Nurses’ judgments of patient risk of deterioration at change-of-shift handoff: Agreement between nurses and comparison with early warning scores

Lavoie, Pierre; Clarke, Sean P.; Clausen, Christina; Purden, Margaret; Emed, Jessica; Mailhot, Tanya; Fontaine, Guillaume; Frunchak, Valerie

doi:10.1016/j.hrtlng.2020.02.037

Cited by 9 publications

(5 citation statements)

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“…The present findings could partly explain the results from the previous mixed‐methods study on these units, which found that nurses exchanged primarily factual data in the form of vital signs and other known objective indicators when they suspected that a patient was at risk of deterioration (Lavoie, Clarke, Clausen, Purden, Emed, Cosencova et al, 2020). However, despite the use of objective data, agreement in their judgements was only moderate and incoming nurses tended to overestimate risks (Lavoie, Clarke, Clausen, Purden, Emed, Mailhot et al, 2020). This suggests that further research on nurses' perceptions and acceptance of each other's clinical judgements is warranted.…”

Section: Discussionmentioning

confidence: 99%

“…Interviews were recorded and transcribed verbatim by a professional transcriptionist. Prior to the focus groups, participants had met the researchers in a mixed‐methods study of nursing handoff that had been conducted on the units (Lavoie et al, 2018; Lavoie, Clarke, Clausen, Purden, Emed, Cosencova et al, 2020). They were informed that the goal of the focus groups was to gain a contextualized understanding of their experience to guide eventual educational or quality improvement efforts.…”

Section: The Studymentioning

confidence: 99%

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Nurses' experience of handoffs on four Canadian medical and surgical units: A shared accountability for knowing and safeguarding the patient

Lavoie

Clausen

Purden

et al. 2021

Journal of Advanced Nursing

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Aims: To explore nurses' experience and describe how they manage various contextual factors affecting the nurse-to-nurse handoff at change of shift.Design: Qualitative descriptive study. Methods:A convenience sample of 51 nurses from four medical and surgical care units at a university-affiliated hospital in Montreal, Canada, participated in one of the 19 focus group interviews from November 2017 to January 2018. Data were analysed through a continuous and iterative process of thematic analysis.Results: Analysis of the data generated a core theme of 'sharing accountability for knowing and safeguarding the patient' that is achieved through actions related to nurses' role in the exchange. Specifically, the outgoing nurse takes actions to ensure continuity of care when letting go, and the incoming nurse takes actions to provide seamless care when taking over. In both roles, nurses navigate each handoff juncture by mutually adjusting, ensuring attentiveness, managing judgements, keeping on track, and venting and debriefing. Handoff is also shaped by contextual conditions related to handoff norms and practices, the nursing environment, individual nurse attributes and patient characteristics. Conclusions:This study generated a conceptualization of nurses' roles and experience that details the relationship among the elements and conditions that shape nurse-tonurse handoffs.Impact: Nursing handoff involves the communication of patient information and relational behaviours that support the exchange. Although many factors are known to influence handoffs, little was known about nurses' experience of dealing with these at the point of care. This study contributed a comprehensive conceptualization of nursing handoff that could be useful in identifying areas for quality improvement and guiding future educational efforts.

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Section: Discussionmentioning

confidence: 99%

Section: The Studymentioning

confidence: 99%

Nurses' experience of handoffs on four Canadian medical and surgical units: A shared accountability for knowing and safeguarding the patient

Lavoie

Clausen

Purden

et al. 2021

Journal of Advanced Nursing

Self Cite

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“…There was a study that compares medical ward and surgical ward nurses. Lavoie et al (15) identified that surgical ward nurses relied more on EWS than medical ward nurses although the EWS should be used more in medical units. The findings showed that there was no relationship between years of working and KAP of EWS.…”

Section: Discussionmentioning

confidence: 99%

Knowledge, Attitudes and Practice of Nurses in Assessing Patients using Early Warning Sign (EWS) Scoring in a teaching hospital in Kuantan Pahang, Malaysia

