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1.
Hu Li Za Zhi ; 67(1): 4-5, 2020 Feb.
Artigo em Chinês | MEDLINE | ID: mdl-31960390

RESUMO

Disease progression often differs among patients. According to study findings, changes in vital signs, blood oxygen saturation, and consciousness are each related closely to acute deterioration in disease status (Sutherasan et al., 2018). The early warning system (EWS) is a predictive approach to detecting deterioration in disease condition based on the observation of slight variations in patient vital signs and clinical symptoms (Smith et al., 2014). Most patients experience changes in specific physiological variables before experiencing a cardiac arrest. The implementation of a comprehensive EWS facilitates the early identification and prevention of serious adverse events such as unexpected cardiac arrest and death, and may help reduce the risk of other unexpected events as well (Gerry et al., 2017). For medical team members, the use of EWS not only permits the detection of changes in patient condition at an early stage but also allows healthcare workers to respond more proactively and effectively. Moreover, EWS has been shown to improve communication, increase cooperation, and strengthen personal responsibility among healthcare workers (Burns et al., 2018). In summary, implementing EWS allows the prompt initiation of appropriate patient treatment and helps improve patient-care outcomes. While recognizing the importance of incorporating EWS into patient care in clinical and home-based institutions as an important strategy to protecting the lives of patients, appropriate standardized warning systems must be tailored to address different disease characteristics. Changes in patient condition are traditionally addressed through nursing assessment followed by physician notification and response. However, this process may be affected by factors such as assessment accuracy, cultural differences, confidence, and past experiences that may result in decision-making errors (Wood, Chaboyer, & Carr, 2019). The integration of EWS and medical informatics technology is expected to reduce the risks of human-interpretation-related omissions and errors (Downey, Tahir, Randell, Brown, & Jayne, 2017). Although the use of medical informatics technology to enhance EWS remains in its infancy, this will certainly be one of the future trends in patient care. The articles in this issue, in addition to introducing EWS, elucidate the current application of EWS in clinical critical conditions and introduce how informatics technology is being combined in home EWS applications. These articles comprise a rich body of information on EWS that may referenced in clinical nursing care, home care, education, and research.


Assuntos
Deterioração Clínica , Diagnóstico Precoce , Parada Cardíaca/prevenção & controle , Humanos , Sinais Vitais
2.
Hu Li Za Zhi ; 67(1): 6-11, 2020 Feb.
Artigo em Chinês | MEDLINE | ID: mdl-31960391

RESUMO

Related studies in the literature indicate that over half (50-84%) of patients exhibit physiological variations 6 hours before experiencing cardiac arrest. Early warning systems improve the ability of medical teams to detect patient deterioration and then immediately treat sudden cardiac arrest during patient hospitalization. This article aims to strengthen general understanding among clinical medical staffs of the early warning system. Understanding the reasons and motivations for establishing this system is expected to help readers better distinguish the physiological monitoring indicators of this system and its importance in terms of improving patient safety. In particular, using the system to identify patients at risk levels of medium or higher will help facilitate their timely transfer to an intensive care unit for appropriate monitoring and care. This article further explores the application of early warning systems in nursing to help nurses understand their professional roles and responsibilities as members of the rapid-response team. Finally, information in this article teaches medical staffs how to avoid unanticipated cardiac arrest events, create a comprehensive patient safety environment, and improve the quality of medical care.


Assuntos
Deterioração Clínica , Diagnóstico Precoce , Parada Cardíaca/prevenção & controle , Equipe de Respostas Rápidas de Hospitais/organização & administração , Humanos , Papel do Profissional de Enfermagem
3.
Hu Li Za Zhi ; 67(1): 19-24, 2020 Feb.
Artigo em Chinês | MEDLINE | ID: mdl-31960393

RESUMO

Monitoring the current and ongoing health status of patients with critical illnesses is an important function in critical care. Science-based assessments permit the early detection of deterioration in patient condition and the early implementation of medical care interventions. In this article, the empirical literature on this topic is reviewed and common early warning systems used currently and previously to detect deterioration in critically ill patients, including the disease severity assessment system, the early warning scoring tool, and the sequential organ failure assessment, are introduced. It is hoped that nursing staffs in acute and intensive care units use the information in this article to apply and validate early warning systems in order to improve the care and prognosis of critically ill patients.


