A fundamental conflict of care: Nurses’ accounts of balancing patients' sleep with taking vital sign observations at night
Authors: Hope, J., Recio-Saucedo, A., Fogg, C., Griffiths, P., Smith, G.B., Westwood, G. and Schmidt, P.E.
Journal: Journal of Clinical Nursing
Volume: 27
Issue: 9-10
Pages: 1860-1871
eISSN: 1365-2702
ISSN: 0962-1067
DOI: 10.1111/jocn.14234
Abstract:Aims and objectives: To explore why adherence to vital sign observations scheduled by an early warning score protocol reduces at night. Background: Regular vital sign observations can reduce avoidable deterioration in hospital. early warning score protocols set the frequency of these observations by the severity of a patient's condition. Vital sign observations are taken less frequently at night, even with an early warning score in place, but no literature has explored why. Design: A qualitative interpretative design informed this study. Methods: Seventeen semi-structured interviews with nursing staff working on wards with varying levels of adherence to scheduled vital sign observations. A thematic analysis approach was used. Results: At night, nursing teams found it difficult to balance the competing care goals of supporting sleep with taking vital sign observations. The night-time frequency of these observations was determined by clinical judgement, ward-level expectations of observation timing and the risk of disturbing other patients. Patients with COPD or dementia could be under-monitored, while patients nearing the end of life could be over-monitored. Conclusion: In this study, we found an early warning score algorithm focused on deterioration prevention did not account for long-term management or palliative care trajectories. Nurses were therefore less inclined to wake such patients to take vital sign observations at night. However, the perception of widespread exceptions and lack of evidence regarding optimum frequency risks delegitimising the early warning score approach. This may pose a risk to patient safety, particularly patients with dementia or chronic conditions. Relevance to clinical practice: Nurses should document exceptions and discuss these with the wider team. Hospitals should monitor why vital sign observations are missed at night, identify which groups are under-monitored and provide guidance on prioritising competing expectations. early warning score protocols should take account of different care trajectories.
https://eprints.bournemouth.ac.uk/30157/
Source: Scopus
A fundamental conflict of care: Nurses' accounts of balancing patients' sleep with taking vital sign observations at night.
Authors: Hope, J., Recio-Saucedo, A., Fogg, C., Griffiths, P., Smith, G.B., Westwood, G. and Schmidt, P.E.
Journal: J Clin Nurs
Volume: 27
Issue: 9-10
Pages: 1860-1871
eISSN: 1365-2702
DOI: 10.1111/jocn.14234
Abstract:AIMS AND OBJECTIVES: To explore why adherence to vital sign observations scheduled by an early warning score protocol reduces at night. BACKGROUND: Regular vital sign observations can reduce avoidable deterioration in hospital. early warning score protocols set the frequency of these observations by the severity of a patient's condition. Vital sign observations are taken less frequently at night, even with an early warning score in place, but no literature has explored why. DESIGN: A qualitative interpretative design informed this study. METHODS: Seventeen semi-structured interviews with nursing staff working on wards with varying levels of adherence to scheduled vital sign observations. A thematic analysis approach was used. RESULTS: At night, nursing teams found it difficult to balance the competing care goals of supporting sleep with taking vital sign observations. The night-time frequency of these observations was determined by clinical judgement, ward-level expectations of observation timing and the risk of disturbing other patients. Patients with COPD or dementia could be under-monitored, while patients nearing the end of life could be over-monitored. CONCLUSION: In this study, we found an early warning score algorithm focused on deterioration prevention did not account for long-term management or palliative care trajectories. Nurses were therefore less inclined to wake such patients to take vital sign observations at night. However, the perception of widespread exceptions and lack of evidence regarding optimum frequency risks delegitimising the early warning score approach. This may pose a risk to patient safety, particularly patients with dementia or chronic conditions. RELEVANCE TO CLINICAL PRACTICE: Nurses should document exceptions and discuss these with the wider team. Hospitals should monitor why vital sign observations are missed at night, identify which groups are under-monitored and provide guidance on prioritising competing expectations. early warning score protocols should take account of different care trajectories.
https://eprints.bournemouth.ac.uk/30157/
Source: PubMed
A fundamental conflict of care: Nurses' accounts of balancing patients' sleep with taking vital sign observations at night
Authors: Hope, J., Recio-Saucedo, A., Fogg, C., Griffiths, P., Smith, G.B., Westwood, G. and Schmidt, P.E.
