Developing the recognition and response skills of student nurses.

Acute deteriorations in health occur in all healthcare settings. Every health professional must therefore have the knowledge and skills to recognise and respond effectively to acute illness, in order to avert further deterioration. It is widely acknowledged that a robust understanding of physiological observations, in addition to effective interpretation and clinical decision-making skills, is required for this task (Odell et al, 2009; Steen, 2010). A significant amount of work has been undertaken in one higher education institution (HEI) to ensure that theoretical preparation adequately equips nurses for this aspect of their role. However, it would appear from this evaluative study that some barriers may exist that prevent this essential theoretical knowledge from being embedded into clinical practice. This gap in transformational knowledge is important to highlight as there is an increasingly urgent need for these skills if acutely ill patients are to be successfully rescued (The National Confidential Enquiry into Patient Outcome and Death (NCEPOD), 2005; 2009; 2012; National Institute for Health and Care Excellence (NICE), 2007 Department of Health (DH), 2009). The dissolution of barriers that prevent the development of effective recognition and response skills is an important task for all those involved in acute care education, in both HEI and clinical settings.

Recognizing and responding to hyperglycaemic emergencies.

Diabetic ketoacidosis (DKA) and hyperglycaemic hyperosmolar state (HHS) are both diabetic emergencies associated with hyperglycaemia and can be fatal if healthcare professionals fail to recognize and intervene appropriately. While many students and qualified nurses may be able to recall common signs and symptoms related to DKA and HHS - for example polyuria, polydipsia and elevated blood sugars - understanding the physiological mechanisms behind abnormal observations and restoring homeostasis through appropriate management is far more complex. Health educators can play a significant role in contextualizing difficult concepts, such as DKA and HHS, so that these complex conditions can be recognized with greater confidence and competence in clinical practice.

Nursing observations: knowledge to help prevent critical illness.

Early warning scoring systems have made some progress in facilitating the earlier identification of critical illness. Nurses should, however, take a professional responsibility to ensure that they can understand the significance of the patient observations that they have recorded. The authors have illustrated, through the use of a case study, how an understanding of the physiological processes that influence trends in the patient's observations could be vital in the prevention of a serious life-threatening event. Conclusions drawn from analyzing these observations with a problem-solving approach can be effectively communicated to the multidisciplinary team and lead to more appropriate care delivery.