced clinical decision-making for medical students. Having an authentic simulated scenario in the primary care environment, where clinical uncertainty and ambiguity are ubiquitous, offered students opportunities in experiential learning in how to make clinical decisions, despite clinical uncertainty and ambiguity, when assessing and caring for acutely unwell patients.
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Affiliation(s)
- Davina Carr
- School of Medicine, Dentistry and Biomedical Sciences, Clinical Skills Education Centre, Queen's University Belfast, Belfast, United Kingdom of Great Britain and Northern Ireland
| | - Gerard J Gormley
- Queen's University Belfast Faculty of Medicine Health and Life Sciences, Clinical Skills Education Centre, Belfast, United Kingdom of Great Britain and Northern Ireland
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Peerboom FBAL, Hafsteinsdóttir TB, Weldam SW, Schoonhoven L. Surgical nurses' responses to worry: A qualitative focus-group study in the Netherlands. Intensive Crit Care Nurs 2022; 71:103231. [PMID: 35396098 DOI: 10.1016/j.iccn.2022.103231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 02/27/2022] [Accepted: 02/28/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Hospital nurses observe and respond to deterioration using the 'National Early Warning Score 2'. Surgical nurses are highly engaged in the early recognition of and response to deterioration. Responses to deterioration are based on deviating vital signs, while nurses also act on subjective indicators like worry. Scientific literature and (inter)national guidelines do not mention any information about acting upon worry. OBJECTIVE To gain an in-depth understanding of the actions nurses on surgical wards undertake to generate an appropriate response to nurses' worry when the 'National Early Warning Score 2' does not indicate deterioration. METHOD A qualitative focus-group study with surgical nurses working at a hospital in the Netherlands. Data was collected by focus-group interviews supported by vignettes and analysed thematically. FINDINGS Four focus-group interviews with a total of 20 participants were conducted between February and April 2020. Two sequential themes emerged: 'Searching for explanation and confirmation' and 'Responding by actively applying nursing interventions'. Nurses gathered additional information about the patient and searched for a reference point to place this information in perspective. Nurses also approached others for co-assessment and verification. However, nurses faced barriers in calling for medical assistance. They felt physicians did not take them seriously. After gathering additional information, nurses responded by applying nursing interventions to comfort the patient. CONCLUSION Nurses mainly try to formalise an in-depth understanding of their feeling of worry to convince a physician to accurately treat the patient. Spending much time on a search to this understanding leads to delays in escalating care.
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Affiliation(s)
- F B A L Peerboom
- Nursing Sciences, Program in Clinical Health Sciences, University of Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508GA Utrecht, The Netherlands; Zuyderland Medical Center, Department of Surgery, 6419PC Heerlen, The Netherlands.
| | - T B Hafsteinsdóttir
- Nursing Sciences, Program in Clinical Health Sciences, University of Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508GA Utrecht, The Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, STR 6.131, P.O. Box 85500, 3508GA Utrecht, The Netherlands.
| | - S W Weldam
- Nursing Sciences, Program in Clinical Health Sciences, University of Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508GA Utrecht, The Netherlands; University Medical Center Utrecht, Division Heart and Lungs. P.O. Box 85500, 3508GA Utrecht, The Netherlands.
| | - L Schoonhoven
- Nursing Sciences, Program in Clinical Health Sciences, University of Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508GA Utrecht, The Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, STR 6.131, P.O. Box 85500, 3508GA Utrecht, The Netherlands; School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, UK.
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Patient Deterioration on General Care Units: A Concept Analysis. ANS Adv Nurs Sci 2022; 45:E56-E68. [PMID: 34879020 DOI: 10.1097/ans.0000000000000396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Patient deterioration is a phenomenon that occurs from the inability to recognize it or respond to a change in condition. Despite the published reports on recognizing a deteriorating patient on general care floors, a gap remains in the ability of nurses to describe the concept, affecting patient outcomes. Walker and Avant's approach was applied to analyze patient deterioration. The aim of this article was to explore and clarify the meaning of patient deterioration and identify attributes, antecedents, and consequences. The defining attributes were compared to early warning scores. An operational definition was developed and its value to nurses established.