Journal: JOURNAL OF CLINICAL NURSING
Volume: 27
Issue: 9-10
Pages: 1860-1871
eISSN: 1365-2702
ISSN: 0962-1067
DOI: 10.1111/jocn.14234
https://eprints.bournemouth.ac.uk/30157/
Source: Web of Science (Lite)
A fundamental conflict of care: Nurses' accounts of balancing patients' sleep with taking vital sign observations at night.
Authors: Hope, J., Recio-Saucedo, A., Fogg, C., Griffiths, P., Smith, G.B., Westwood, G. and Schmidt, P.E.
Journal: Journal of clinical nursing
Volume: 27
Issue: 9-10
Pages: 1860-1871
eISSN: 1365-2702
ISSN: 0962-1067
DOI: 10.1111/jocn.14234
Abstract:Aims and objectives
To explore why adherence to vital sign observations scheduled by an early warning score protocol reduces at night.Background
Regular vital sign observations can reduce avoidable deterioration in hospital. early warning score protocols set the frequency of these observations by the severity of a patient's condition. Vital sign observations are taken less frequently at night, even with an early warning score in place, but no literature has explored why.Design
A qualitative interpretative design informed this study.Methods
Seventeen semi-structured interviews with nursing staff working on wards with varying levels of adherence to scheduled vital sign observations. A thematic analysis approach was used.Results
At night, nursing teams found it difficult to balance the competing care goals of supporting sleep with taking vital sign observations. The night-time frequency of these observations was determined by clinical judgement, ward-level expectations of observation timing and the risk of disturbing other patients. Patients with COPD or dementia could be under-monitored, while patients nearing the end of life could be over-monitored.Conclusion
In this study, we found an early warning score algorithm focused on deterioration prevention did not account for long-term management or palliative care trajectories. Nurses were therefore less inclined to wake such patients to take vital sign observations at night. However, the perception of widespread exceptions and lack of evidence regarding optimum frequency risks delegitimising the early warning score approach. This may pose a risk to patient safety, particularly patients with dementia or chronic conditions.Relevance to clinical practice
Nurses should document exceptions and discuss these with the wider team. Hospitals should monitor why vital sign observations are missed at night, identify which groups are under-monitored and provide guidance on prioritising competing expectations. early warning score protocols should take account of different care trajectories.https://eprints.bournemouth.ac.uk/30157/
Source: Europe PubMed Central
A fundamental conflict of care: nurses' accounts of balancing sleep with taking vital signs observations at night.
Authors: Hope, J., Recio-Saucedo, A., Fogg, C., Griffiths, P., Smith, G.B., Westwood, G. and Schmidt, P.E.
Journal: Journal of Clinical Nursing
Volume: 27
Issue: 9-10
Pages: 1860-1871
ISSN: 0962-1067
Abstract:AIMS AND OBJECTIVES: To explore why adherence to vital signs observations scheduled by an Early Warning Score protocol reduces at night. BACKGROUND: Regular vital signs observations can reduce avoidable deterioration in hospital. Early Warning Score protocols set the frequency of these observations by the severity of a patient's condition. Vital signs observations are taken less frequently at night, even with an Early Warning Score in place, but no literature has explored why. DESIGN: A qualitative interpretative design informed this study. METHODS: Seventeen semi-structured interviews with nursing staff working on wards with varying levels of adherence to scheduled vital signs observations. A thematic analysis approach was used. RESULTS: At night, nursing teams found it difficult to balance the competing care goals of supporting sleep with taking vital signs observations. The night-time frequency of these observations was determined by clinical judgement, ward-level expectations of observation timing and the risk of disturbing other patients. Patients with COPD or dementia could be under-monitored while patients nearing the end of life could be over-monitored. CONCLUSION: In this study we found an Early Warning Score algorithm focused on deterioration prevention did not account for long-term management or palliative care trajectories. Nurses were therefore less inclined to wake such patients to take vital signs observations at night. However the perception of widespread exceptions and lack of evidence regarding optimum frequency risks delegitimising the Early Warning Score approach. This may pose a risk to patient safety, particularly patients with dementia or chronic conditions. RELEVANCE TO CLINICAL PRACTICE: Nurses should document exceptions and discuss these with the wider team. Hospitals should monitor why vital signs observations are missed at night, identify which groups are under-monitored and provide guidance on prioritising competing expectations. Early Warning Score protocols should take account of different care trajectories. This article is protected by copyright. All rights reserved.
https://eprints.bournemouth.ac.uk/30157/
Source: BURO EPrints