Nurses’ experiences with continuous vital sign monitoring on the general surgical ward: a qualitative study based on the Behaviour Change Wheel

Abstract

Background To support early recognition of clinical deterioration on a general ward continuous vital signs monitoring (CMVS) systems using wearable devices are increasingly being investigated. Although nurses play a crucial role in successful implementation, reported nurse adoption and acceptance scores vary significantly. In-depth insight into the perspectives of nurses regarding CMVS is lacking. To this end, we applied a theoretical approach for behaviour change derived from the Behaviour Change Wheel (BCW). Aim To provide insight in the capability, opportunity and motivation of nurses working with CMVS, in order to inform future implementation efforts. Methods A qualitative study was conducted, including twelve nurses of a surgical ward in a tertiary teaching hospital with previous experience of working with CMVS. Semi-structured interviews were audiotaped, transcribed verbatim, and analysed using thematic analysis. The results were mapped onto the Capability, Opportunity, Motivation – Behaviour (COM-B) model of the BCW. Results Five key themes emerged. The theme ‘Learning and coaching on the job’ linked to Capability. Nurses favoured learning about CVSM by dealing with it in daily practice. Receiving bedside guidance and coaching was perceived as important. The theme ‘interpretation of vital sign trends’ also linked to Capability. Nurses mentioned the novelty of monitoring vital sign trends of patients on wards. The theme ‘Management of alarms’ linked to Opportunity. Nurses perceived the (false) alarms generated by the system as excessive resulting in feelings of irritation and uncertainty. The theme ‘Integration and compatibility with clinical workflow’ linked to Opportunity. CVSM was experienced as helpful and easy to use, although integration in mobile devices and the EMR was highly favoured and the management of clinical workflows would need improvement. The theme ‘Added value for nursing care’ linked to Motivation. All nurses recognized the potential added value of CVSM for postoperative care. Conclusion Our findings suggest all parts of the COM-B model should be considered when implementing CVSM on general wards. When the themes in Capability and Opportunity are not properly addressed by selecting interventions and policy categories, this may negatively influence the Motivation and may compromise successful implementation.

Wearable wireless continuous vital signs monitoring on the general ward

“…In recent studies, most systems have only limited integration into the hospital electronic Health Record (EHR) and other hospital information systems, such as the wireless connectivity and mobile applications for nurses. Interoperability standards for CVSM systems are necessary and a prerequisite for adequate usability by nurses [69]. Once in place, this could dramatically increase their successful implementation in clinical practice.…”

Environmental sustainability and gynaecological surgery: Which factors influence behaviour? An interview study

“…The factors in this framework are: capability, opportunity, motivation and behaviour. This model has been successfully applied to various behaviour types, from patient groups to professionals 18,19 . By utilising both frameworks, the analysis process could be effectively guided, ensuring a comprehensive coverage of relevant factors in behavioural change.…”

Feasibility of wireless continuous monitoring of vital signs without using alarms on a general surgical ward: A mixed methods study

“…This may have been caused by the relatively short period (3 months) of working with the continuous monitoring system, which is in line with experiences of continuous monitoring in previous studies. [20,39] and also reflected in the qualitative theme about gaining practical experience. Professionals not only mentioned the need for more experience for performing adequate trend analysis, but also better practical skills in applying the sensor or in operating the software.…”

“…Professionals not only mentioned the need for more experience for performing adequate trend analysis, but also better practical skills in applying the sensor or in operating the software. Moreover, a possible factor enhancing the acceptability of continuous monitoring system is having witnessed a serious clinical adverse event in a patient who's vitals sign trends were deteriorating [39,40]. This may not only refer to the need to gain experience in trend assessment, but also to gain trust in the novel vital sign monitoring work process.…”

“…In our study deteriorating trends were, however, quite rare and observed in only seventeen cases during almost 5000 hours of monitoring, Importantly, although continuous vital sign monitoring systems are well accepted on high care departments, this is a completely new concept for most care-professionals on general wards. So apart from gaining practical experience, the process of building confidence in novel concepts of continuous monitoring needs to be taken into account when implementing these systems [39]. The introduction of digital health innovations, will therefore have to be done very carefully to increase adoption and acceptance [41,42].…”