Self-Leadership in a Critical Care Outreach Service for Quality Patient Care

Abstract

The deterioration of patients in general wards could go unnoticed owing to the intermittent monitoring of vital data. The delayed or missed recognition of deteriorating patients results in serious adverse events in general wards. These challenges have resulted in the development of a critical care outreach service. Australia was the first country to establish critical care outreach services in 1990. In South Africa, critical care outreach services were implemented in 2005 at a private hospital in Pretoria. The researcher has noticed certain phenomena supported by literature such as the hesitancy of nurses working in general wards to escalate a patient to a critical care outreach service, and incorrect interpretation of modified early warning scores which could cause delays in patients being referred to outreach nurse experts. In this study, nurses’ (professional, staff and auxiliary nurses) experiences in respect of their self-leadership in critical care outreach services were explored. To this end, a qualitative phenomenological research approach was followed. Focus groups were held with the nurses (all nurse categories) working in a South African private hospital which provides critical care outreach services. It is recommended that nurses be granted access to training sessions, workshops and information to provide appropriate nursing care. Nurses should be encouraged to focus on the positive outcomes of providing nursing care and to “applaud themselves mentally” when they have successfully assisted or cared for their patients. Nurses also need to identify and correct negative assumptions about their competence.

A practical approach to establishing a critical care outreach service: An expert panel research design

“…80 The CCON must balance their critical care expertise with the immediate needs of the ward environment, working in collaboration with ward staff to navigate the approach taken to monitor and manage the patient. Being accessible, approachable, 16,81,82 friendly, and knowledgeable 16 enables CCONs to have key roles in supporting nurses' and junior doctors' decision-making by sharing their knowledge and skills 37,82,83 and building ward nurses' confidence in managing deteriorating patients. 81,83 Many interventions performed by the CCOS relate to communication and education 8,36 and include patient and family advocacy, which may comprise of assisting the team with early decision-making regarding patient treatment limitations and transition to end-of-life care.…”

“…Being accessible, approachable, 16,81,82 friendly, and knowledgeable 16 enables CCONs to have key roles in supporting nurses' and junior doctors' decision-making by sharing their knowledge and skills 37,82,83 and building ward nurses' confidence in managing deteriorating patients. 81,83 Many interventions performed by the CCOS relate to communication and education 8,36 and include patient and family advocacy, which may comprise of assisting the team with early decision-making regarding patient treatment limitations and transition to end-of-life care. 80,84e87 Cross et al 88 identified nurses new to CCOS need clinical supervision, role clarification, understanding how to deal with personal issues, dedicated time for reflection, and debriefing.…”

Strategies for the Facilitation of Self-Leadership Among Ward Nurses in a Nurse-Led Critical Care Outreach Service

“…Although these approaches are known by diverse terms – including the ‘rapid response system’, ‘medical emergency team’ and the ‘patient-at-risk team’ – all have the same goal, namely to assist nurses with the management of patients whose health is at risk of deteriorating or is deteriorating at that moment. Prinsloo (2020) states that the diversity of CCOS approaches all share one element, namely the tracking of vital data by using a referral algorithm, for instance the modified early warning score (MEWS), to indicate when a patient needs to be referred to CCOS. CCOS assist nursing staff in implementing suitable and personalised interventions for the referred patient to prevent them from further deterioration; alternatively, CCOS assists nurses in transferring the patient to a higher level of care, if necessary.…”

Self-leadership of nurses in a critical care outreach service: The development of a conceptual framework

“…The assistance and mentoring of bedside nurses increased bedside nurses’ competence in providing nursing care to patients whose health is declining. Globally, diverse CCOS approaches exist, and Prinsloo ( 2020 ) stated that the diverse CCOS approaches all share common features such as the tracking of vital data by means of, for example, modified early warning score (MEWS) as a referral algorithm. Critical care outreach services assist nursing staff to undertake timely, suitable and personalised interventions when a patient is referred to the CCOS.…”