Critically Ill Patient Assessment Essay

Nurses knowledge on initial assessment of critically ill patients
Nurses knowledge is playing an important role on assess and identify critically ill patient. Ongoing specific clinically education and skills training enable nurses to recognize and respond to critically ill patient. The level of education was identified as an important predictor in ward nurses’ ability to quickly recognize patient deterioration (Massey at al., 2017).
The study done in Greece on the factors influencing nurse’s decisions to activate medical emergency team showed that nurses who are at masters level were more confident in assess and recognizing patient deterioration. Nurses who had graduated from a 4-year university educational programme identified patient deterioration
significantly quicker than nurses who had graduated from a 2-year educational Programme (Pantazopoulos et al., 2012).

The study done in England on knowledge aspect of acute care in trainee doctors (Pre registration house officer (PRHO) and Senior house officer (SHO)) demonstrated that: there is a knowledge gap or lack of knowledge and understanding on initial assessment and treatment of acute ill patients in the ward (Smith & Poplett., 2002).
Another study conducted in United Kingdom on early managements of acutely ill ward patients identified that undergraduate and junior physician they lack of knowledge, confidence, and competence in all aspect of acute care including basic task of assessment, recognition and management of acute ill patient. Also the researcher identified that inadequate training in acute care skills remain a major problem (Frost & Wise, 2012).
In addition, the study done in Australia to the registered nurses in simulated setting to assess and manage deteriorating patient using measures of knowledge, situation awareness and skill performance showed that nurses have the average of 67% on knowledge of deterioration management, low scores (50%) on situation awareness and skill performance with a lot of importance observation and action missed. The study indicated that there is a low knowledge and skills of nurses working in rural area with notable performance decrements as patients acutely declined (Copper at al., 2011).

