Using the NEWS2 and ABCDE assessment to identify early signs of clinical deterioration

Nurses may encounter deteriorating patients in their clinical practice, so they require an understanding of the early physiological signs of deterioration and a structured approach to patient assessment. This enables appropriate management and a timely response to the most life-threatening issues identified, such as a compromised airway. This article describes how nurses can use early warning scores and a structured patient assessment, using the ABCDE (airway, breathing, circulation, disability, exposure) framework, to identify early signs of deterioration and facilitate the timely escalation of patient care where necessary.

Nurse and Physician Perceptions and Decision Making During Interdisciplinary Communication: Factors That Influence Communication Channel Selection

Errors in decision making and communication play a key role in poor patient outcomes. Safe patient care requires effective decision making during interdisciplinary communication through communication channels. Research on factors that influence nurse and physician decision making during interdisciplinary communication is limited. Understanding influences on nurse and physician decision making during communication channel selection is needed to support effective communication and improved patient outcomes. The purpose of the study was to explore nurse and physician perceptions of and decision-making processes for selecting interruptive or noninterruptive interdisciplinary communication channels in medical-surgical and intermediate acute care settings. Twenty-six participants (10 RNs, 10 resident physicians, and six attending physicians) participated in semistructured interviews in two acute care metropolitan hospitals for this qualitative descriptive study. The Practice Primed Decision Model guided interview question development and early data analysis. Findings include a core category, Development of Trust in the Communication Process, supported by three main themes: (1) Understanding of Patient Status Drives Communication Decision Making; (2) Previous Interdisciplinary Communication Experience Guides Channel Selection; and (3) Perceived Usefulness Influences Communication Channel Selection. Findings from this study provide support for future design and research of communication channels within the EHR and clinical decision support systems.

Could Spatial Awareness Affect Situation Awareness: A Conceptual Examination

PURPOSE

The purpose of this study was to explore the relationship between situation awareness (SA) and the physical environment in patient rooms through building a conceptual model.

BACKGROUND

Nurses work in very complicated and dynamic environments where having high levels of SA could be critical for their performance. Studies have also shown that nurses' awareness of the physical environment and patient room is a part of their awareness of dynamic situations in which nurses' spatial awareness may play a role in SA. Despite literature outlining the importance of SA, there is a lack of studies exploring the relationship between the two.

METHOD

A literature review was conducted for the study from nursing and psychology databases. Thirty-three articles, books, and dissertations from a scoping review were included for in-depth review.

RESULTS

An in-depth review of the harvested literature indicated that there is in fact a relationship between these two phenomena. Founded on Endsley's model of SA, the literature review in this study offers a conceptual model that articulates a plausible causal pathway between the physical environment and SA.

CONCLUSIONS

There are a lot of studies focusing on SA and various aspects of it related to nursing, but almost none mention the physical environment and its impact on SA. The current inquiry suggests that spatial awareness plays a prominent role in SA.

Identifying firefighters' situation awareness requirements for fire and non-fire emergencies using a goal-directed task analysis

A firefighter's situation awareness (SA) is considered crucial to making effective tactical decisions and actions at the scene. Despite the importance of the firefighter's SA, there have been limited research efforts to understand what cues and information firefighters use to assess ongoing situations and predict future conditions. In addition to fire events, contemporary firefighters respond to an increasing volume of non-fire incidents. Thus, this study aims to identify firefighters' SA during three fire incidents (single house fire, vehicle fire, and passenger aircraft fire) and three non-fire incidents (medical emergency, hazardous materials, and urban search and rescue). A goal-directed task analysis was conducted via focus group discussions with eight career firefighters. Findings indicate that firefighters build their SA by processing various cues from hazards (e.g., fire, ignition source), humans (e.g., occupants, bystanders, drivers, passengers), spatial elements (e.g., building structure, location of hazards), and surrounding conditions (e.g., traffic, weather). Our findings provide insights into SA measurement, SA-oriented work processes, training for SA, and designing technologies to support firefighters' SA during all-hazard responses.

Measuring situation awareness in health care providers: a systematic review of measurement properties using COSMIN methodology

BACKGROUND

Situation awareness (SA) is a key factor in accountability and ensuring patient safety in health care. SA is an essential element to research on human factors in healthcare. It is essential to identify valid instruments for measuring this concept and assessing how it is affected by interventions and educational methods.

METHODS

This systematic review aimed to assess the measurement properties of situation awareness instruments in health care providers' (HCP_S) using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology. Four databases (Medline (through PubMed), Embase, Scopus, and Web of Science) were systematically searched. A manual search was also conducted on Google Scholar and the reference list of the included primary studies to supplement the electronic search. Studies aiming to determine the measurement properties of SA instruments or non-technical skills in HCP_S were included. The overall results for each measurement property were reported as sufficient, insufficient, inconsistent, or indeterminate, and the quality of evidence was reported as high, moderate, low, or very low.

RESULTS

A total of 25 studies and 15 instruments were included in the study. More than one measurement property was reported in some of the studies, and none of the studies presented all measurement properties. The most common measurement properties were content validity (12/25) and internal consistency (12/25). Cross-cultural validity and responsiveness were not investigated in any study. Evidence quality for the measurement properties was not high in any of the 15 instruments.

CONCLUSIONS

None of the instruments can be recommended as the most suitable instrument, and all instruments were classified as promising instruments in need of further psychometric assessment. This systematic review proves the dire need for the development and psychometric evaluation of instruments to measure SA in HCPs in clinical settings.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42020147349.

