Seeing the whole picture in enrolled and registered nurses’ experiences in recognizing clinical deterioration in general ward patients: A qualitative study

Chua, Wei Ling; Legido‐Quigley, Helena; Ng, P Y; McKenna, Lisa; Hassan, Norasyikin; Liaw, Sok Ying

doi:10.1016/j.ijnurstu.2019.04.012

Cited by 45 publications

(85 citation statements)

References 45 publications

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“…The belief that RNs do not need to delegate to junior colleagues is particularly problematic given the reported association between poor delegation and aspects of nursing care being delayed or missed entirely (Kalisch, 2006). On this basis, we echo the suggestions in other work (Chua et al, 2019; Kalisch, 2006), and recommend that attention be given to raising the importance of delegation as a safety critical aspect of the RN role. We also encourage educators to equip registrants with the necessary communication and leadership skills to delegate care effectively in increasingly complex clinical environments.…”

Section: Discussionsupporting

confidence: 84%

“…This is worthy of note given that, in the UK context, RNs are accountable for the actions and omissions of their unregistered colleagues, and are required by their professional code of conduct to appropriately delegate care (Nursing & Midwifery Council, 2015). Notwithstanding the difference in context, similar discrepancies were reported in a qualitative study conducted in Singapore (Chua et al, 2019). Here, the researchers reported inadequate direction and supervision of Enrolled nurses (licensed practitioners who are educated at a lower level than a RN) by RNs, when vital signs were being monitored (Chua et al, 2019).…”

Section: Discussionsupporting

confidence: 62%

“…Notwithstanding the difference in context, similar discrepancies were reported in a qualitative study conducted in Singapore (Chua et al, 2019). Here, the researchers reported inadequate direction and supervision of Enrolled nurses (licensed practitioners who are educated at a lower level than a RN) by RNs, when vital signs were being monitored (Chua et al, 2019). The belief that RNs do not need to delegate to junior colleagues is particularly problematic given the reported association between poor delegation and aspects of nursing care being delayed or missed entirely (Kalisch, 2006).…”

Section: Discussionsupporting

confidence: 62%

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Barriers and enablers of recognition and response to deteriorating patients in the acute hospital setting: A theory‐driven interview study using the Theoretical Domains Framework

Smith

Cartwright

Dyson

et al. 2021

Journal of Advanced Nursing

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Aim To explore barriers and enablers of recognition and response to signs of patient deterioration by nursing staff in an acute hospital. Design A theory‐driven interview study underpinned by the Theoretical Domains Framework of behaviour change. Methods Between 07/01/2019 and 18/12/2019 a purposive sample of registered nurses and healthcare assistants was recruited to participate in a semi‐structured (audio‐recorded) interview, to explore the determinants of seven specified behaviours of the afferent limb. Anonymised transcripts were deductively coded (using the 14 Theoretical Domains Framework domains as coding categories) and then extracts within each domain were inductively analysed to synthesise belief statements and themes. Prioritisation criteria from published literature were applied. Results Thirty‐two semi‐structured interviews were conducted. From 1,888 quotes, 184 belief statements and 66 themes were synthesised. One hundred and forty‐six belief statements, represented by 58 themes, met prioritisation criteria. Nine domains of the Theoretical Domains Framework were of high importance: Knowledge; Social, Professional Role and Identity; Beliefs about Consequences; Reinforcement; Intentions; Goals; Memory, Attention and Decision Processes; Environment, Context and Resources and Social Influences. Conclusions Barriers and enablers most likely to impact on nursing staff afferent limb behaviour were identified in nine domains of the Theoretical Domains Framework.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionsupporting

confidence: 62%

Section: Discussionsupporting

confidence: 62%

See 1 more Smart Citation

Barriers and enablers of recognition and response to deteriorating patients in the acute hospital setting: A theory‐driven interview study using the Theoretical Domains Framework

Smith

Cartwright

Dyson

et al. 2021

Journal of Advanced Nursing

View full text Add to dashboard Cite

show abstract

“…The ENs in this study reported a lack of backup from the RNs, which resulted in them feeling overwhelmed with their overloaded nursing tasks. A previous study also reported a lack of supervision and backup behaviours from RNs, which could have led to missed nursing care in vital signs monitoring among overloaded ENs (Chua et al., 2019). As workload can act as a stressor that impedes team performance, Salas et al.…”

Section: Discussionmentioning

confidence: 99%

Nursing teamwork in general ward settings: A mixed‐methods exploratory study among enrolled and registered nurses

