Critical Care Nursing

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This essay sets out to discuss the importance of comprehensive and accurate assessment on a registered nurses’ ability to make excellent clinical decisions. It will examine what factors can change a nurses’ capability to be aware of, and act on abnormal assessment findings. As well as assessment being part of the nursing process that is used in every day nursing, it is also a critical part of patient safety (Higgins, 2008). Assessment findings are used to determine what needs to be done for the patient next. Early warning scoring systems currently exist to aid in the early detection of patient deterioration (Goldhill, 2005). The rationale for the use of these systems is that early recognition of deterioration in the vital signs of a patient can afford opportunities for earlier, more effective intervention (DeVita, 2006). This essay will analyse the use of early warning scoring system tools and their relevance to patient deterioration and early detection.

ASSESSMENT

It is essential that nurses are able to recognise and assess changing vital signs in regards to cardiac arrest in the hospital setting. Proper recognition of early warning signs of cardiac arrest allow nurses to provide early, effective and appropriate intervention, thus improving patient outcomes. Garret (2010) stated that around 11% of hospital deaths are a result of clinical deterioration not being recognised. It is also stated by Higgins, et al (2008) that out of 425 patient deaths, 64 were related to patient deterioration that had not been recognised or acted on. In 14 of the cases, no observations had been made for a long time prior to death, and in 30 cases despite recording of vital signs, there was no recognition of clinical deterioration or no action taken.

Accurate and comprehensive assessment includes knowing how to measure vital signs properly and performing every aspect of an assessment. Nurses need to be properly educated on what is required of them when physically assessing a patient. As well as vital signs, which typically include heart rate, blood pressure, oxygen saturation, temperature and respiration rate, physical assessment also includes examining a patients mental state, skin, mobility, hydration status, elimination, pain and dressings.

The issue of consistency is raised when discussing how to ensure assessments are comprehensive, complete and that the data is recorded using the same guidelines as other nurses. To enable consistency of assessment, the same nurse should be taking the observations of a patient for the duration of a shift (Moore, 2007). This ensure that the interpretation of results don’t differ each time the vital signs are done. It also allows the nurse to detect subtle changes in the patients state that may not have been written down. For example, in most clinical environments the respiration rate is recorded as just a number, and the rhythm, degree of effort, quality of breathing and evidence of wheezing or other abnormal breathing sounds are not recorded. The rate may stay the same over a period of time while other aspects of respiration may change, and this is something that a nurse is more likely to notice if they have assessed that patient before. During handover, a nurse should tell the next nurse looking after their patients how they took observations and detail what tools they used to ensure consistency is maintained.

Nurses may not pick up on abnormal assessment findings because they do not know what the normal ranges are, or perhaps do not know what combinations of abnormal clinical findings are indicative of patient deterioration. On the other hand, when nurses fail to act on the warning signs of patient deterioration it could be that they recognise an abnormality but do not understand the urgency or importance of early and appropriate intervention. It may also be that they don’t know how to intervene. These are issues that urgently need addressing in order to ensure...
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