Nurses' understanding and detection of physiological deterioration.

Abstract

Nurses have long played a pivotal role in the detection of physiological deterioration. The early recognition and correction of physiological abnormalities can improve patient outcome by reducing the risk of adverse events, making nurses' ability to detect, interpret and respond to physiological abnormalities imperative. The aim of this quantitative study is to explore the way Maltese nurses understand physiological detection and deterioration in their clinical context. As this issue has not been studied locally, an exploratory approach was adopted. Data was collected using a self-administered questionnaire, consisting of predominantly closed ended questions, analysed descriptively, with one open ended question, analysed using thematic content analysis. Vignettes were used to test knowledge. A convenient sample of 20 nurses, currently working on acute medical wards were approached to take part voluntarily in this study; all nurses accepted, a 1 00% response rate was achieved. Findings showed that nurses pre-eminently understand detection of physiological deterioration as they achieved an average score of 81% in knowledge. This satisfactory score could be explained by physiological detection being a fundamental, routine skill carried out consistently, to all patients under their care. The findings revealed a discrepancy between what parameters and criteria nurses considered being important and what is actually monitored or documented in their clinical context apropos physiological recognition. This disparity could be explained; that nurse's monitoring observations are highly influenced by what doctors order rather what they autonomously think should be observed. Nurses also highlighted the factors that could inhibit identification of patients at risk of deterioration, which could have an effect on their confidence in early stage detection. Although these findings can be considered insightful, they cannot be considered conclusive and must be considered with caution in light of the various limitations of the study. Nurses' detection of physiological deterioration must be effective in its early recognition in patient assessment. The adoption of a tool, such as an Early Warning Score could be of help in the timely recognition of theses patients.