Exploring Patient Assessment Practices in the Acute Hospital Environment: An Ethnography

Purpose: In Australia, as in other countries, recognising and responding to clinical deterioration in hospitalised patients has become a national priority. Ward nurses play an essential role in detecting acute care patients at risk of clinical deterioration through attentive surveillance, diligent assessment, and timely intervention. Much attention in the literature has been given to the efferent limb of the clinical deterioration pathway, such as hospitals’ implementation of the use of early warning scores, track and trigger systems, and rapid response teams. Yet, unrecognised clinical deterioration continues to be a significant problem. The literature is consistent in viewing the situation of clinical deterioration from the perspective of improving detection and documentation of clinical deterioration with scant attention to the nature of assessment practices.

The purpose of the study was to improve understanding of the unexamined factors that influence patient assessment practices by exploring patterns of behaviour, and interpersonal, cultural and geographical factors related to nursing assessment practices in the acute care hospital environment.

Methods: The study design was a hospital ethnography using participant observation and informal and formal interviews. Data, collected in the form of field notes and transcribed audio-recorded interviews, was analysed using an iterative process

Results: Nurses’ assessment and surveillance of patients is practiced in the context of the medical emergency response framework. As such this creates a culture that dominates and dictates a focus on monitoring and recording of patient’s vital signs for medical team review and response. This focus influences multidisciplinary relationships and roles and the organisation factors that govern nurses’ work.

Conclusion: The study findings illustrate the complex interplay of factors that influence nurses’ assessment practice in the acute care setting. Development of holistic picture of patient assessment practices will inform development of effective health service improvements in managing patients at risk for clinical deterioration.