Situation Awareness-Oriented Dashboard in ICUs in Support of Resource Management in Time of Pandemics

In a pediatric intensive care unit (PICU) of 32 beds, clinicians manage resources 24 hours a day, 7 days a week, from a large-screen dashboard implemented in 2017. This resource management dashboard efficiently replaces the handwriting information displayed on a whiteboard, offering a synthetic view of the bed's layout and specific information on staff and equipment at bedside. However, in 2020 when COVID-19 hit, the resource management dashboard showed several limitations. Mainly, its visualization offered to the clinicians limited situation awareness (SA) to perceive, understand and predict the impacts on resource management and decision-making of an unusual flow of patients affected by the most severe form of coronavirus. To identify the SA requirements during a pandemic, we conducted goal-oriented interviews with 11 clinicians working in ICUs. The result is the design of an SA-oriented dashboard with 22 key indicators (KIs): 1 on the admission capacity, 15 at bedside and 6 displayed as statistics in the central area. We conducted a usability evaluation of the SA-oriented dashboard compared to the resource management dashboard with 6 clinicians. The results showed five usability improvements of the SA-oriented dashboard and five limitations. Our work contributes to new knowledge on the clinicians' SA requirements to support resource management and decision-making in ICUs in times of pandemics.

Developing a Preclinical Nurse-Nurse Communication Framework for Clinical Trial Patient-Related Safety Information

Clinical trial trials have become increasingly complex in their design and implementation. Investigational safety profiles are not easily accessed by clinical nurses and providers when trial participants present for clinical care, such as in emergency or urgent care. Wearable devices are now commonly used as bridging technologies to obtain participant data and house investigational product safety information. Clinical nurse identification and communication of safety information are critical to dissuade adverse events, patient injury, and trial withdrawal, which may occur when clinical care is misaligned to a research protocol. Based on a feasibility study and follow-up wearable device prototype study, this preclinical nurse-nurse communication framework guides clinical nurse verbal and nonverbal communication of safety-related trial information to direct patient care activities in the clinical setting. Communication and information theories are incorporated with Carrington's Nurse-to-Nurse Communication Framework to encompass key components of a clinical nurse's management of a trial participant safety event when a clinical trial wearable device is encountered during initial assessment. Use of the preclinical nurse-nurse communication framework may support clinical nurse awareness of trial-related wearable devices. The framework may further emphasize the importance of engaging with research nurses, patients, and caregivers to acquire trial safety details impacting clinical care decision-making.

Start here- principles of effective undergraduate training

Obstetric and gynaecology undergraduate training is an intense time for learners as they encounter various health conditions related to women's health and also learn about pregnancy care and birth. The experience is directed to familiarise students with basic clinical management of gynaecological conditions, also develop communication and related core examination and procedural skills. Similarly, midwifery training encompasses independent care of low-risk pregnant women and assist in care of high-risk pregnancy in partnership with obstetricians. Although its necessary to acquaint most learners with core clinical skills in obstetrics and gynaecology, learning opportunities on patients can be limited, due to the intrusive nature of women's health examination. Simulation Based Education (SBE) can facilitate learning hands-on clinical examination and procedural skills, using realistic part-task and high-fidelity simulators prior to approaching patients. This can apply to both medical and midwifery undergraduate training, further creating opportunities for professional interaction and shared learning space to facilitate interprofessional education. IPE has been shown to improve professional relationships in practicing clinicians. This learning pedagogy can be applied in the undergraduate setting as well, to decrease risk of conflict and appreciate roles of other interprofessional staff in future clinical practice. In this chapter we highlight some challenges faced by medical and midwifery undergraduates in their learning from a global perspective. We also describe some teaching and learning initiatives that can be applicable across various settings of obstetrics, gynaecology medical undergraduate and midwifery teaching with relevant case studies to facilitate new graduates preparedness for practice.

Life Events and Adaptive Coping Approaches to Self-Management From the Perspectives of Hospitalized Cardiovascular Patients: A Qualitative Study

Objectives: This study aimed to explore the association between hospitalized cardiovascular patients' life events and adaptive coping approaches to self-management. Methods: The study was a qualitative study that was conducted in a cardiology department of one affiliated university hospital in Hangzhou, China. Twenty-eight participants with cardiovascular diseases were recruited through a purposive sampling procedure. Semi-structured interviews were used to gain insights into adaptive coping approaches to self-management when living with different life events. Interviews were audio-recorded and transcribed, and the data were analyzed by thematic analysis. Results: Life events reported by hospitalized cardiovascular participants could be summarized in four categories: daily routines, life changes, life-threatening experiences, and emotional sufferings. The adaptive coping approaches were also summarized in four themes: decision-making, avoidance, consistent responses, and episodic responses. Conclusion: This study described essential insights into the mutual influences between various life events and adaptive coping approaches to self-management by a group of hospitalized cardiovascular patients. Participants coped with their problems flexibly by processing comprehensive information from various and unpredictable life events regarding the situations and contexts. While inequity was cumulated, psychological resilience was a vital mediator between stressful events and their responses. The study illuminated the importance of understanding context, situations, and experiences on how cardiovascular patients adapted to their self-management regimens.

Leadership's Impact on Quality, Outcomes, and Costs

In the move to increase effectiveness in valued-based organizational cultures, mindfulness leaders are charged to create environments that foster curiosity and creativity in uncertain times. Mindfulness increases situational awareness and improved communication enhances a culture of safety and better patient outcomes. Mindfulness leadership matters, providing effective ways to communicate and collaborate with others. Results matter, increasing the ability to sustain improvement through increased awareness, and enhancing healthy work environments and joy in the workplace. This article provides useful tools, strategies, and tips for mindful leaders and facilitates greater impact on improved patient and employee outcomes.