Assuntos
Deterioração Clínica , Estado Terminal , Diagnóstico Precoce , Humanos
4.
Medicine (Baltimore) ; 99(2): e18719, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914086

RESUMO

BACKGROUND: Hematoma expansion (HE) is related to clinical deterioration and unfavorable prognosis in intracerebral hemorrhage (ICH). Some studies have revealed that low serum magnesium level is associated with larger hematoma volume at admission, HE, and unfavorable outcomes. However, the conclusions remain unsettled. The purpose of this study is to evaluate the association between low serum magnesium level and HE by meta-analysis. METHODS: We will search the following electronic bibliographic databases: PubMed, Medline, Embase, Web of Science, and The Cochrane Library. Studies will be included if they reported a relationship of low serum magnesium level and HE, mortality or poor outcome. RESULTS: The results of this study will be submitted to a peer-reviewed journal for publication. CONCLUSION: This will be the first systematic review and meta-analysis to evaluate the association of HE following ICH with Hypomagnesemia. We look forward to the results will offer scientific proof to predict HE for ICH patients with low serum magnesium level. PROSPERO REGISTRATION NUMBER: This protocol has been registered in the PROSPERO network with number: CRD42019135995.


Assuntos
Hemorragia Cerebral/patologia , Hematoma/patologia , Magnésio/sangue , Biomarcadores , Deterioração Clínica , Humanos , Prognóstico
5.
Medicine (Baltimore) ; 98(52): e18475, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31876731

RESUMO

Rapid response system (RRS) efficacy and national early warning score (NEWS) performances have largely been reported in inpatient settings, with few such reports undertaken in outpatient settings.This study aimed to investigate NEWS validity in predicting poor clinical outcomes among outpatients who had activated the RRS using single-parameter criteria.A single-center retrospective cohort studyFrom April 1, 2014 to November 30, 2017 in an urban 350-bed referral hospital in JapanWe collected patient characteristics such as activation triggers, interventions, arrival times, dispositions, final diagnoses, and patient outcomes. Poor clinical outcomes were defined as unplanned intensive care unit transfers or deaths within 24 hours. Correlations between the NEWS and clinical outcomes at the time of deterioration and disposition were analyzed.Among 31 outpatients, the NEWS value decreased significantly after a medical emergency team intervention (median, 8 vs 4, P < .001). The difference in the NEWS at the time of deterioration and at disposition was significantly less in patients with poor clinical outcomes (median 3 vs 1.5, P = .03). The area under the curve (AUC) for the NEWS high-risk patient group at the time of deterioration for predicting hospital admission was 0.85 (95% confidence interval [CI], 0.67-1.0), while the AUC for the NEWS high-risk patient group at disposition for predicting poor clinical outcomes was 0.83 (95% CI, 0.62-1.0).The difference between the NEWS at the time of deterioration and at disposition might usefully predict admissions and poor clinical outcomes in RRS outpatient settings.


Assuntos
Assistência Ambulatorial/métodos , Equipe de Respostas Rápidas de Hospitais , Triagem/métodos , Idoso , Deterioração Clínica , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , Resultado do Tratamento
7.
BMC Health Serv Res ; 19(1): 639, 2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31488141

