Assessing changes in a patient’s condition

Kvande, M. et. al. Assessing changes in a patient’s condition – perspectives of intensive care nurses Nursing in Critical Care. First published: 21 September 2016

NHS Framework Documant 2008

Aim
To explore the phenomenon of assessing changes in patients’ conditions in intensive care units from the perspectives of experienced intensive care nurses.

Background
Providing safe care for patients in intensive care units requires an awareness and perception of the signs that indicate changes in a patient’s condition. Nurses in intensive care units play an essential role in preventing the deterioration of a patient’s condition and in improving patient outcomes.

 
Design and methods
This hermeneutic phenomenological study conducted close observations and in-depth interviews with 11 intensive care nurses. The nurses’ experience ranged from 7 to 28 years in the intensive care unit. Data were collected at two intensive care units in two Norwegian university hospitals. The analysis was performed using the reflective methods of van Manen.

 
Findings
An overarching theme of ‘sensitive situational attention’ was identified, in which the nurses were sensitive in relation to a patient and understood the significance of a given situation. This theme was further unfolded in four subthemes: (1) being sensitive and emotionally present, (2) being systematic and concentrating, (3) being physically close to the bedside and (4) being trained and familiar with the routines.

 
Conclusions
Nurses understand each patient’s situation and foresee clinical eventualities through a sensitive and attentive way of thinking and working. This requires nurses to be present at the bedside with both their senses (sight, hearing, smell and touch) and emotions and to work in a concentrated and systematic manner. Knowledge about the unique patient exists in interplay with past experiences and medical knowledge, which are essential for nurses to understand the situation.

 
Relevance to clinical practice
Clinical practice should develop routines that enable nurses to be present at the bedside and to work in a concentrated and systematic manner. Furthermore, providing safe care requires nurses to be sensitive and attentive to each patient’s unique situation.

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