Nurses’ knowledge and self-reported clinical reasoning on clinical deterioration after surgery

Abstract

Background: Clinical deterioration is defined as a decline in a patient’s haemodynamic stability, and this can be evidenced by physiological decompensation that is expressed in abnormal vital signs and clinical observations. Patients who have undergone a surgical procedure, require close monitoring during their hospital stay, and nurses and other professionals should be able to identify early signs and respond to clinical deterioration accordingly. No local research is available on nurses’ level of knowledge on clinical deterioration after surgery; therefore, this study aims to address this gap in research. Aims: To assess local nurses’ level of knowledge of clinical parameters associated with clinical deterioration after surgery; to explore the factors affecting nurses’ ability to identify and respond to patient deterioration after surgery; to assess the nurses’ self-reported clinical reasoning ability on clinical deterioration after surgery. Participants and Setting: All nurses working in surgical wards in the main acute hospital in Malta. Methods and Design: A descriptive, cross-sectional survey was conducted. Data were collected through a paper-based questionnaire assessing nurses’ perceived ability to identify and respond to clinical deterioration, nurses’ level of knowledge on the physiological parameters and clinical observations indicating early signs of deterioration and nurses’ self-reported clinical reasoning ability. Questionnaires were distributed to nurses working in all surgical wards in an acute hospital in Malta. A total of 204 questionnaires were distributed to all nurses working in surgical wards. Results: A response rate of 66.7% was achieved (n=136). The results of the study present a moderately low level of knowledge (55.93%) and high perceived ability to identify and respond to clinical deterioration and self-reported clinical reasoning skills. Nurses with a higher nursing-related qualification and more years of clinical experience reported a significantly higher self-reported ability to identify and respond to clinical deterioration. Statistical differences were noted between nurses’ level of knowledge and clinical experience. Nurses with a higher nursing-related qualification, older age and more years of clinical experience had a higher self-reported clinical reasoning. A strong positive relationship was observed between nurses perceived ability to identify and respond to clinical deterioration and self-reported clinical reasoning. Conclusion: Locally, more efforts need to be made to improve nurses’ level of knowledge on clinical deterioration after surgery. A better level of knowledge may improve the overall quality of care, minimise the risk of adverse events, intensive care admissions and improve the general conditions of the patients. This can only be achieved if nurses are prompt to identify the early signs of clinical deterioration. Further research is recommended to determine further the level of knowledge of nurses, and the factors influencing nurses’ ability to identify and respond clinical deterioration after surgery. Additionally, efforts need to be made by policymakers and hospital management to address these factors and present clear guidelines on the early signs of deterioration.