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Towner EC, East LS, Lea J. The experiences of new graduate nurses caring for the deteriorating patient in rural areas: An integrative review. Collegian 2022. [DOI: 10.1016/j.colegn.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Zachar JJ, Reher P. Frequency and characteristics of medical emergencies in an Australian dental school: A retrospective study. J Dent Educ 2021; 86:574-580. [PMID: 34962657 DOI: 10.1002/jdd.12859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/25/2021] [Accepted: 11/23/2021] [Indexed: 11/07/2022]
Abstract
PURPOSE/OBJECTIVES The frequency of medical emergencies in a dental setting is relatively low. However, most dental treatment occurs outside of a hospital setting; thus the time to respond to a life-threatening situation is crucial. The aim of this study was to determine the frequency and characteristics of medical emergencies that occurred at the Griffith University Dental Clinic over a 6-year period. METHODS Data involving medical emergencies was collected at a dental school between January 2014 and December 2019. Data was obtained from the risk incident reporting system (GSafe), and descriptive statistics were analyzed using IBM SPSS. RESULTS The frequency of medical emergencies in a dental setting over the 6-year retrospective period based on the number of dental services provided was 0.037% (n = 108). The three most common medical emergencies were syncope (25.0%), hypoglycemia (16.7%), and foreign body ingestion (13.9%). These happened more often during dental extractions (26.9%), followed by local anesthesia (16.7%) and restorative procedures (13.0%). A larger portion of these incidents occurred during dental treatment (62.0%) as opposed to before (12.0%) or after (26.0%). Most medical emergencies happened within the dental student clinic (72.2%) followed by the dental waiting room (19.5%) and dental private clinic (8.3%). CONCLUSION Overall, the number of medical emergencies at the Griffith University Dental Clinic was low. The most common medical emergencies were syncope, hypoglycemia, and foreign body ingestion. Dental education in preventative strategies and training in basic life support is necessary to ensure dental practitioners can manage the acute deterioration of a patient promptly.
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Affiliation(s)
| | - Peter Reher
- School of Dentistry and Oral Health, Griffith University, Southport, Queensland, Australia
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Krom ZR. Patient Deterioration in the Adult Progressive Care Unit: A Scoping Review. Dimens Crit Care Nurs 2021; 39:211-218. [PMID: 32467405 DOI: 10.1097/dcc.0000000000000421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The American Heart Association set a goal in 2010 to double the percentage of hospitalized adult patients who survive cardiac arrest by 2020. Because of acuity and interventions, progressive care patients are a population of interest to address this goal. The state of the literature involving patient deterioration, which can lead to cardiac arrest, in the progressive care setting has yet to be explored. OBJECTIVE A scoping review was done to investigate the literature involving patient deterioration in adult progressive care units in order to map knowledge, identify themes, and discover areas for research potential. METHODS The scoping review began with an extensive literature search and a multistep review. The characteristics of the final group of studies were charted and grouped according to common themes. RESULTS There were 13 studies in the final group. All studies were conducted in the United States and most by interprofessional teams. Three themes were evident in the review, training methods, surveillance, and monitoring systems. DISCUSSION Patient deterioration in the progressive care unit may benefit from team-based training methods involving checklists or protocols. Nurses can use surveillance, including physical assessment and technology, to recognize early warning signs. Lastly, the use of systems that identify patterns in vital signs can be useful to reduce patient harm. Further research in this area care is warranted and could potentially improve patient outcomes and nursing practice.
