Clinical deterioration and perception of cues among medical surgical nurses

Abstract

[ACCESS RESTRICTED TO THE UNIVERSITY OF MISSOURI AT AUTHOR'S REQUEST.] In the medical-surgical setting, failure to rescue events continue to remain prevalent. While failure to rescue events are often proceeded by changes in patient cues (i.e. vital signs), prior research suggests that both subtle and overt patient cues are sometimes missed or misinterpreted. Prompt recognition and management of failure to rescue events is dependent on nurses' capacity and tendency to perceive changes in patient cues that indicate clinical deterioration. To better understand the cognitive nature of medical-surgical nurses' deterioration cue perception, a cross-sectional non-experimental study was conducted. The Situation Awareness Model and Signal Detection Theory were used as a framework to examine nurses' capacity to perceive deterioration cues and associated nurse characteristics. Findings showed that as nurses' capacity to perceive deterioration cues increased, nurses were more likely to classify patient cues as indicators of deterioration. Though fatigue, education, and certification were not predictors of nurses' capacity to perceive deterioration cues, experience was observed to be a predictor based on levels of skills acquisition. Future research should aim to examine whether other individual characteristics such as information processing mechanisms and signal detection training affect nurses' ability to perceive deterioration cues.