Creating a culture of support for nursing surveillance.

BACKGROUND: An estimated 98,000 deaths annually result from medical errors. Preventing these deaths must be a US healthcare goal. Surveillance decreases adverse events. Surveillance is essential for patient safety. Creating a unit culture that supports surveillance requires attention to its antecedents (nurse education, nurse expertise, nurse staffing, as well as organizational culture). METHOD: The current literature on topics salient to creating a culture of nursing surveillance including its antecedents and its attributes were reviewed. The findings are summarized and presented. DISCUSSION: Suggestions and tools enhancing a culture of safety allow the transition from one set of behaviors to another. An organizational culture that strives for excellence promotes surveillance which results in improved patient outcomes and better qualified nurses. CONCLUSION: Unit change resulting in support for surveillance can minimize failure to rescue and promote interruption of adverse events. The patient outcomes include decreased morbidity and mortality.

Nursing surveillance of respiratory adverse events among hospitalized adults: A systematic review to guide evidence-based practice.

BACKGROUND: Nursing surveillance (NS) involves the purposeful, ongoing acquisition, interpretation, and synthesis of patient data for clinical decision-making. Surveillance is used to identify patients with early signs of distress and prevent adverse events. The processes that support and measure the outcomes of nursing surveillance are not clearly specified. AIM: The aim of this systematic review was to describe the impact of NS on respiratory adverse events for adult hospitalized patients. METHODS: The PRISMA model guided this systematic search of Academic Search Complete (EBSCOhost), CINAHL Complete (EBSCOhost), Nursing & Allied Health (ProQuest), and PubMed databases for articles published between 1990 and 2019. Search terms included nursing surveillance, data points typically attributed to nursing surveillance, adult hospitalized patients, and adverse respiratory events. The protocol for this review was registered as PROSPERO: CRD42020147557. RESULTS: Of the 2907 references screened, 67 full-text articles were reviewed and 10 were eligible for inclusion. Research on nursing surveillance in the presence of respiratory deterioration is limited. Six studies used assessment tools that were generated from early warning scores, and four used research or institutionally designed trigger criteria. Surveillance, like other types of nursing care, was difficult to isolate and measure. Although components of surveillance were described in the selected studies, the nurse's role was not explicitly identified. Further research is required to highlight the role nursing surveillance plays in clinical decision-making to keep patients safe. LINKING EVIDENCE TO ACTION: The attributes of NS provide a useful intervention guide for the hospitalized patient at risk of deterioration. Early warning score techniques provide empirical evidence for identifying patients at risk of deterioration. The findings of this study provide evidence of the significance for research focused on the attributes of NS relative to responding to patients at risk of deterioration.

Nursing surveillance: A concept analysis.

AIM: To provide a framework to assess and evaluate nursing surveillance of patients. BACKGROUND: The Nursing Interventions Classifications define surveillance as the purposeful and ongoing acquisition, interpretation, and synthesis of patient data for clinical decision making and is essential for improving patient safety. DATA SOURCE: The existing literature was searched using CINAHL, OVID, EmCare, and 11 ScienceDirect databases. METHODS: The Walker and Avant method was used to analyze the concept of surveillance. RESULTS: Technology that facilitates surveillance in the community is ubiquitous in acute care settings. Nurses caring for patients use a tremendous volume of patient data to inform their clinical decision-making. Five attributes are associated with nursing surveillance: systematic process, pattern recognition, coordinated communication, the anticipation of problems of instability, and decision making. Surveillance is dynamic and extends over time. Antecedents to nursing surveillance include sufficient nurse education, nurse expertise, nurse staffing, as well as an organizational culture that supports nursing surveillance. When nursing surveillance is present, patient safety is enhanced and adverse events that harm patients are reduced. The concept of nursing surveillance is complex and defies empirical measurement, though it is possible to measure the attributes and outcomes. CONCLUSIONS: Nursing surveillance is essential to the safe management of complex patient cases. Surveillance is more than monitoring or simple patient observation. Monitoring is an essential part of surveillance but incorporating the critical attributes of surveillance lead to improved patient outcomes.