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Evaluation of Nurses' Approaches to Deteriorating Patients: Survey Study

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Evaluation of Nurses' Approaches to Deteriorating Patients: Survey Study Doi: 10.5152/TJAR.2021.866 Original Article Other Evaluation of Nurses’ Approaches to Deteriorating Patients: Survey Study Levent O¨ zdemir , Nurcan Doruk , Handan Birbic¸er , Aslınur Sagu¨n , Mustafa Azizog˘lu Department of Anaesthesiology and Intensive Care, Mersin University School of Medicine, Mersin, Turkey Cite this article as: O¨ zdemir L, Doruk N, Birbic¸er H, Sagu¨n A, Azizog˘lu M. Evaluation of Nurses’ Approaches to Deteriorating Patients: Survey Study. Turk J Anaesthesiol Reanim. 2021; 49(4):320-324. Abstract Objective: Prevention of cardiopulmonary arrest in hospitalised patients is the first and most important step in the life-saving chain. When the condition of the inpatients is worsened, nurses are usually the first to see and evaluate the patient. The aim of this study was to evaluate the atti- tudes of the nurses working at the Mersin University Hospital, during their routine follow-up to the deteriorating patients and the early warning scoring (EWS) awareness. Methods: A web-based questionnaire was sent to all nurses working in inpatient services and intensive care units (ICUs) and registered to the hospital database at Mersin University Hospital via e-mail. In the questionnaire, a total of 10 multiple-choice questions were asked to the nurses questioning the unit they worked for, the EWS they used, the complaints they frequently complain about and the applications for the call for help. A total of 146 nurses were included in the study. Results: 43.8% (n ¼ 64) of the participants were in ICU, and 56.1% (n ¼ 82) were in service units. Participants were asked whether they used a special scoring system to recognise the deteriorating patient; 45.2% (n ¼ 66) used the scoring system; and 54.8% (n ¼ 80) reported that they did not use it. Participants working in ICU were more likely to use EWS system. Participants answered the most commonly used scoring system as the Glasgow Coma Scale (n ¼ 40). The participants reported that the most common respiratory distress (n ¼ 135), changes in consciousness (n ¼ 109), palpitations (n ¼ 98) and chest pain (n ¼ 92) occurred in the deteriorating patients. Participants reported that they frequently asked for help from a doctor (80.1%), other nurses (7.5%) and a blue code team (7.5%). Conclusion: According to the findings, it is necessary to determine the habits of calling for help and raising awareness for a functional EWS. Keywords: Deteriorating patient, early warning score, nursing assessment, patient safety, hospitalised patients, practice nursing, physiological responses, critical care outreach Introduction Prevention of cardiopulmonary arrest (CPA) in hospitalised patients is the first and most important step of the life- saving chain.1 Just 20% of the patients could be discharged from hospital after CPA has occurred.2,3 When the condition of the inpatients is worsened, nurses are usually the first to see and evaluate the patient, so the nurses have a central role for this situation. Many different early warning scoring (EWS) systems have been developed for rapid intervention of deteriorating patients, implementation of examination and treatment modalities and be able to handle different protocols for follow-up. To know how and in what way EWSs, designed by each hospital according to its own local conditions, practically used is important for control of efficacy. In this study, to evaluate the approaches of the nurses working at the Mersin University Medical Faculty Hospital during their routine follow-up to deteriorating patients and their observations for applications made by the team coming for help, through a survey is aimed. Methods Ethics committee approval for this study was received from ethics committee for the non-invasive clinical studies in Mersin University. A web-based questionnaire entitled as “Evaluation of nurses’ approaches to deteriorating patients” was sent to all nurses working in inpatient services and intensive care units (ICUs) and registered to the 320 Corresponding Author: Levent O¨ zdemir E-mail: [email protected] Received: June 25, 2020 Accepted: September 14, 2020 VC Copyright 2021 by Turkish Society of Anaesthesiology and Reanimation - Available online at www.turkjanaesthesiolreanim.org Available Online Date: August 3, 2021 O¨ zdemir et al. Evaluation of Nurses’ Approaches to Deteriorating Patients Turk J Anaesthesiol Reanim 2021;49(4):320-324 54.8% (n ¼ 80) reported they do not use any. Rate of EWS Table 1. Use of EWS According to the Unit Participants system use found significantly higher in the participants Work working in ICU (Table 1). ICU Service units Total Glasgow Coma Scale (GCS) (n ¼ 40) was the most common EWS users, n 50 16 66 (45.2%) answer from scoring system users to the question asking EWS non-users, n 14 66 80 (54.7%) which EWS system they use; and followed by Appearance, Pulse, Grimace, Activity, Respiration (n ¼ 3), Modified EWS: early warning score; ICU, intensive