Alias

Ludin

2021

Int J Care Scholars

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Introduction: Early Warning Sign (EWS) is a tool made up of vital signs chart and scoring to detect any changes in patient so that immediate and appropriate care can be further determined and provided. The objectives of the study are to assess the level of knowledge, attitudes, and practice of nurses in assessing patient using EWS scoring and to identify association between socio-demographic with knowledge, attitudes, and practice, as well as to determine the associations between knowledge with attitudes, attitudes with practice and knowledge of nurses in assessing patient using EWS scoring. Methods: A quantitative cross- sectional study with convenience sampling study was conducted on 132 nurses from medical, surgical and orthopedics wards in Sultan Ahmad Shah Medical Centre (SASMEC) from November 2020 until January 2021. Printed questionnaires were distributed to the nurses in English language. The questionnaire consisted of two parts. Part A was about socio-demographic data (area and on years of nursing practice, & service, area of practice, educational level, as well as whether holding post-basic/ advance course certificate, attending life support training and ICU outreach participant). Part B was about knowledge, attitudes, and practices of EWS. Data analysis was interpreted in descriptive and inferential analysis using Statistical Package for the Social Sciences (SPSS) version 20.0. Results: A total of 108 respondents involved in the study represents 82% response rate. Majority of respondents scored low in knowledge questions with grade F (n=106, 98.3%). One respondent scored grade D, correctly answering 8 over 13 questions (62%). Only one respondent obtained grade B with 85% score. Based on the result, there are more participants (n=58, 53.7%) achieving good attitudes while respondents with poor attitudes were (n=50, 46.3%). Moreover, 59 respondents (54.6%) have higher practice level than mean score, indicating good EWS practice. The remaining 49 respondents (45.4%) scored below the mean score cut off point indicating poor practice. The mean values are different depending on working areas in terms of attitudes and practice. The association between attitudes and practice (r= 0.641, p-value<0.01) is confirmed having a positive and strong correlation. Conclusion: The study revealed that despite having poor knowledge on EWS, the nurses have demonstrated good attitudes and practice in detecting patients’ progressive deteriorating conditions; thus, confirming that there are associations in area of practice with attitudes and practice. The results also shows that there is a significant difference between attitudes and practice of nurses in assessing patient using EWS with (p- value< 0.05).

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“…The score indicates the risk of developing a critical event and the level of care needed 6. In conjunction, clinicians use their education and clinical experience, as when EWS did not exist, to make clinical judgements 7 8. Implementing EWS advises clinical assessment when puzzles are missing from knowledge and experience.…”

Section: Introductionmentioning

confidence: 99%

Implementation of a digital early warning score (NEWS2) in a cardiac specialist and general hospital settings in the COVID-19 pandemic: a qualitative study

et al. 2023

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ObjectivesTo evaluate implementation of digital National Early Warning Score 2 (NEWS2) in a cardiac care setting and a general hospital setting in the COVID-19 pandemic.DesignThematic analysis of qualitative semistructured interviews using the non-adoption, abandonment, scale-up, spread, sustainability framework with purposefully sampled nurses and managers, as well as online surveys from March to December 2021.SettingsSpecialist cardiac hospital (St Bartholomew’s Hospital) and general teaching hospital (University College London Hospital, UCLH).ParticipantsEleven nurses and managers from cardiology, cardiac surgery, oncology and intensive care wards (St Bartholomew’s) and medical, haematology and intensive care wards (UCLH) were interviewed and 67 were surveyed online.ResultsThree main themes emerged: (1) implementing NEWS2 challenges and supports; (2) value of NEWS2 to alarm, escalate and during the pandemic; and (3) digitalisation: electronic health record (EHR) integration and automation. The value of NEWS2 was partly positive in escalation, yet there were concerns by nurses who undervalued NEWS2 particularly in cardiac care. Challenges, like clinicians’ behaviours, lack of resources and training and the perception of NEWS2 value, limit the success of this implementation. Changes in guidelines in the pandemic have led to overlooking NEWS2. EHR integration and automated monitoring are improvement solutions that are not fully employed yet.ConclusionWhether in specialist or general medical settings, the health professionals implementing early warning score in healthcare face cultural and system-related challenges to adopting NEWS2 and digital solutions. The validity of NEWS2 in specialised settings and complex conditions is not yet apparent and requires comprehensive validation. EHR integration and automation are powerful tools to facilitate NEWS2 if its principles are reviewed and rectified, and resources and training are accessible. Further examination of implementation from the cultural and automation domains is needed.

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Nurses’ judgments of patient risk of deterioration at change-of-shift handoff: Agreement between nurses and comparison with early warning scores

Cited by 9 publications

References 34 publications

Nurses' experience of handoffs on four Canadian medical and surgical units: A shared accountability for knowing and safeguarding the patient

Nurses' experience of handoffs on four Canadian medical and surgical units: A shared accountability for knowing and safeguarding the patient

Knowledge, Attitudes and Practice of Nurses in Assessing Patients using Early Warning Sign (EWS) Scoring in a teaching hospital in Kuantan Pahang, Malaysia

Implementation of a digital early warning score (NEWS2) in a cardiac specialist and general hospital settings in the COVID-19 pandemic: a qualitative study

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