A study conducted in Australia, on critical care: monitoring of eight vital signs reported that nurses relied on traditionally vital signs to assess patients, but hospitalized patients nowdays are sicker than in the past. Traditional vital signs may not be adequate to identify those who are critically ill, but require to add other parameters which is urine output, pain and level of consciousness, when the nurses performing assessment of patients. Knowledge, skills and the ability to think critically is required not only to measure vital signs accurately but also to interpret it in the context of the patient’s illness and medical treatment (Elliott & Coventry, 2012).
Another study conducted in Muhimbili National Hospital on nurses practices and knowledge on assessment and observations of adult critically ill patients in the ward indicated that about 81% of nurses fail to recognise signs of hypovolemic shock, while 67% fail to recognize signs of poor circulation and 50% unable to conduct quick assessment of Airway, Breathing, and Circulation, in sequential order. The study concluded that nurses working in general wards who care for critically ill patients have suboptimal practice and minimal knowledge on the patient assessment and observation (Mkoka 2009). Nurses practice on observation of critically ill patients
Vital role of critical care nurses is to offer continuous observation of critically ill patients. Observation will reduce a patient’s risk of abrupt deterioration. Observation involves assimilation, monitored physiological parameters, interpretation, and physical and psychological response to interventions. The appropriately trained and experienced nurses can provide this complete level of observation (Galley& O’Riordan, 2003).
The study done in Singapore on nurses experience with deteriorating ward patients: found that observation of the vital signs was not completely performed and interpreted by the enrolled nurses. Also assessment of the respiratory rate was reported to be frequently omitted from routine vital signs and lack of awareness of changes in respiratory rate as an important parameter in detecting deterioration of patients. The study noted that enrolled nurses perceived that saturation of oxygen monitoring as more reliable assessment in reflecting early signs of respiratory dysfunction rather than counting abnormal respiratory rate (Chuwa, Mackey & Liaw, 2013). Another literature illustrated that accurately measuring respiratory rate is a fundamental part of patient assessment and an important baseline observation. Nurses are expected to be competent in the accurate measurement and interpretation of respiratory rate, but monitoring of this vital sign is poor (Jevon, 2010).
Another study conducted in United Kingdom on comparing the monitoring of patients transferred from a critical care unit to hospital wards found that lower nurse to patient ratio in the ward link in failure to observe vital signs, interpret, and prevent avoidable complication from underlying illness or medical care, which lead to death to patient. This is cause by failure to notify physician, obtain physician response to initiate immediate action and inadequate level of surveillance (both recording and interpreting the clinical observations). If nurses fail to record findings and communicated to the appropriate staff, intervention can be delayed (Wood al al.,2014).
Another review of literatures on monitoring of vital signs using early warning score system: found that infrequent monitoring, incomplete recording and misinterpretation of vital signs lead to delay in reporting and hence mislead in given appropriate interventions among nurses working in the ward. Also reported that patient survival depends on nurse’s decisions to call for assistance promptly if abnormal vital signs noted. Usually ward nurses delay to report after documenting about patients vital signs which resulted in treatment delays of patient intervention(Kyriacos, 2011).
The study done in New Zealand on physical observation and nursing intervention in pre arrest patient: the result showed that there is an infrequency observation and incomplete set of vital sign, poor documentation, absence of intervention on abnormal neurological, insufficient of oxygen delivery to meet patient requirement and poor awareness of medical staff on abnormal physiology of patients.
Also noted that there were few interventions to treat abnormal physiology on which 32% of patients with abnormal physiology without intervention did not survive (Ryton-malden, 2011). The study conducted in Australia on nurses documentation of physiological observation in three acute care setting. It was observed that the most frequently documented physiological parameters across all clinical areas are respiratory rates, saturation of oxygen, heart rates and systolic blood pressure while temperature and Glasgow coma scale (GCS) were least recorded (Considine, Trotter, & Currey,
2015).
The study on nursing assessment of continuous vital signs surveillance to improve patient safety on medical and surgical unit at USA showed that continuous, multi parameters patient monitoring performed on medical and surgical units with a small and appropriate level of caution. Continous vital signs assessment may initiate nursing intervention that will prevent failure to rescue events. Majority of nurses surveyed agreed that continuous vital signs surveillance will help to enhance patient safety (Watkins, Whisman, & Booker, 2015).
2.4 Challenges of nurses on assessing critical ill patient
Nurses encounter various challenges or barriers on compliance and accuracy of vital signs measurement. Some of the most common issues were related to insufficient time, resources, distractions from multi-tasking and individual judgments about the importance of vital signs. Other researchers have also cited poor decision-making skills, equipment management issues, and poor nurse activity organization (Tysinger, 2014).
The study conducted in Iran on caring for acutely ill patients in general wards illustrated that there were several challenges that hinder proper assessment and observation of critical ill patients. Among challenges mentioned were increased workload of ward staff, shortage of equipments, used individual judgement rather than using protocol and guideline, which consequently leads to all patients receiving low-quality care . Others were knowledge and work experience among some nursing staff (Nazila, 2014).
The study on vital signs measurement as an indicator of safe care delivered to elderly patients found that the barriers that interfere in the proper monitoring of vital signs were workload, lack of availability and accessibility of basic equipments such as thermometers, stethoscopes and sphygmomanometers, which compromises the nursing assessment and leads to a greater susceptibility to incidents. Although the facility does not provide conditions to measure vital signs properly, the nursing staff attempts to do what is feasible given their current knowledge and context to achieve the best outcome possible in view of the resources available (Teixeira et al., 2015).
Another study done in London showed that there were number of barriers facilitate to monitoring and escalation of abnormal vital signs, whereby equipment issues both electronic and manual devices and workload of nurses were inevitable barriers for effective assessment and monitoring of patients in the general ward (Smith & Aitken, 2015). In addition, the case study done in Uganda on nursing documentation dilemma; mentioned that the credibility of the hospital in caring critically ill patients can be gauged from the quality of the nurse’s documentation as they stay with the patients most of the time. The study revealed that lack of time for proper documentation is due to a big number of patients to take care of, work overload, lack of stationary and basic monitoring equipment, nursing documentation forms and knowledge skills on Documentation (Nakate, Dahl, Petrucka, Drake, & Dunlap, 2015)