care unit. Aldrete Scoring (n ¼ 3). EWS answer was given by only one participant. hospital database at Faculty Hospital via e-mail. A total of In order of frequency, respiratory distress (n ¼ 135), changes 146 nurses answering the questionnaire were included to the in consciousness (n ¼ 109), palpitations (n ¼ 98) and chest study. pain (n ¼ 92) were found as the first complaints expressed by the deteriorating patients to the participants. Participants In the questionnaire, a total of 10 multiple-choice questions also reported that they most frequently call for help in situa- were asked to the nurses. Information letter about the aim tions like decrease in oxygen saturation, respiratory depres- and qualification of the study was given to the participants at sion and change in consciousness (Figure 1). the beginning of the questionnaire. Questions including the demographic information, first complaints expressed by dete- Participants reported that they most frequently asked for riorating patients, frequently encountered signs and symp- help from the service doctor (80.1%), other nurses (7.5%) toms of the patients, the EWSs they used, their routine to and the blue code team (7.5%). Assessment of consciousness, call for help and their observations about the intervention oxygen supply, aspiration and drug administrations were methods of the team coming for help were asked to the reported as the initial interventions made by the team nurses. coming for help; and arterial blood gas analysis, electrocardi- ography (ECG) and biochemical tests were reported as the Statistical Analysis first tests asked (Figure 2). For statistical evaluation, data were analysed using the STATA MP 11 for Windows package programme (Texas, Participants reported that adrenaline (n ¼ 115), dopamine (n USA). Descriptive statistics were used for categorical varia- ¼ 65) and inhalation treatment (n ¼ 63) were applied by the bles, and frequency calculations were expressed in percen- team coming for help in order of frequency. Participants also tages. The questionnaire form applied to the nurses replied the question about the most difficultly provided med- participating in the study is presented at the end of the study ical equipment during an intervention to the patient as dif- (Appendix 1). ferent sized facial masks, non-invasive ventilator and ECG device. Results Discussion A total of 146 nurses answering the questionnaire were included to the study. 43.8% (n ¼ 64) of the participants Deterioration of patients can be early recognised by making were working in the ICU, and 56.1% (n ¼ 82) in the service regular registrations about hospitalised patient’s physiological units. Participants were asked whether they used a special parameters like respiratory rate, oxygen saturation, heart rate, scoring system to recognise the deteriorating patient; 45.2% arterial blood pressure and state of consciousness. Use of these (n ¼ 66) reported that they use a scoring system, while physiological parameters as a EWS has a critical role on pre- venting of CPA by providing a chance for early intervention. Main Points Researches are available that find mortality and cardiac arrest rates significantly lower at hospitals using EWS effec- • An appropriate and timely triggered early warning score (EWS) 4,5 system can prevent many cardiac arrest cases from occurring. tively. EWSs have been used in many different clinical fields like ICUs, emergency services, postoperative care units • Each hospital needs to develop EWS in accordance with its local con- 6 ditions and the characteristics of the patient groups. and inpatient wards. Subbe et al. found a significant decline in mortality rate with the use of EWS in a research they • To achieve this, it is necessary to identify existing deficiencies and 7 error points in applications. made in ICU (63% vs. 33%). Moon et al. determined a sig- • This study provides information to increase the awareness and prob- nificant decline in cardiac arrest calls with the use of EWSs lems faced by nurses in hospitals that have not yet used a routine at two hospital accepting all adult patients. With the addition early warning scoring. of EWS protocol to the standard nurse team, early recogni- tion of the deteriorating patients has been provided by early 321 Turk J Anaesthesiol Reanim 2021;49(4):320-324 O¨ zdemir et al. Evaluation of Nurses’ Approaches to Deteriorating Patients Figure 1. Complaints expressed to nurses by deteriorated patients. Figure 2. Tests requested by the medical emergency team to help the deteriorating patient. triggering and determining the need for ICU in these studies. way of protecting against cardiac arrest, such as the deterio- Also, in EWS by constitution of a scoring system appropriate rating patient and calling for early help, are not determined for their local conditions, both making a risk classification clearly, a situation such as not starting the necessary action with the score achieved by the patient and clarifying the fre- and being late may be encountered.8 For this reason, it should quency of doctor’s visit seem as important points.
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