Paper
Thursday, July 14, 2005
Abnormal Patient Vital Signs in the Emergency Department: Clinicians' Responses
Lesley M. Wilkes, PhD, MHPEd, GradDip, ED, CM, RN, Clinical Nursing Research Unit, Wentworth Area Health Service, Penrith, NSW, Australia, Jane Cioffi, RN, BSC, MAS, School of Nursing Family & Community Health, University of Western Sidney, Sydney, Australia, Cate Salter, RN, Emergency Department, Wentworth Area Health Service, Penrith, NSW, Australia, Janet Scott, RN, Intensive care/High dependancy, Wentworth Area Health Service, Penrith, NSW, Australia, and Oana Vonu-Boriceanu, BA, School of Psychology, University of Western Sydney, Penrith, NSW, Australia.
| Learning Objective #1: Develop an understanding of clinicians’ responses to abnormal patient vital signs in the emergency department |
| Learning Objective #2: Develop clinical guidelines to manage abnormal patient vital signs more effectively by overcoming barriers to prompt identification of abnormal vital signs |
Clinicians' responses to abnormal vital signs have been identified as a significant reason for delaying clinical management in Emergency department practice, jeopardising patient safety. Recognition of abnormal patient vital signs and subsequent action involves clinical judgement and decision-making. This has been minimally explored in the Emergency department. This study aimed to explore and describe clinicians' experiences of responding to patients with abnormal vital signs in the Emergency department. A qualitative approach was used and three focus group interviews were conducted with a mixed group of nine registered nurses and seven doctors working in the Emergency department in an area health service in Western Sydney. Transcribed interviews were managed with NVivo software program which assisted in coding and sorting of coded segments of the text and in analysis. Written descriptions of clinicians' responses to changes in vital signs in patients in the Emergency unit were written and distributed to participants to examine credibility and to a panel of six expert Emergency department clinicians to check fittingness. Findings from focus group discussion are described under the following main categories: Avoiding abnormal vital signs due to lack of knowledge; apathy of senior staff; flaws in education for emergency care; resistance of junior staff to approach senior staff and, workload issues and short staffing. Implication of the findings for clinicians in Emergency department practice will be elaborated.