RESUMO

BACKGROUND: The Australian Commission on Safety and Quality in Health Care released a set of national standards which became a mandatory part of accreditation in 2013. Standard 9 focuses on the identification and treatment of deteriorating patients. The objective of the study was to identify changes in the characteristics and perceptions of rapid response systems (RRS) since the implementation of Standard 9. METHODS: Cross-sectional study of Australian hospitals. Baseline data was obtained from a pre-implementation survey in 2010 (220 hospitals). A follow-up survey was distributed in 2015 to staff involved in implementing Standard 9 in public and private hospitals (276 responses) across Australia. RESULTS: Since 2010, the proportion of hospitals with formal RRS had increased from 66 to 85. Only 7% of sites had dedicated funding to operate the RRS. 83% of respondents reported that Standard 9 had improved the recognition of, and response to, deteriorating patients in their health service, with 51% believing it had improved awareness at the executive level and 50% believing it had changed hospital culture. CONCLUSIONS: Implementing a national safety and quality standard for deteriorating patients can change processes to deliver safer care, while raising the profile of safety issues. Despite limited dedicated funding and staffing, respondents reported that Standard 9 had a positive impact on the care for deteriorating patients in their hospitals.


Assuntos
Deterioração Clínica , Equipe de Respostas Rápidas de Hospitais/normas , Acreditação/normas , Austrália , Estudos Transversais , Hospitais Privados/normas , Hospitais Públicos/normas , Humanos , Cultura Organizacional , Padrões de Referência , Inquéritos e Questionários
8.
BMJ Case Rep ; 12(8)2019 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-31451457

RESUMO

Kaposi sarcoma (KS) is an angioproliferative disorder that is commonly associated with human herpes virus 8 as well as the HIV. In fact, KS is one of the most common AIDS-defining illnesses. KS typically presents with diffuse, violaceous cutaneous nodules, and may have concomitant visceral involvement. However, visceral involvement rarely occurs without skin manifestations. A rare case of localised bronchopulmonary KS without skin involvement is described in a patient with previously undiagnosed HIV. This atypical presentation represents a challenge for modern-day physicians in developed countries where the prevalence of AIDS-related diseases is decreasing.


Assuntos
Síndrome de Imunodeficiência Adquirida , Infecções por HIV , Neoplasias Pulmonares , Oseltamivir/administração & dosagem , Sarcoma de Kaposi , Síndrome de Imunodeficiência Adquirida/diagnóstico , Síndrome de Imunodeficiência Adquirida/etiologia , Antivirais/administração & dosagem , Lavagem Broncoalveolar/métodos , Contagem de Linfócito CD4/métodos , Deterioração Clínica , Confusão/diagnóstico , Confusão/etiologia , Desidratação/complicações , Desidratação/diagnóstico , Desidratação/terapia , Diagnóstico Diferencial , Evolução Fatal , Hidratação/métodos , Infecções por HIV/complicações , Infecções por HIV/diagnóstico , Infecções por HIV/fisiopatologia , Infecções por HIV/terapia , Humanos , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/fisiopatologia , Masculino , Sarcoma de Kaposi/patologia , Sarcoma de Kaposi/fisiopatologia , Tomografia Computadorizada por Raios X/métodos , Carga Viral/métodos
9.
BMJ Case Rep ; 12(8)2019 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-31451477

RESUMO

Thyroid storm (accelerated hyperthyroidism) is an uncommon life-threatening emergency. The diagnosis is difficult and at times delayed owing to atypical presentation. Early diagnosis is the key to its successful management. We came across a patient who had presentations of acute abdomen but later diagnosed in thyroid storm. Multiorgan involvement leads all resuscitative measures futile and prevented us to salvage the patient.


