Emergency nurses' decisions regarding frequency and nature of vital sign assessment.
OBJECTIVE
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.


METHODS
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.


CONCLUSIONS
Emergency nurses are tailoring vital sign assessment to patients' clinical status, and nurses are integrating known vital sign data into vital sign decision-making.


CONCLUSIONS
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.
Nursing and Midwifery Education and Strategy, Monash Health, School of Nursing and Midwifery, Deakin University, Geelong, Vic., Australia.
Katherine
K
Lambe
Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Deakin University, Geelong, Vic., Australia.
Judy
J
Currey
Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Deakin University, Geelong, Vic., Australia.|Centre for Quality and Patient Safety - Eastern Health Partnership, Australia.
Julie
http://orcid.org/0000-0003-3801-2456
J
Considine
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D016529:Emergency Nursing / Q000379:methods*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D063189:Symptom Assessment / Q000379:methods / Q000706:statistics & numerical data; D013997:Time Factors; D055986:Vital Signs
clinical deterioration; emergency department; emergency nursing; patient assessment; patient safety; risk assessment; vital signs