Goh

Ser

Cooper

et al. 2020

Journal of Clinical Nursing

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Aim To examine the perceived level of nursing teamwork and factors influencing teamwork among enrolled nurses (ENs) and registered nurses (RNs) in general ward settings. Background The nursing care delivery model includes RNs, ENs and others who work as a team to deliver patient care. The potential impact of teamwork on nursing care highlights the need to explore the work of nursing teams. Design A mixed‐methods exploratory study. Method Quantitative and qualitative data were collected concurrently from ENs and RNs in 2018. Two hundred and forty‐eight (n = 248) nurses completed the Nursing Teamwork Survey. Sixteen nurses participated in focus group discussions. Qualitative data were reported following COREQ guidelines, while quantitative data followed the STROBE guidelines. Results Both ENs and RNs scored highest for the shared mental model subscale but lowest for the team orientation subscale. Factors including qualification level, years of working experience, perceived job staffing adequacy and job satisfaction were found to influence teamwork. Three themes emerged from the qualitative findings: expectations of each other's role, delegation practices and interpersonal relationships. ENs and RNs differed in their expectations of their role in basic patient care activities and faced power struggles related to delegation practices. Open and structured communication was deemed essential in building interpersonal relationships. Conclusion The ENs and RNs have clear understanding of their personal roles and responsibilities towards achieving a common goal. However, teamwork may be improved with a shared mental model in performing basic nursing care tasks, mutual support for workload management, better delegation practices, effective communication, enhanced interpersonal relationships and better team orientation. Relevance to clinical practice Nurse managers and educators need to work collaboratively to foster positive delegation practices in clinical practice supported by applicable team training that enhances mutual trust, backup behaviours and collective orientation in nursing teams.

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“…The initial item pool was generated based on our two previously published qualitative studies on the experiences of general ward staff in recognising and escalating care in clinical deterioration [16,22] and themes from an earlier systematic review on factors influencing activations of the MET by frontline ward staff [23]. All items used a 5-point Likert response format (1 ¼ strongly disagree to 5 ¼ strongly agree).…”

Section: Phase 1: Development Of the Preliminary Cared Scalementioning

confidence: 99%

The development and psychometric evaluation of the Clinicians' Attitudes towards Responding and Escalating care of Deteriorating patients scale

Chua

Tee

Hassan

et al. 2021

Australian Critical Care

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Background: Validated measures of ward nurses' safety cultures in relation to escalations of care in deteriorating patients are lacking.Objectives: This study aimed to develop and evaluate the psychometric properties of the Clinicians' Attitudes towards Responding and Escalating care of Deteriorating patients (CARED) scale for use among ward nurses. Methods: The study was conducted in two phases: scale development and psychometric evaluation. The scale items were developed based on a systematic literature review, informant interviews, and expert reviews (n ¼ 15). The reliability and validity of the scale were examined by administering the scale to 617 registered nurses with retest evaluations (n ¼ 60). The factor structure of the CARED scale was examined in a split-half analysis with exploratory and confirmatory factor analyses. The internal consistency, test eretest reliability, convergent validity, and known-group validity of the scale were also analysed. Results: A high overall content validity index of 0.95 was obtained from the validations of 15 international experts from seven countries. A three-factor solution was identified from the final 22 items: 'beliefs about rapid response system', 'fears about escalating care', and 'perceived confidence in responding to deteriorating patients'. The internal consistency reliability of the scale was supported with a good Cronbach's alpha value of 0.86 and a Spearman-Brown split-half coefficient of 0.87. An excellent testeretest reliability was demonstrated, with an intraclass correlation coefficient of 0.92. The convergent validity of the scale was supported with an existing validated scale. The CARED scale also demonstrated abilities to discriminate differences among the sample characteristics. Conclusions: The final 22-item CARED scale was tested to be a reliable and valid scale in the Singaporean setting. The scale may be used in other settings to review hospitals' rapid response systems and to identify strategies to support ward nurses in the process of escalating care in deteriorating ward patients.

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Seeing the whole picture in enrolled and registered nurses’ experiences in recognizing clinical deterioration in general ward patients: A qualitative study

Cited by 45 publications

References 45 publications

Barriers and enablers of recognition and response to deteriorating patients in the acute hospital setting: A theory‐driven interview study using the Theoretical Domains Framework

Barriers and enablers of recognition and response to deteriorating patients in the acute hospital setting: A theory‐driven interview study using the Theoretical Domains Framework

Nursing teamwork in general ward settings: A mixed‐methods exploratory study among enrolled and registered nurses

The development and psychometric evaluation of the Clinicians' Attitudes towards Responding and Escalating care of Deteriorating patients scale

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