Assuntos
Dor Abdominal , Hipoglicemia , Enteropatias/diagnóstico , Icterícia , Insuficiência de Múltiplos Órgãos , Crise Tireóidea , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Deterioração Clínica , Tratamento Conservador/métodos , Cuidados Críticos/métodos , Diagnóstico Diferencial , Evolução Fatal , Feminino , Humanos , Hipoglicemia/diagnóstico , Hipoglicemia/etiologia , Icterícia/diagnóstico , Icterícia/etiologia , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/diagnóstico , Insuficiência de Múltiplos Órgãos/etiologia , Insuficiência de Múltiplos Órgãos/terapia , Crise Tireóidea/sangue , Crise Tireóidea/complicações , Crise Tireóidea/diagnóstico , Crise Tireóidea/terapia , Torsades de Pointes/diagnóstico , Torsades de Pointes/etiologia
10.
Medicine (Baltimore) ; 98(32): e16470, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31393351

RESUMO

We aimed to investigate the correlation of long noncoding RNA nuclear enriched abundant transcript 1 (lnc-NEAT1), microRNA-124 (miR-124) and lnc-NEAT1/miR-124 axis with disease risk, severity, inflammatory cytokines, and survival of sepsis.Eighty-two patients with sepsis and 82 healthy controls (HCs) were consecutively enrolled. Blood samples were collected for detection of lnc-NEAT1 and miR-124 expressions (using RT-qPCR) and measurement of inflammatory cytokines expressions (by ELISA). Severity and organ failure were assessed by acute physiology and chronic health evaluation II (APACHE II) score and sequential organ failure assessment (SOFA) score, and survival was assessed.Lnc-NEAT1 expression was increased while miR-124 expression was decreased in patients with sepsis compared to HCs, and both of them were able to distinguish patients with sepsis from HCs. For disease condition, lnc-NEAT1 positively associated with APACHE II score, SOFA score, and expressions of C-reactive protein (CRP), procalcitonin, tumor necrosis factor α (TNF-α), and interleukin-1ß (IL-1ß), whereas miR-124 negatively correlated with APACHE II score, SOFA score and levels of serum creatinine (Scr), CRP, TNF-α, IL-1ß, interleukin-6 (IL-6) and interleukin-17 (IL-17). Regarding prognosis, lnc-NEAT1 was upregulated but miR-124 was downregulated in nonsurvivors compared to survivors. Additionally, lnc-NEAT1 negatively correlated with miR-124. Besides, lnc-NEAT1/miR-124 axis was increased in patients with sepsis compared to HCs, and positively associated with APACHE II score, SOFA score, and levels of Scr, CRP, TNF-α, IL-1ß, IL-6, and IL-17, while negatively correlated with survival. Most importantly, lnc-NEAT1/miR-124 axis presented numerically increased predictive value for sepsis risk and survival compared to each index alone.Lnc-NEAT1/miR-124 axis correlates with increased sepsis risk, and associates with higher inflammation, deteriorative disease condition, and decreased survival in patients with sepsis.


Assuntos
Mediadores da Inflamação/metabolismo , RNA Longo não Codificante/biossíntese , Sepse/mortalidade , Sepse/fisiopatologia , APACHE , Adulto , Idoso , Deterioração Clínica , Citocinas/metabolismo , Feminino , Humanos , Masculino , MicroRNAs/biossíntese , Pessoa de Meia-Idade , Escores de Disfunção Orgânica , Índice de Gravidade de Doença
11.
J Clin Nurs ; 28(21-22): 4139-4149, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31327164

RESUMO

BACKGROUND: To optimise care of deteriorating patients, healthcare organisations have implemented rapid response systems including an "afferent" and "efferent" limb. Afferent limb behaviours include monitoring vital signs and escalating care. To strengthen afferent limb behaviour and reduce adverse patient outcomes, the National Early Warning Score was implemented in the UK. There are no published reports of how National Early Warning Score guidance has translated into trust-level deteriorating patient policy and whether these documents provide clear, actionable statements guiding staff. AIM: To identify how deteriorating patient policy documents provide "actionable" behavioural instruction for staff, responsible for actioning the afferent limb of the rapid response system. DESIGN: A structured content analysis of a national guideline and local policies using a behaviour specification framework. METHODS: Local deteriorating patient policies were obtained. Statements of behaviour were extracted from policies; coded using a behaviour specification framework: Target, Action, Context, Timing and Actor and scored for specificity (1 = present, nonspecific; 2 = present, specific). Frequencies and proportions of statements containing elements of the Target, Action, Context, Timing and Actor framework were summarised descriptively. Reporting was guided by the COREQ checklist. RESULTS: There were more statements related to monitoring than escalation behaviour (65% vs 35%). Despite high levels of clear specification of the action (94%) and the target of the behaviour (74%), context, timing and actor were poorly specified (37%, 37% and 33%). CONCLUSION: Delay in escalating deteriorating patients is associated with adverse outcomes. Some delay could be addressed by writing local protocols with greater behavioural specificity, to facilitate actionability. RELEVANCE TO CLINICAL PRACTICE: Numerous clinical staff are required for an effective response to patient deterioration. To mitigate role confusion, local policy writers should provide clear specification of the actor. As the behaviours are time-sensitive, clear specification of the time frame may increase actionability of policy statements for clinical staff.


