title: Knowing 'something is not right' is beyond intuition: development of a clinical algorithm to enhance surveillance and assist nurses to organise and communicate clinical findings.
abstract: OBJECTIVE
  To develop a clinical algorithm to guide nurses' critical thinking through systematic surveillance, assessment, actions required and communication strategies. To achieve this, an international, multiphase project was initiated.
  
  
  BACKGROUND
  Patients receive hospital care postoperatively because they require the skilled surveillance of nurses. Effective assessment of postoperative patients is essential for early detection of clinical deterioration and optimal care management. Despite the significant amount of time devoted to surveillance activities, there is lack of evidence that nurses use a consistent, systematic approach in surveillance, management and communication, potentially leading to less optimal outcomes. Several explanations for the lack of consistency have been suggested in the literature.
  
  
  METHODS
  Mixed methods approach.
  
  
  METHODS
  Retrospective chart review; semi-structured interviews conducted with expert nurses (n = 10); algorithm development.
  
  
  RESULTS
  Themes developed from the semi-structured interviews, including (1) complete, systematic assessment, (2) something is not right (3) validating with others, (4) influencing factors and (5) frustration with lack of response when communicating findings were used as the basis for development of the Surveillance Algorithm for Post-Surgical Patients.
  
  
  CONCLUSIONS
  The algorithm proved beneficial based on limited use in clinical settings. Further work is needed to fully test it in education and practice.
  
  
  CONCLUSIONS
  The Surveillance Algorithm for Post-Surgical Patients represents the approach of expert nurses, and serves to guide less expert nurses' observations, critical thinking, actions and communication. Based on this approach, the algorithm assists nurses to develop skills promoting early detection, intervention and communication in cases of patient deterioration.
authors.affiliation: The Miriam Hospital, Providence, RI, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Brier
authors.forename: Moalem
authors.initials: M
authors.lastname: Carolyn
authors.forename: Marsha
authors.initials: M
authors.lastname: Haverly
authors.forename: Mary Ellen
authors.initials: ME
authors.lastname: Januario
authors.forename: Cynthia
authors.initials: C
authors.lastname: Padula
authors.forename: Ahuva
authors.initials: A
authors.lastname: Tal
authors.forename: Henia
authors.initials: H
authors.lastname: Triosh
mesh_terms: D000465:Algorithms; D000066491:Clinical Decision-Making; D003142:Communication; D006801:Humans; D019545:Intuition; D009730:Nursing Assessment; D011159:Population Surveillance; D012189:Retrospective Studies; D013850:Thinking
keywords: acute care; adverse events; clinical decision-making; clinical judgment; critical thinking; nursing assessment; nursing practice; postoperative care