title: The experiences of nurses implementing the Modified Early Warning Score and a 24-hour on-call Mobile Intensive Care Nurse: An exploratory study.
abstract: OBJECTIVE
  To explore experiences of nurses implementing and using the Modified Early Warning Score (MEWS) and a Mobile Intensive Care Nurse (MICN) providing 24-hour on-call nursing support.
  
  
  BACKGROUND
  To secure patient safety in hospital wards, nurses may increase the quality of care using a tool to detect the failure of vital functions. Possibilities for support can be provided through on-call supervision from a qualified team or nurse.
  
  
  METHODS
  This exploratory qualitative investigation used focus group interviews with nurses from two wards of a university hospital in Norway.
  
  
  METHODS
  A purposive sample of seven registered nurses was interviewed in focus groups. A semi-structured guide and an inductive thematic analysis were used to identify interview themes.
  
  
  RESULTS
  Three themes emerged: (1) experiences with the early recognition of deterioration using the MEWS, (2) supportive collaboration and knowledge transfer between nurses and (3) a "new" precise language using the score for communicating with physicians. The use of scores and support were perceived as improving care for deteriorating patients and for supporting the collaboration of nurses with other professionals.
  
  
  CONCLUSIONS
  In our study, nurses described increased confidence in the recognition of deteriorating patients and in the management of such situations. The non-critical attitude, supportive communication and interactive learning according to the MICN were essential elements for success.
authors.affiliation: Division of Emergencies and Critical Care, Oslo University Hospital-Rikshospitalet, P.O. Box 4950 Nydalen, NO-0424 Oslo, Norway; Department of Research and Development, Oslo University Hospital-Rikshospitalet, P.O. Box 4950 Nydalen, NO-0424 Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway. Electronic address: sistaf@ous-hf.no.
authors.forename: Siv K
authors.initials: SK
authors.lastname: Stafseth
authors.affiliation: Division of Emergencies and Critical Care, Oslo University Hospital-Rikshospitalet, P.O. Box 4950 Nydalen, NO-0424 Oslo, Norway. Electronic address: stugro@ous-hf.no.
authors.forename: Sturle
authors.initials: S
authors.lastname: Grønbeck
authors.affiliation: Department of Master and Continuing Education in Nursing, Lovisenberg Diaconal University College, Lovisenberggt. 15, NO-0456 Oslo, Norway. Electronic address: tine.lien@ldh.no.
authors.forename: Tine
authors.initials: T
authors.lastname: Lien
authors.affiliation: Department of Master and Continuing Education in Nursing, Lovisenberg Diaconal University College, Lovisenberggt. 15, NO-0456 Oslo, Norway. Electronic address: irene.randen@ldh.no.
authors.forename: Irene
authors.initials: I
authors.lastname: Randen
authors.affiliation: Department for Patient Safety and Development, Lovisenberg Diaconal Hospital, Lovisenberggt. 17, NO-0440 Oslo, Norway; Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, P.O. Box 1130 Blindern, NO-0318 Oslo, Norway. Electronic address: anners.lerdal@medisin.uio.no.
authors.forename: Anners
authors.initials: A
authors.lastname: Lerdal
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000592:standards; D003299:Cooperative Behavior; D020000:Decision Support Systems, Clinical / Q000592:standards*; D005260:Female; D017144:Focus Groups; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration; D008297:Male; D008875:Middle Aged; D009664:Norway; D009726:Nurses / Q000523:psychology*; D036301:Qualitative Research; D012720:Severity of Illness Index
keywords: Clinical deterioration; Critical care; Qualitative research; Vital sign monitoring