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Affiliation(s)
- Zachary R Krom
- Zachary R. Krom, PhD, RN, CCRN, CHSE, NPD-BC, is an education program coordinator for Critical Care Nursing Services at Cedars-Sinai Medical Center, Los Angeles, California
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Ashokka B, Dong C, Law LSC, Liaw SY, Chen FG, Samarasekera DD. A BEME systematic review of teaching interventions to equip medical students and residents in early recognition and prompt escalation of acute clinical deteriorations: BEME Guide No. 62. MEDICAL TEACHER 2020; 42:724-737. [PMID: 32493155 DOI: 10.1080/0142159x.2020.1763286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Background: Current educational interventions and teaching for acute deteriorations seem to address acute care learning in discreet segments. Technology enhanced and team training methodologies are in vogue though well studied in the nursing profession, teaching avenues for junior 'doctors in training' seem to be a lacuna.Aims: The BEME systematic review was designed to (1) appraise the existing published evidence on educational interventions that are intended for 'doctors in training' to teach early recognition and prompt escalation in acute clinical deteriorations (2) to synthesise evidence & to evaluate educational effectiveness.Methodology: The method applied was a descriptive, justification & clarification review. Databases searched included PubMed, PsycINFO, Science Direct and Scopus for original research and grey literature with no restrictions to year or language. Abstract review, full text decisions and data extraction were completed by two primary coders with final consensus by a third reviewer.Results: 5592 titles and abstracts were chosen after removal of 905 duplications. After exclusion of 5555 studies, 37 full text articles were chosen for coding. 22 studies met final criteria of educational effectiveness, relevance to acute care. Educational platforms varied from didactics to blended learning approaches, small group teaching sessions, simulations, live & cadaveric tissue training, virtual environments and insitu team-based training. Translational outcomes with reduction in long term (up to 3-6 years) morbidity & mortality with financial savings were reported by 18% (4/22) studies. Interprofessional training were reported in 41% (9/22) of studies. Recent evidence demonstrated effectiveness of virtual environment and mobile game-based learning.Conclusions: There were significant improvements in teaching initiatives with focus on observable behaviours and translational real patient outcomes. Serious game-based learning and virtual multi-user collaborative environments might enhance individual learners' cognitive deliberate practice. Acute care learning continuum with programmatic acute care portfolios could be a promise of the future.
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Affiliation(s)
| | | | | | - Sok Ying Liaw
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore
| | - Fun Gee Chen
- Anaesthesia, National University of Singapore, Singapore
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Lavoie P, Clarke SP, Clausen C, Purden M, Emed J, Mailhot T, Fontaine G, Frunchak V. Nurses' judgments of patient risk of deterioration at change-of-shift handoff: Agreement between nurses and comparison with early warning scores. Heart Lung 2020; 49:420-425. [PMID: 32111344 DOI: 10.1016/j.hrtlng.2020.02.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/07/2020] [Accepted: 02/11/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Nurses begin forming judgments regarding patients' clinical stability during change-of-shift handoffs. OBJECTIVES To examine the agreement between incoming and outgoing nurses' judgments of deterioration risk following handoff and compare these judgments to commonly used early warning scores (MEWS, NEWS, ViEWS). METHODS Following handoffs on three medical/surgical units, nurses completed the Patient Acuity Rating. Nurse ratings were compared with computed early warning scores based on clinical data. In follow-up interviews, nurses were invited to describe their experiences of using the rating scale. RESULTS Sixty-two nurses carried out 444 handoffs for 158 patients. While the agreement between incoming and outgoing nurses was fair, correlations with early warning scores were low. Nurses struggled with predicting risk and used their impressions of differential risk across all the patients to whom they had been assigned to arrive at their ratings. CONCLUSION Nurses shared information that influenced their clinical judgments at handoff; not all of these cues may necessarily be captured in early warning scores.
