Combining the Nurse Intuition Patient Deterioration Scale with the National Early Warning Score provides more Net Benefit in predicting serious adverse events: A prospective cohort study in medical, surgical, and geriatric wards

OBJECTIVES

This prospective cohort study aimed to assess the predictive value of the Nurse Intuition Patient Deterioration Scale (NIPDS) combined with the National Early Warning Score (NEWS) for identifying serious adverse events in patients admitted to diverse hospital wards.

RESEARCH METHODOLOGY/DESIGN

Data was collected between December 2020 and February 2021 in a 350-bed acute hospital near Brussels, Belgium. The study followed a prospective cohort design, employing NIPDS alongside NEWS for risk assessment. Patients were monitored for 24 h post-registration, with outcomes recorded.

SETTING

The study was conducted in a hospital with a Rapid Response System (RRS) and electronic patient record wherein NEWS was routinely collected. Patients admitted to two medical, two surgical, and two geriatric wards were included.

MAIN OUTCOME MEASURES

The primary outcome included death, urgent code calls, or unplanned ICU transfers within 24 h after NIPDS registration. The secondary outcome comprised rapid response team activations or changes in Do-Not-Resuscitate codes.

RESULTS

In a cohort of 313 patients, 10/313 and 31/313 patients reached the primary and secondary outcome respectively. For the primary outcome, NIPDS had a sensitivity of 0.900 and specificity of 0.927, while NEWS had a sensitivity of 0.300 and specificity of 0.974. Decision Curve Analysis demonstrated that NIPDS provided more Net Benefit across various Threshold Probabilities. Combining NIPDS and NEWS showed potential for optimizing rapid response systems. Especially in resource-constrained settings, NIPDS could be used as a calling criterion.

CONCLUSION

The NIPDS displayed strong predictive capabilities for adverse events. Integrating NIPDS into existing rapid response systems can objectify nurse intuition, enhancing patient safety.

IMPLICATIONS FOR CLINICAL PRACTICE

The Nurse Intuition Patient Deterioration Scale (NIPDS) is a valuable tool for detecting patient deterioration. Implementing NIPDS alongside traditional scores such as NEWS can improve patient care and safety. The optimal NIPDS threshold to activate rapid response is ≥5.

Use of immersive virtual reality to reduce anxiety during complex paediatric dressing changes

In recent years, there has been an increasing interest in the practical applications of virtual reality (VR) in healthcare. One discussed application of this technology is to reduce anxiety during procedures for paediatric patients. Following skin loss in paediatric patients, careful management of the wound with appropriate dressings and frequent dressing changes is a key part of the treatment process. In children, continued dressing changes are often a source of anxiety, which complicates procedures causing distress to the child, their parents and staff members. VR systems have the potential to not only reduce anxiety but also pain in children requiring frequent dressing changes. Although our knowledge of this technology is improving, further research is needed to evaluate its full potential in this population and to establish guidelines to take advantage of the full potential of VR technology.

Nicaraguan and US nursing collaborative evaluation study: Identifying similarities and differences between US and Nicaraguan curricula and teaching modalities using the community engagement model

BACKGROUND

Curricula evaluation is an essential phase of curriculum development. Study describes the implementation of a formative evaluation used by faculty members between Universidad Nacional Autonóma de Nicaragua (UNAN-Leon) Escuela de Enfermeriá, Nicaragua and East Carolina University College of Nursing (ECU CON) in North Carolina, US.

OBJECTIVES

Program evaluation study to conduct an assessment, comparison of a medical-surgical adult curriculum and teaching modalities. Also, explore the Community Engagement (CE) Model to build a Central American-US faculty partnership.

DESIGN

Methodological evaluation study utilizing a newly developed International Nursing Education Curriculum Evaluation Tool related to adult medical and surgical nursing standards. Also, the CE Model was tested as a facilitation tool in building partnerships between nurse educators.

DATA

Nicaragua and US nursing faculty teams constructed the curriculum evaluation by utilizing the International Nursing Education Curriculum Evaluation Tool (INECET) by reviewing 57 elements covering 6 Domains related to adult medical and surgical nursing standards.

METHODS

Developed, explored the utilization of the INECET based on a standard of practice framework. The Community Engagement Model, a fivephase cycle, Inform, Consult, Involve, Collaborate, and Empower was utilized to facilitate the collaborative process.

RESULTS

Similarities between the US and Nicaraguan curricula and teaching modalities were reflective based on the 57 elements covering 6 Domain assessment tool. Case studies, lecture, and clinical hospital rotations were utilized as teaching modalities. Both schools lacked sufficient time for clinical practicum time. The differences, included UNAN-Leon had a lack of simulation skill lab, equipment, and space, whereas ECU CON had sufficient resources. The ECU school lacked applied case studies from a rural health medical-surgical adult nursing perspective and less time in rural health clinics. The UNAN-Leon nursing standards generalized based on the Ministry of Health (MINSA) and the US program was specific based on the American Nurses Association and various sub-specialties of nursing practice requirements. The CE Model was a useful framework to facilitate a collaborative partnership.

CONCLUSION

Collaborative evaluation study using the International Nursing Education Curriculum Evaluation Tool can be an effective method to evaluate medical and surgical curricula similarities and differences within international nursing schools. The Community Engagement Model fostered a faculty partnership.