Interventions used by surgical ward nurses when worried, based on professional intuition, about a patient’s clinical condition

Abstract

Background: The early recognition and treatment of deteriorating patients in surgical wards constitute a key task of nurses in daily practice. Nurses often recognise deteriorating patients through professional intuition. Nurses may use vital signs to confirm their concerns about the patients’ clinical condition but whether further interventions are undertaken remains unclear. Exploring interventions used by nurses could lead to determining which interventions improve the quality of care of deteriorating patients and thereby contribute to the prevention of unplanned admissions to the intensive care unit. Objective: To explore interventions used by surgical ward nurses when worried, based on professional intuition, about a patient’s clinical condition. Method: Data were collected through semi-structured interviews. Nurses were selected using purposive sampling and maximum variation. Interviews were transcribed verbatim and analysed using inductive content analysis (Atlas.ti). A member check of the preliminary analysis was performed. Results: Twelve nurses of two teaching hospitals were interviewed. From the interviews five phases emerged: nurses first attempts to obtain an overview of the patient, after which they would decide whether or not to call for medical assistance. Subsequently nurses monitored the patient for changes and made a further assessment of the patient. To ensure continuity, nurses reported orally and in writing about their observations and interventions. When vital signs deviated nurses acted accordingly. In addition, influencing factors on the judgement of nurses in these phases were identified. Conclusion: The findings of this study show that surgical ward nurses use a variety of interventions when worried about a patient’s clinical condition based on professional intuition and these interventions seem to follow five phases. Recommendations: The interventions should be further explored to determine to what degree these interventions contribute to the quality of care of deteriorating patients.