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Affiliation(s)
- Patrick Lavoie
- Faculty of Nursing, Université de Montréal, C.P. 6128, succ. Centre-Ville, Montreal, QC H3C 3J7, Canada; Montreal Heart Institute Research Center, 5000 rue Bélanger, Montreal, QC H1T 1C8, Canada.
| | - Sean P Clarke
- Rory Meyers College of Nursing, New York University, 433 First Avenue, New York, NY 10010, USA.
| | - Christina Clausen
- Center for Nursing Research, Jewish General Hospital, Montreal, Canada, 3755 ch. Côte-Ste-Catherine, Montreal, QC H3T 1E2, Canada; Department of Nursing, Jewish General Hospital, Montreal, Canada, 3755 ch. Côte-Ste-Catherine, Montreal, QC H3T 1E2, Canada.
| | - Margaret Purden
- Center for Nursing Research, Jewish General Hospital, Montreal, Canada, 3755 ch. Côte-Ste-Catherine, Montreal, QC H3T 1E2, Canada; Ingram School of Nursing, McGill University, Montreal, Canada, 680 Sherbrooke West #1800, Montreal, QC H3A 2M7, Canada.
| | - Jessica Emed
- Ingram School of Nursing, McGill University, Montreal, Canada, 680 Sherbrooke West #1800, Montreal, QC H3A 2M7, Canada; Department of Nursing, Jewish General Hospital, Montreal, Canada, 3755 ch. Côte-Ste-Catherine, Montreal, QC H3T 1E2, Canada.
| | - Tanya Mailhot
- Faculty of Nursing, Université de Montréal, C.P. 6128, succ. Centre-Ville, Montreal, QC H3C 3J7, Canada.
| | - Guillaume Fontaine
- Faculty of Nursing, Université de Montréal, C.P. 6128, succ. Centre-Ville, Montreal, QC H3C 3J7, Canada; Montreal Heart Institute Research Center, 5000 rue Bélanger, Montreal, QC H1T 1C8, Canada.
| | - Valerie Frunchak
- Ingram School of Nursing, McGill University, Montreal, Canada, 680 Sherbrooke West #1800, Montreal, QC H3A 2M7, Canada; Department of Nursing, Jewish General Hospital, Montreal, Canada, 3755 ch. Côte-Ste-Catherine, Montreal, QC H3T 1E2, Canada.
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Recording and interpretation of vital signs in a selected private hospital in the KwaZulu-Natal province of South Africa. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2020. [DOI: 10.1016/j.ijans.2020.100199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Insight into hospital ward nurses' concerns about patient health and the corresponding Medical Emergency Team nurse response. Intensive Crit Care Nurs 2019; 53:100-108. [PMID: 31076253 DOI: 10.1016/j.iccn.2019.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 04/22/2019] [Accepted: 04/28/2019] [Indexed: 11/23/2022]
Abstract
AIM This study aims to understand the concerns of nurses when making MET calls which did not fulfil the vital sign criteria, and the MET nurses subsequent responses to these calls. METHODS This was a retrospective report-based study. Research material included nursing reports and MET forms related to MET calls made due to nurses' concern. Inductive content analysis was used to identify observations, which were then quantified based on the research material. FINDINGS From a total of 546 MET calls, 39 visits (7%) were due to nurses' concern. In these 39 visits, the vital sign criteria did not reach the alert threshold, but nurses made the call due to subjective worry. In 13% of visits, the alert concern was inadequate contact with the doctor. MET nurses responded to the alert by providing clinical and indirect nursing; more specifically, they performed examinations and nursing interventions and collaborated with other professionals. CONCLUSION A nurse's worry is influenced by subjective changes in the patient's condition or an inadequate doctor's response rather than objective physiological measurements. A MET nurse's ability to assess patient condition, respond to nurses' calls, and acknowledge justified alerts help MET nurses support concerned nurses and encourage them to contact the MET if necessary.