Assuntos
Deterioração Clínica , Políticas , Guias de Prática Clínica como Assunto , Equipe de Respostas Rápidas de Hospitais , Humanos , Fatores de Tempo , Sinais Vitais
12.
BMC Pregnancy Childbirth ; 19(1): 259, 2019 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-31331287

RESUMO

BACKGROUND: Acute Fatty Liver of Pregnancy (AFLP) is a rare, catastrophic disease affecting women in the third trimester of pregnancy or in the post-partum period. It is usually a diagnosis of exclusion and requires a strong index of suspicion for a timely diagnosis and prompt intervention. CASE PRESENTATION: We report a case of AM, an 18 year patient, in her first pregnancy at 35 weeks gestation who presented with nausea, vomiting and jaundice. She had a vaginal delivery following spontaneous preterm labour. A clinical diagnosis of acute fatty liver of pregnancy was made on the 3rd day post-delivery. The post-delivery course was complicated by a deterioration of clinical symptoms with worsening hepatorenal function and development of encephalopathy. The patient died 3 days after admission and the diagnosis was confirmed on post-mortem and histology. CONCLUSION: Delay in the diagnosis is associated with morbid complications with high mortality and this case highlights the importance of a high index of suspicion of the condition in women presenting with jaundice in pregnancy.


Assuntos
Fígado Gorduroso , Icterícia , Complicações na Gravidez , Adolescente , Deterioração Clínica , Diagnóstico Tardio , Parto Obstétrico/métodos , Diagnóstico , Diagnóstico Diferencial , Evolução Fatal , Fígado Gorduroso/diagnóstico , Fígado Gorduroso/fisiopatologia , Fígado Gorduroso/terapia , Feminino , Humanos , Icterícia/diagnóstico , Icterícia/etiologia , Testes de Função Renal/métodos , Testes de Função Hepática/métodos , Paridade , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/fisiopatologia , Complicações na Gravidez/terapia , Terceiro Trimestre da Gravidez
13.
Contemp Nurse ; 55(2-3): 139-155, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31225768

RESUMO

Background: Clinical deterioration and adverse events in hospitals is an increasing cause for concern. Rapid response systems have been widely implemented to identify deteriorating patients. Aim: We aimed to examine the literature highlighting major historical trends leading to the widespread adoption of rapid response systems, focussing on Australian issues and identifying future focus areas. Method: Integrative literature review including published and grey literature. Results: Seventy-eight sources including journal articles and Australian government matierlas resulted. Pertinent themes were the increasing acuity and aging of the population, importance of hospital cultures, the emerging role of the consumer, and proliferation, evolution and standardisation of rapid response systems. Discussion: Translating evidence to usual care practice is challenging and strongly driven by local factors and political imperatives. Conclusion: Rapid response systems are complex interventions requiring consideration of contextual factors at all levels. Appropriate resources, a skilled workforce and positive workplace cultures are needed for these systems to reach their full potential.


