RISK OF DETERIORATION AMONG GENERAL WARD PATIENTS: NURSES’ ABILITY IN ASSESSING EARLY WARNING SIGNS
The challenge of recognizing ward-based patients at risk of deterioration is discussed frequently within the relevant literature. Nurses in particular hold the prime position to identify problems at an early stage using systematic patient assessment. However, general ward nurses’ perceived knowledge, attitudes, and practice related to assessment of the risk of deterioration are not well understood. Failures to recognize or act upon the deterioration of general ward patients has sometimes resulted in the implementation of early warning scoring systems and Critical Care Outreach teams.
Aim: The study aim to explore general ward nurses’ perceived knowledge, attitude, and practice (KAP) in assessing patients at risk of deteriorating in general wards.
A Cross-sectional study design with Modified Early Warning Score questionnaire for general ward nurses was done in one tertiary hospital in Malaysia in 2013 and 2014.
Results: General ward nurses perceived that they struggled with knowledge and attitude, but they feel they performed good practice in assessing patients at risk for deterioration. Nevertheless, the study finding shows otherwise. Only one respondent achieved ‘grade B’ (85%) and the remainder scored in the band ‘grade F’ (very poor). The respondents’ attitude was measured by their perception of their levels of confidence and concern. The mean confidence level was greater than six out of 10 for all categories. The attitudes mean score ± SD was set at 42.02 ±7.76. The data showed that 51% (N=50) scored below mean core of 42.02. However, participants’ overall mean score ±SD for perceptions of practice (risk of deterioration assessment) was 90.27 ± 21.87 (6.94+/-1.683). The majority of participants awarded themselves a score between eight and nine, which is in the ‘good’ range for the scale (0-2 weak; 3-5 moderate; 6-8 good; 9-10 excellent). Those who scored above it were classified as having a good attitude.
Conclusion: A need exists for general ward nurses to gain a knowledge foundation in detecting abnormality to address lack of confidence, poor attitude and alertness, and concern.
Keywords:General ward nurses, Risk of deterioration, Nurses’ perceptions, Critical Care outreach services, Malaysia
APA Council of Representatives (2011) Principles for the recognition of specialties in professional
psychology, Retrieved May 20, 2014 from https://www.apa.org/about/policy/principlesrecognition.
Audit Commission Critical to Success: The place of efficient and effective critical care serviced within the acute hospital, 1999; Audit Commission. London
Bainbridge D, Adsetts D, Bray K, Mcdonnell A. & Tod A., (2010) An evaluation of the impact of introducing a new model for recognizing and responding to early signs of deterioration in patients
at the Rotherham NHS Foundation Trust. Retrieved May 20, 2014, from http://shura.shu.ac.uk
Bonnici, T., Gerry, S., Wong, D., Knight, J. & Watkinson,P., (2016) Evaluation of the effects of implementing an electronic early warning score system: protocol for a stepped wedge study. BMC medical informatics and decision making, 16(1), pp 19.
Carberry, M., (2006). Hospital Emergency Care Teams: our solution to out of hours emergency care.
Nursing in Critical Care, 11, pp 177–187.
Chan PS, (2015). Public health burden of in-hospital cardiac arrest. (Paper commissioned by the Committee on the Treatment of Cardiac Arrest: Current Status and Future Directions). http://www?.iom.edu/~?/media/Files/Report%20Files/2015/GWTG?.pdf. [Reference list]
Chapman L, Blackman J., (2010). Using supported learning to ensure nurse recruits are skilled to care for acutely ill patients. Nursing Times, 106, pp 10-11
Chen J., Ou L, Hillman KM, Flabouris A, Bellomo A,Hollis SJ & Assareh H., (2014). Cardiopulmonary
arrest and mortality trends and their association with rapid response system expansion, The Medical
Journal of Australia; 201 (3), pp 167-170.
Cooper S., McConnell-Henry T., Cant R. & Porter J.,(2011). Missen K, Kinsman L, Endacott R, Scholes
J.Managing deteriorating patients: registerednurses' performance in a simulated setting. Open Nursing Journal. 5, pp 120-6
Davis L., Taylor H. & Reyes H., (2014). Lifelong learning in nursing: a Delphi study. Nurse Education Today, 34(3), pp 441-5
Elliott M, Coventry A., (2012). Critical care: the eight vital signs of patient monitoring. British Journal of Nursing, 21(10),pp 621-5
Fletcher G., Flin R., McGeorge P., Glavin R., Maran N. & Patey R. (2003). Anaesthetists' non‐technical skills (ANTS): evaluation of a behavioural marker system. British Journal of Anaesthesia, 90(5), pp 580-8
Hart P.L., Spiva L., Baio P., Huff B., Whitfield D., Law T., Wells T. & Mendoza I.G. (2003). Medicalsurgical nurses' perceived self-confidence and leadership abilities as first responders in acute patient deterioration events. Journal Clinical Nursing, 23, pp 2769–78
Hill, K. (2010). Improving quality and patient safety by retaining nursing expertise. Online Journal of Issues in Nursing, 15(3).
Institute of Health and Nursing Australia, (2014).The importance of nurse having the right attitude. Retrieved May 20, 2014 , from: http://blog.ihna.edu.au/2014/01/the-importanceof-
Kerridge, R.K. & Saul, W.P. (2003). The medical emergency team, evidence-based medicine and
ethics. Medical Journal of Australia, 179,pp 313-315.
Kyriacos, U., Jelsma, J., James, M. and Jordan, S., (2015). Early warning scoring systems versus
standard observations charts for wards in South Africa: a cluster randomized controlled trial. Trials,16(1), pp 103.
Massey D, Chaboyer W, Anderson V. (2017) What factors influence ward nurses' recognition of and response to patient deterioration? An integrative review of the literature. Nursing Open. 4(1), pp 6-23.
Massey D., Chaboyer W. & Aitken L. (2014). Nurses' perceptions of accessing a Medical Emergency Team: A qualitative study. Australian Critical Care, 27(3), pp 133–8.
McDonnell A., Esmonde L., Morgan R., Brown R., Bray K., Parry G., Adam S., Sinclair R., Harvey S., Mays N. & Rowan K. (2007). The provision of critical care outreach services in England: findings from a national survey. Journal Critical Care, 22(3), pp 212-8.
Melnyk BM, Fineout-Overholt E., (2005). Evidencebased practice in nursing & healthcare: a guide to best practice. Lippincott Williams & Wilkins. Philadelphia
Morrison L.J., Neumar R.W., Zimmerman J.L., Link M.S., Newby L.K., McMullan P.W. Jr., Hoek T.V., Halverson C.C., Doering L., Peberdy M.A. & Edelson D.P., (2013). Strategies for improving survival after in-hospital cardiac arrest in the United States: 2013 consensus recommendations: A consensus statement from the American Heart Association. Circulation. 127(14),pp 1538–1563.
Nolan J.P., Soar J., Zideman D.A., Biarent D., Bossaert L.L., Deakin C., Koster R.W., Wyllie J. & Bottiger B., (2010). European Resuscitation Council guidelines for resuscitation 2010 section 1.
Executive summary. Resuscitation. 81(10), pp 1219–1276.
Odell, M., Victor, C. & Oliver, D., (2009). Nurses' role in detecting deterioration in ward patients: systematic literature review. Journal of advanced nursing, 65(10), pp.1992-2006.
How to Cite
Copyright (c) 2017 Malaysian Journal of Medical Research (MJMR)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.