Vital signs monitoring to detect patient deterioration: An integrative literature review

Vital signs monitoring is an important nursing assessment. Yet, nurses seem to be doing it as part of a routine and often overlooking their significance in detecting patient deterioration. An integrative literature review was conducted to explore factors surrounding ward nursing practice of vital signs monitoring in detecting and reporting deterioration. Twenty papers were included. The structural component of a Nursing Role Effectiveness Model framework, which comprises of patient, nurse and organizational variables, was used to synthesize the review. Patient variables include signs of deterioration displayed by patients which include physical cues and abnormal vital signs. Nursing variables include clinical knowledge, roles and responsibilities, and reporting of deteriorating vital signs. Organizational variables include heavy workload, technology, and observation chart design. This review has highlighted current nursing practice in vital signs monitoring. A myriad of factors were found to surround ward practice of vital signs monitoring in detecting and reporting deterioration.     

Effect of levalbuterol on prehospital patient parameters

This study was performed to determine if levalbuterol improves dyspnea as assessed by prehospital clinical parameters. All EMS patients >or=16 years old given nebulized levalbuterol over 6 months were included in this prospective, open-label work. Data collected included demographics, initial pulse rate (P), respiratory rate (R), patient report of respiratory distress (S), and peak expiratory flow (PF). Outcome variables were P, R, S, and PF after levalbuterol use. Statistical analysis used t tests, with P 相似文献   

Influence of structured encounter forms on documentation by community pediatricians

BACKGROUND: Age-specific structured encounter forms for well-child examinations have been shown to improve thoroughness of documentation among pediatric house staff. This study evaluated the influence of such forms on completeness of documentation by practicing pediatricians. METHODS: In this before-after trial at 5 urban community health clinics, participants were 8 pediatricians practicing for at least 1 year. Brief group training sessions on use of the forms were provided to the participating physicians. Completeness of documentation was defined as the proportion of elements from a full well-child examination recorded in the medical record. RESULTS: After introduction of the standardized forms, completeness of documentation significantly increased for all components. CONCLUSIONS: The use of age-specific structured encounter forms improved the completeness of documentation of pediatric well-child examinations done by pediatricians.     

Effect of vital signs on advanced life support interventions for prehospital patients

Objective. Routine vital signs assessment is considered a fundamental component of patient assessment. This study was undertaken to determine whether advanced life support (ALS) emergency medical services (EMS) providers depend on vital signs information in managing their patients.

Methods. Emergency medical technician-paramedics (EMT-Ps) and EMT-Intermediates (EMT-Is) were presented with 20 randomized patient scenarios that did not included vital signs information. The participants were asked to identify all of the interventions they would perform for each hypothetical patient. At least six weeks later the same scenarios were presented in a new order, with vital signs information, and the participants again identified the interventions they would perform. The participants' estimations of the patients' blood pressures, as well as the frequencies with which 18 specific interventions were performed, were compared for the no-vital signs and the vital signs groups using chi-square or Fisher's exact test, with an alpha value of 0.05 considered significant.

Results. Fourteen EMT-Ps and 16 EMT-Is completed both the no-vital signs and vital signs portions of the study, for a total of 1,160 hypothetical patient encounters. When vital signs were given, the EMT-Is were more likely to apply a cardiac monitor (65.2% vs 80.1%, p = 0.000), more likely to start at least one intravenous (IV) line (82.1% vs 87.8%, p = 0.038), and more likely to administer a medication (1.3% vs 5.6%, p = 0.003). The EMT-Ps were also more likely to apply a cardiac monitor (84.4% vs 90.3%, p = 0.041), more likely to run an IV at a “wide open” rate (9.5% vs 19.0%, p = 0.004), and less likely to identify patients as being hypotensive (39.9% vs 26.4%, p = 0.004).

Conclusion. The presence or absence of vital signs information does influence some of the patient care decisions of EMS providers; however, the clinical implications of these decisions are unclear. Further studies are needed to determine whether ALS providers can adequately manage actual patients without obtaining vital signs.     

Commercial filming of prehospital patient care

Commercial filming of patients in the hospital and now the prehospital environment is becoming increasingly common. Television programmes that focus on medical emergencies with real footage of events remain highly successful and can make compelling viewing for both medical professionals and the general public alike. Recently several commentators have questioned the ethical aspects of filming in hospital emergency departments, and noted the lack of available evidence. This article reviews commercial filming and its impact in the prehospital environment and examines the ethical implications and current guidance in this unique setting.     

More than medical treatment: the patient's first encounter with prehospital emergency care

A common feature of emergency care services is the short, fragmented encounters with great demands for rapid treatment and efficiency. The aim of this study was to describe and understand the patient's first encounter with prehospital emergency care as experienced by the patient and the first responders. A lifeworld perspective was used in four different traumatic situations. The data consisted of 18 unstructured interviews with patients and first responders. The phenomenological analysis showed that the concept of lifesaving means more than just upholding vital functions. The patient needs to retain his/her identity by means of a communicative contact, to be confirmed in the lived encounter and to recapitulate the elapsed time of the unexpected event in order to regain a state of equilibrium. Five constituents further described the variations of the patients' first encounter; the encounter with the helpless injured body, the confirming existential encounter, the encounter while waiting, the lived encounter and the recapitulated encounter. This finding highlights the importance of a new understanding about empowering the patient with narratives throughout the whole caring process. There are also implications for educating personnel and students in emergency care about the first encounter with the patient in emergency care where the senses, the time and the narrative are essential elements that are unique for each person.     

Vital signs in hospital patients: a systematic review

Objectives: This review was initiated to identify the best available evidence on vital sign measurements in hospital patients. Method: Inclusion Criteria – Studies that evaluated some aspect of vital signs. Search – Covered all major databases and the references of identified studies. Data Analysis. because of the nature of identified studies, data were summarised using narrative rather than statistical methods. Results: A total of 737 papers of which 69 met the inclusion criteria. Conclusion: This review has highlighted a need for further investigation of issues related to the role, nature and optimal practice of monitoring patient vital signs.     

Consensus on the prehospital approach to burns patient management

Burns patients form a large group of trauma patients cared for by first aiders, ambulance staff, nurses, and doctors before reaching specialist care in hospital. Guidance for these important carers is often poor or confused and this engenders anxiety and detracts from optimal patient care. This paper outlines nine key steps in the initial management of burn patients in the prehospital environment based on current available evidence and a consensus of specialists from all disciplines caring for burns patients. The basis of care should be that simple things should always be performed well.