Assuntos
Deterioração Clínica , Serviços Médicos de Emergência/estatística & dados numéricos , Serviços Médicos de Emergência/tendências , Equipe de Respostas Rápidas de Hospitais/estatística & dados numéricos , Equipe de Respostas Rápidas de Hospitais/tendências , Adulto , Idoso , Idoso de 80 Anos ou mais , Austrália , Feminino , Previsões , Humanos , Masculino , Pessoa de Meia-Idade
14.
J Med Case Rep ; 13(1): 179, 2019 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-31186057

RESUMO

INTRODUCTION: Sublingual microcirculation monitoring is suitable for bedside use in critically ill patients. We present a case in which severely impaired sublingual microcirculation was the first alarming sign of an early deterioration of the patient's medical situation. CASE PRESENTATION: This is the case of a 58-year-old white woman admitted to our intensive care unit after the removal of parts of her small intestine due to a volvulus. Her microcirculation was checked the day after surgery in terms of an ongoing study and predicted a massive deterioration of her clinical situation. CONCLUSIONS: This case highlights the potential value of monitoring the microcirculation in critically ill patients. Two full hours could have been saved for diagnostic workup and earlier treatment had we considered the impaired microcirculation alone as a warning sign. Regardless of the supposed cause, impaired microcirculation should alert the responsible physician and should be followed by a diagnostic workup. Sublingual microcirculation monitoring can be useful in intensive care units to detect a deteriorated microcirculation earlier than with standard monitoring.


Assuntos
Deterioração Clínica , Colo Descendente/irrigação sanguínea , Microcirculação , Soalho Bucal , Imagem de Perfusão , Testes Imediatos , Complicações Pós-Operatórias/diagnóstico , Sepse , Cuidados Críticos/métodos , Estado Terminal/terapia , Diagnóstico Precoce , Feminino , Humanos , Volvo Intestinal/diagnóstico , Volvo Intestinal/fisiopatologia , Isquemia/diagnóstico , Isquemia/etiologia , Isquemia/fisiopatologia , Isquemia/cirurgia , Laparotomia/efeitos adversos , Laparotomia/métodos , Pessoa de Meia-Idade , Soalho Bucal/irrigação sanguínea , Soalho Bucal/diagnóstico por imagem , Imagem de Perfusão/instrumentação , Imagem de Perfusão/métodos , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/cirurgia , Reoperação/métodos , Sepse/diagnóstico , Sepse/etiologia , Tomografia Computadorizada por Raios X/métodos
15.
J Nurses Prof Dev ; 35(4): E1-E8, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31206418

RESUMO

Early recognition of and prompt intervention for the deteriorating pediatric patient remains paramount in preventing cardiac arrests from occurring outside intensive care units. To decrease these events, we developed a three-part simulation-based blended learning course consisting of a computer-based training module, a simulation scenario, and follow-up in situ scenarios for inpatient nurses. After initiation of the course, our facility has seen a decrease in the number of codes outside critical care areas.


Assuntos
Conscientização , Deterioração Clínica , Parada Cardíaca/prevenção & controle , Treinamento por Simulação/métodos , Criança , Competência Clínica , Humanos , Unidades de Terapia Intensiva , Recursos Humanos de Enfermagem no Hospital/educação , Pediatria
16.
Br J Community Nurs ; 24(6): 291-294, 2019 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-31166776

RESUMO

The revised National Early Warning Score (NEWS2), a tool used to measure acute deterioration in hospital, has been introduced in acute NHS hospitals and ambulance services. Community nurses report that when they call 999 requesting an ambulance to take a person to hospital, they are asked to provide a NEWS score. They report that when the NEWS score is high, ambulance staff prioritise the call. The NEWS score is being introduced in the community by default. This article will outline how the NEWS score is calculated, its uses and limitations and asks if the NEWS score accurately measures acute deterioration in people living in the community and predicts the need for referral to accident and emergency services.