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King L, Belan I, Wilson C. Are there still barriers to MET calls–Metropolitan and regional nurses’ and midwives’ perspectives? Collegian 2019. [DOI: 10.1016/j.colegn.2018.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Alastalo M, Salminen L, Jeon Y, Vahlberg T, Leino-Kilpi H. Critical care nurses' self-assessed patient observation skills: a cross-sectional survey study. Nurs Crit Care 2019; 24:268-275. [PMID: 30637884 DOI: 10.1111/nicc.12412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 09/05/2018] [Accepted: 12/07/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Observing a patient's clinical condition is an important responsibility of critical care nurses and an essential component of their competence. Critical care nurses' patient observation skills contribute to patient safety and quality of care. These observation skills have not been assessed or measured previously. AIM The aim of this study was to measure the self-assessed level of critical care nurses' patient observation skills and to explore the factors associated with these skills. STUDY DESIGN This was a multicentre cross-sectional survey conducted in Finland. METHODS The sample consisted of critical care nurses working at Finnish university hospitals. The data were collected between September 2017 and January 2018 using an instrument developed for the study - Patient Observation Skills in Critical Care Nursing (visual analogue scale 0-100). Descriptive and inferential statistics were used to analyse the data. RESULTS A total of 372 critical care nurses (49%) responded. Finnish critical care nurses assessed their patient observation skills overall as excellent. The bio-physiological foundation was assessed as good, whereas skills in using observation methods and skills in recognizing changing clinical condition were assessed as excellent. Education for special tasks in intensive care units, information searching in scientific journals, working experience in critical care nursing and critical care nurses' perception of critical care as a preferred field of nursing were factors promoting patient observation skills. CONCLUSIONS AND RELEVANCE TO CLINICAL PRACTICE The study provided a novel instrument for measuring critical care nurses' patient observation skills. The instrument may be used as an assessment tool in clinical practice and education. Developing orientation and on-the-job training in intensive care units are essential in assuring critical care nurses' adequate patient observation skills. Patient observation skills could be developed during nursing education by providing students with opportunities for clinical training and applying patient cases in virtual learning environments.
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Affiliation(s)
- Mika Alastalo
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Leena Salminen
- Professor, Department of Nursing Science, University of Turku, Turku, Finland
| | - Yunsuk Jeon
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Tero Vahlberg
- Biostatistician, Department of Biostatistics, University of Turku, Turku, Finland
| | - Helena Leino-Kilpi
- Professor, Department of Nursing Science and Nurse Director, Turku University Hospital, University of Turku, Turku, Finland
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Ertuğ N. Evaluating the validity and reliability of the V-scale instrument (Turkish version) used to determine nurses' attitudes towards vital sign monitoring. Int J Nurs Pract 2018; 24:e12637. [PMID: 29506320 DOI: 10.1111/ijn.12637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 02/02/2018] [Accepted: 02/03/2018] [Indexed: 12/15/2022]
Abstract
AIM The aim of this study was to determine the validity and reliability of the Turkish version of the V-scale, which measures nurses' attitudes towards vital signs monitoring in the detection of clinical deterioration. METHODS This validity and reliability study was conducted at a tertiary hospital in Ankara, Turkey, in 2016. A total of 169 ward nurses participated in the study. Exploratory factor analysis, Cronbach's alpha coefficient, and the intraclass correlation coefficient were used to determine the validity and reliability of the scale. RESULTS A 5-factor, 16-item scale explained 60.823% of the total variance according to the validity analysis. Our version matched the original scale in terms of the number of items and factor structure. Cronbach's alpha coefficient of the Turkish version of the V-scale was 0.764. The test-retest reliability results were 0.855 for the overall intraclass correlation coefficient, and the t-test result was P > 0.05. CONCLUSION The V-scale is a reliable and valid instrument to measure Turkish nurses' attitudes towards vital signs monitoring in the detection of clinical deterioration.
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Affiliation(s)
- Nurcan Ertuğ
- School of Nursing, Ufuk University, Ankara, Turkey
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Albarran J, Scholes J. WiJ 2016 (March/April). Nurs Crit Care 2018; 21:61-3. [PMID: 26889645 DOI: 10.1111/nicc.12236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rihari-Thomas J, Newton PJ, Sibbritt D, Davidson PM. Rapid response systems: where we have come from and where we need to go? J Nurs Manag 2018; 26:1-2. [PMID: 29314413 DOI: 10.1111/jonm.12533] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2017] [Indexed: 12/01/2022]
Affiliation(s)
- John Rihari-Thomas
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Phillip J Newton
- Centre for Cardiovascular and Chronic Care, University of Technology Sydney, Sydney, NSW, Australia
| | - David Sibbritt
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
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