When Nursing Assertion Stops

Nursing Surveillance for Deterioration in Pediatric Patients: An Integrative Review

“…Most were published after 2009. Thirteen studies were conducted in the United States (Akre et al, 2010;Bonafide et al, 2013;Brady et al, 2015;Brady & Goldenhar, 2014;Dudley & Carr, 2004;Kaul et al, 2014;Martin, Keller, Long, & Ryan-Wenger, 2016;Reese, Simmons, & Barnard, 2016;Roberts et al, 2014;Thrasher, McNeely, & Adrian, 2017;Voepel-Lewis, Pechlavanidis, Burke, & Talsma, 2013;Watson, Skipper, Steury, Walsh, & Levin, 2014;Zenker et al, 2007), three in Canada (Lobos, Fernandes, Ramsay, & McNally, 2014 Compliance with vital assessment recordings: 2010), three in the United Kingdom (Doman, Prowse, & Webb, 2004;Oliver, Powell, Edwards, & Mason, 2010;Theilen et al, 2013), two in Australia (Azzopardi et al, 2011;McKay et al, 2013), two in Sweden (Almblad, Siltberg, Engvall, & Malqvist, 2018;Ygge & Arnetz, 2004), and one in Italy (Gawronski et al, 2018). Twenty-one studies were conducted in children's hospitals (Akre et al, 2010;Almblad et al, 2018;Azzopardi et al, 2011;Bonafide et al, 2013;Brady et al, 2015;Brady & Goldenhar, 2014;Gawronski et al, 2018;Kaul et al, 2014;Lobos et al, 2014;Lobos et al, 2015;Martin et al, 2016;McGillis Hall et al, 2010;Oliver et al, 2010;Reese et al, 2016;Roberts et al, 2014;…”

“…Twelve observational descriptive studies used cohort (Akre et al, 2010;Almblad et al, 2018;Lobos et al, 2014;Lobos et al, 2015;Martin et al, 2016;Oliver et al, 2010;Theilen et al, 2013), case-control (Brady et al, 2015;McKay et al, 2013;Voepel-Lewis et al, 2013;Zenker et al, 2007), or cross-sectional designs (Kaul et al, 2014). Nine studies reported the use of qualitative research methodologies including five grounded theory (Bonafide et al, 2013;Brady & Goldenhar, 2014;Doman et al, 2004;Roberts et al, 2014;Ygge & Arnetz, 2004), three thematic analysis studies (Gawronski et al, 2018;Reese et al, 2016;Thrasher et al, 2017), and one ethnographic study (Dudley & Carr, 2004). Three studies used mixed methods with cohort or crosssectional designs combined with thematic analysis of observations or open-ended responses to questionnaires (Azzopardi et al, 2011;McGillis Hall et al, 2010;Watson et al, 2014).…”

“…Four studies addressed factors associated with pediatric nurse surveillance or facilitators and barriers to recognizing or managing clinical deterioration (Brady & Goldenhar, 2014;Gawronski et al, 2018;Thrasher et al, 2017;Voepel-Lewis et al, 2013). The remaining 20 studies, although not focused on nursing surveillance, reported findings that elucidate our understanding of the conditions or context of nursing surveillance of clinical deterioration.…”

“…Performing and documenting assessments were identified as important activities in recognizing patient deterioration and marshalling support for intervention. Knowledge of patients' baseline assessment, professional experience, and recognizing the early signs of clinical deterioration were acknowledged to be essential in deciding how and when to intervene (Azzopardi et al, 2011;Brady & Goldenhar, 2014;Gawronski et al, 2018;Kaul et al, 2014;McKay et al, 2013;Thrasher et al, 2017). Education about the indicators of deterioration, clinical experience, situation awareness, and use of a standard assessment tool such as the PEWS enhanced nurses' ability to evaluate instability (Azzopardi et al, 2011;Bonafide et al, 2013;Brady & Goldenhar, 2014;Kaul et al, 2014;Martin et al, 2016;McKay et al, 2013;Theilen et al, 2013).…”

“…Readily accessible resources such as a rapid response team (RRT) or medical emergency team (MET) and diverse and clinically competent staff provided assistance to the bedside clinician in determining course of treatment or the need to escalate care (Brady & Goldenhar, 2014;Gawronski et al, 2018;Lobos et al, 2014;McKay et al, 2013;Zenker et al, 2007). Deciding whether to call for help and who to call were influenced by hierarchical or cultural norms, nurses' self-confidence, fear of reprisal or criticism, physician bias not to escalate, clinician preference, and failure to recognize physiologic decline in patients who appeared to be asymptomatic (Azzopardi et al, 2011;Gawronski et al, 2018;Reese et al, 2016;Roberts et al, 2014;Thrasher et al, 2017). Nurses were more prone to activate the RRT or MET for surgical patients because they perceived that surgeons were less available and less likely to address medical issues (Lobos et al, 2014).…”