Assuntos
Deterioração Clínica , Enfermagem em Saúde Comunitária , Vida Independente , Serviço Hospitalar de Emergência , Humanos , Encaminhamento e Consulta , Medicina Estatal , Reino Unido
17.
J Adv Nurs ; 75(9): 2024-2035, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31115082

RESUMO

AIM: To develop a theory-based complex intervention (targeting nursing staff), to enhance enablers and overcome barriers to enact expected behaviour when monitoring patients and responding to abnormal vital signs that signal deterioration. DESIGN: A mixed method design including structured observations on hospital wards, field notes, brief, unrecorded interviews and semi-structured interviews to inform the development of an intervention to enhance practice. METHODS: Semi-structured interviews will be conducted with nursing staff using a topic guide informed by the Theoretical Domains Framework. Semi-structured interviews will be transcribed verbatim and coded deductively into the 14 Theoretical Domains Framework domains and then inductively into "belief statements". Priority domains will be identified and mapped to appropriate behaviour change techniques. Intervention content and mode of delivery (how behaviour change techniques are operationalized) will be developed using nominal groups, during which participants (clinicians) will rank behaviour change techniques/mode of delivery combinations according to acceptability and feasibility. Findings will be synthesised to develop an intervention manual. DISCUSSION: Despite being a priority for clinicians, researchers and policymakers for two decades, "sub-optimal care" of the deteriorating ward patient persists. Existing interventions have been largely educational (i.e. targeting assumed knowledge deficits) with limited evidence that they change staff behaviour. Staff behaviour when monitoring and responding to abnormal vital signs is likely influenced by a range of mediators that includes barriers and enablers. IMPACT: Systematically applying theory and evidence-based methods, will result in the specification of an intervention which is more likely to result in behaviour change and can be tested empirically in future research.


Assuntos
Deterioração Clínica , Equipe de Respostas Rápidas de Hospitais , Monitorização Fisiológica/métodos , Cuidados de Enfermagem/métodos , Recursos Humanos de Enfermagem no Hospital/psicologia , Sinais Vitais/fisiologia , Adulto , Atitude do Pessoal de Saúde , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Desenvolvimento de Programas
18.
Int J Nurs Stud ; 95: 73-86, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31121386

RESUMO

BACKGROUND: From a baseline of near zero, there has in recent years been a growing number of empirical studies related to mental health nurses' delivery of healthcare for severely physically deteriorating patients or in medical emergency situations. To date, this evidence-base has not been systematically identified, appraised, and integrated. OBJECTIVES: To systematically identify, appraise and synthesise the available empirical evidence about mental health nurses, medical emergencies, and the severely physiologically deteriorating patient. DESIGN: A systematic review in accordance with relevant points of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES: Multiple electronic databases (CINAHL; PubMed; MedLine; Scopus, ProQuest Dissertations and Theses) were searched using comprehensive terms. REVIEW METHODS: Inclusion criteria: English language papers describing empirical studies (any design) about i) the effectiveness of interventions to improve any outcome related to mental health nurses' delivery of emergency medical care or care for the severely deteriorating patient; or ii) mental health nurses' emergency medical care-related knowledge, skills, experience, attitudes, or training needs. Further information was sought from study authors. Included studies were independently assessed for quality. Effect sizes from intervention studies were extracted or calculated where there was sufficient information. An integrative synthesis of study findings was conducted. RESULTS: A total of 22 studies, all but one published since 2011, met inclusion criteria. Ten were intervention studies and twelve were cross-sectional observational or qualitative studies. Intervention studies were all of weak quality overall and utilised pre- post designs mostly with limited post intervention follow-up time. Observational and qualitative studies were generally of good quality but only parts of the evidence from these studies were relevant to emergency physical care since most focused on mental health nurses and their routine physical healthcare practice. CONCLUSIONS: There are currently no validated instruments to investigate mental health nurses' emergency medical care-related attitudes. More rigorous controlled trials of interventions are needed to better establish an evidence-base for educational interventions to improve this groups' emergency care-related practice.


