Indicators of acute deterioration in adult patients nursed in acute wards: A factorial survey

摘要: Objectives.  The primary objective of the study was to determine which professional, situational and patient characteristics predict nurses’ judgements acuity likelihood referral for further review. A secondary aim test feasibility factorial survey method in an acute area. Background.  There is increasing recognition that indicators deterioration acutely unwell adults are being missed referrals delayed. reasons this unclear require exploration. Assessing clinical decision-making or a ‘real-world’ situation problematic. Design.  used design where participants completed randomly generated paper-based vignettes on one occasion. Methods.  dependent variables were assessment referral. Independent consisted number characteristics, i.e. heart rate, blood pressure, nurse experience, staffing. Setting participants.  Participants registered nurses working areas excluding intensive care theatre. Ninety-nine responded resulting 1940 vignettes. Results.  An early warning score single most significant predictor behaviour accounting 9·6% variance. When not included vignette, physiological e.g. respiratory urine output, neurological status. These explained 12% variance model predicting 9·4% referral. Conclusions.  given series vignettes, appear use appropriate parameters make decisions about need Our results support scoring systems. Education professional development should focus more developing maximising experience expertise rather than knowledge acquisition alone. feasible explore area. Relevance practice.  This has several implications practice. emergence system as individual supports such However, small amount suggests there other influences measured by approach. Educational provision might just but include educational delivery methods incorporate mimic real-ward settings.