Abstract
BackgroundNurses' clinical competence involves an integration of knowledge, skills, attitudes, thinking ability, and values, which strongly affects how deteriorating patients are managed. ObjectivesThe aim of the study was to examine nurses' attitudes as part of clinical competence towards the rapid response system in two acute hospitals with different rapid response system models. MethodsThis is a comparative cross-sectional correlational study. A modified “Nurses' Attitudes Towards the Medical Emergency Team” tool was distributed among 388 medical and surgical registered nurses in one acute hospital in the UK and one in Finland. A total of 179 nurses responded. Statistical analyses, including exploratory factor analysis, Mann–Whitney U tests, Kruskal–Wallis tests, chi-square tests, and univariate and multivariate regression analyses, were used. FindingsGenerally, nurses had positive attitudes towards rapid response systems. British and Finnish nurses' attitudes towards rapid response system activation were divided when asked about facing a stable (normal vital signs) but worrisome patient. Finnish nurses relied more on intuition and were more likely to activate the rapid response system. Approximately half of the nurses perceived the physician's influence as a barrier to rapid response system activation. The only sociodemographic factor that was associated with nurses activating the rapid response system more freely was work experience ≥10 years. ConclusionsThe findings are beneficial in raising awareness of nurses' attitudes and identifying attitudes that could act as facilitators or barriers in rapid response system activation. The study suggests that nurses' attitudes towards physician influence and intuition need to be improved through continuing development of clinical competence. When the system model included “worrisome” as one of the defined parameters for activation, nurses were more likely to activate the rapid response system. Future rapid response system models may need to have clear evidence-based instructions for nurses when they manage stable (normal vital signs) but worrisome patients and should acknowledge nurses’ intuition and clinical judgement.
Highlights
Rapid response systems (RRSs) were introduced over two decades ago in health care to enhance patient safety and avoid hospital mortality.[1]
The findings are beneficial in raising awareness of nurses' attitudes and identifying attitudes that could act as facilitators or barriers in rapid response system activation
I think that medical emergency team (MET)/National Early Warning Score (NEWS) is overused in the management of hospital patients
Summary
Rapid response systems (RRSs) were introduced over two decades ago in health care to enhance patient safety and avoid hospital mortality.[1]. Continuing clinical competence is defined as nurses' ability to demonstrate that they have maintained their competence concerning the context of its practice and the related competence standards.[15] All nurses working at acute hospitals should have competence in recognising and responding to deteriorating patients.[16] Importantly, nurses' ability to identify deteriorating patients and activate an RRS is still suboptimal.[2] Nurse activation of RRSs is inconsistent, and one-third of RRS cases are not activated by nurses.[2,17] Evidence suggests that RRS implementation is associated with decreased hospital mortality, saving 1.5 lives per week,[18,19] and decreased in-hospital cardiac arrests.[19] Failure or delay in RRS activation leads to adverse outcomes for patients, including both an increased rate of hospital mortality and inhospital cardiac arrest.[20] In the event of in-hospital cardiac arrest, cardiopulmonary resuscitation is commonly used.[21,22] The cardiopulmonary resuscitation success rate is rather low, at only 24.8%, and most surviving patients develop cardiovascular disease. Improving clinical competence relies on nurses' insight and awareness of their individual strengths and limitations in the identification and management of deteriorating patients.[24]
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