Assuntos
Deterioração Clínica , Emergências , Transtornos Mentais/enfermagem , Enfermagem Psiquiátrica , Competência Clínica , Humanos , Transtornos Mentais/fisiopatologia
19.
Int J Nurs Stud ; 95: 56-64, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31077951

RESUMO

BACKGROUND: The implementation of early warning scoring systems and medical emergency teams that aim to reduce failure to rescue in general wards is only effective if frontline nurses can recognize and act on clinical deterioration in a timely manner. While much of the research to date has primarily focused on registered nurses as recognizers of clinical deterioration, little research has sought to explore the role of enrolled nurses in recognizing clinical deterioration and to provide a big picture of how enrolled and registered nurses recognize clinical deterioration in general ward patients. OBJECTIVES: To conduct an exploration of the experiences of enrolled and registered nurses in recognizing clinically deteriorating patients in general wards. DESIGN: A qualitative, descriptive design. SETTING: General wards at a 1,000-bed acute general hospital in Singapore. PARTICIPANTS: A purposive sample of 22 enrolled and registered nurses who had at least 6 months of nursing experience and who were working in the general wards. METHODS: Individual semi-structured interviews were conducted between October 2016 and February 2017. Interviews were transcribed verbatim and analyzed using thematic analysis. RESULTS: Four salient themes emerged from the data analysis. The first, 'Having a sense of knowing', illustrates how knowing a patient and past experiences facilitated the early recognition of clinical deterioration before the patient turned haemodynamically unstable. The second, 'Patient assessment practices', depicts the physical assessment skills that nurses used to detect clinical deterioration. The third, 'Delegation of routine patient care and assessment to enrolled nurses', demonstrates that nursing activities were delegated to enrolled nurses with lesser directional and supervisory aspects that "delegation" implies, which can potentially compromise patient safety. The fourth, 'Missing the big picture', identifies overwhelming workload and fixation on specific parameters of a patient as reasons for both enrolled and registered nurses missing the big picture of the patient's deterioration. CONCLUSIONS: This study provides a snapshot of the recognition of clinical deterioration among enrolled and registered nurses in general wards. Our findings illuminate the need to support the roles of enrolled and registered nurses, with an emphasis on patient assessment and strengthening collaborative practices among nurses, to improve early recognition and timely treatment of clinically deteriorating ward patients.


Assuntos
Competência Clínica , Deterioração Clínica , Recursos Humanos de Enfermagem no Hospital/psicologia , Adulto , Feminino , Unidades Hospitalares , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Singapura
20.
Crit Care Nurs Q ; 42(3): 227-234, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31135473

RESUMO

In response to national and local drivers, a clinical emergency response system (CERS) incorporating an intensivist-led rapid response team (RRT) was implemented at a Sydney (Australia) hospital. The authors present a pragmatic evaluation of the 5 years since this major initiative was commenced. A "partner not conquer" philosophy was adopted. Implementation of the RRT was based on a collaborative pragmatic quality improvement approach. A team of intensive care specialist trained medical doctors (n = 2) and clinical nurse consultants (n = 2) set up the service with executive support and funding. Roles and responsibilities were clearly detailed, reinforcing a positive, partnership-driven culture. A constantly evolving education strategy was a critical element of implementation and maintenance. Ongoing evaluation includes process and patient outcome data. Serious patient deterioration-related incidents have decreased significantly (from 7 to 1 per year) and the RRT has been universally accepted by clinicians. Key lessons learned include the need for specific protected funding, a partnership approach ensuring hospital clinicians retain responsibility of patient treatment, ongoing education and reinforcement, and strong nursing leadership. However, generalizations cannot be made about the implementation of the CERS. It is important to consider context; "one size does not fit all."


Assuntos
Enfermagem de Cuidados Críticos , Cuidados Críticos/organização & administração , Equipe de Respostas Rápidas de Hospitais/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Avaliação de Programas e Projetos de Saúde , Austrália , Deterioração Clínica , Hospitais , Humanos , Melhoria de Qualidade
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