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Emergency nurses’ decisions regarding frequency and nature of vital sign assessment

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  • Katherine Lambe
  • Judy Currey
  • Julie Considine

Abstract

Aims and objectives To explore the factors emergency nurses use to inform their decisions regarding frequency and nature of vital sign assessment. Background Research related to clinical deterioration and vital sign assessment in the emergency department is in its infancy. Studies to date have explored the frequency of vital sign assessment in the emergency department; however, there are no published studies that have examined factors that emergency nurses use to inform their decisions regarding frequency and nature of ongoing vital sign assessment. Design A prospective exploratory design was used. Data were collected using a survey consisting of eight patient vignettes. Methods The study was conducted in one emergency department in metropolitan Melbourne. Participants were emergency nurses permanently employed at the study site. Results A 96% response rate was achieved (n = 47/49). The most common frequency of patient reassessment nominated by participants was 15 or 30 minutely, with an equal number of participants choosing these frequency intervals. Abnormality in initial vital sign parameters was the most common factor identified for choosing either a 15‐ or 30‐minute assessment interval. Frequency of assessment decisions was influenced by years of emergency nursing experience in one vignette and level of postgraduate qualification in three vignettes. Heart rate, respiratory rate and blood pressure were all nominated by over 80% of participants as vital signs that participants considered important for reassessment. The frequency and nature of vital signs selected varied according to vignette content. There were significant negative correlations between assessment of conscious state and years of nursing experience and assessment of respiratory rate and years of emergency nursing experience. Level of postgraduate qualification did not influence selection of parameters for reassessment. Conclusion Emergency nurses are tailoring vital sign assessment to patients’ clinical status, and nurses are integrating known vital sign data into vital sign decision‐making. Relevance to clinical practice Accurate assessment and interpretation of vital sign data is fundamental to patient safety. Emergency nurses are responsible for the initial and ongoing assessment of undiagnosed or undifferentiated patients. Prior to medical assessment, emergency nurses are solely responsible for patient assessment, escalation of care and implementation of interventions within nursing scope of practice.

Suggested Citation

  • Katherine Lambe & Judy Currey & Julie Considine, 2017. "Emergency nurses’ decisions regarding frequency and nature of vital sign assessment," Journal of Clinical Nursing, John Wiley & Sons, vol. 26(13-14), pages 1949-1959, July.
  • Handle: RePEc:wly:jocnur:v:26:y:2017:i:13-14:p:1949-1959
    DOI: 10.1111/jocn.13597
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    References listed on IDEAS

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    1. Belinda Munroe & Kate Curtis & Margaret Murphy & Luke Strachan & Julie Considine & Jennifer Hardy & Mark Wilson & Kate Ruperto & Judith Fethney & Thomas Buckley, 2016. "A structured framework improves clinical patient assessment and nontechnical skills of early career emergency nurses: a pre–post study using full immersion simulation," Journal of Clinical Nursing, John Wiley & Sons, vol. 25(15-16), pages 2262-2274, August.
    2. Belinda Munroe & Kate Curtis & Julie Considine & Thomas Buckley, 2013. "The impact structured patient assessment frameworks have on patient care: an integrative review," Journal of Clinical Nursing, John Wiley & Sons, vol. 22(21-22), pages 2991-3005, November.
    3. Julie Considine & Carissa Trotter & Judy Currey, 2016. "Nurses' documentation of physiological observations in three acute care settings," Journal of Clinical Nursing, John Wiley & Sons, vol. 25(1-2), pages 134-143, January.
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    1. Gitte Bunkenborg & Lars Smith‐Hansen & Ingrid Poulsen, 2019. "Implementing mandatory early warning scoring impacts nurses’ practice of documenting free text notes," Journal of Clinical Nursing, John Wiley & Sons, vol. 28(15-16), pages 2990-3000, August.

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