Elsevier

Heart & Lung

Volume 29, Issue 4, July–August 2000, Pages 262-268
Heart & Lung

Issues in Critical Care
Recognition of patients who require emergency assistance: A descriptive study*,**

https://doi.org/10.1067/mhl.2000.108327Get rights and content

Abstract

Objective: The purpose of this study was to explore and describe the patient characteristics and the process of recognition nurses use to recognize patients about whom they are seriously worried. Design: The study design was qualitative, exploratory, and descriptive, and it used in-depth interviews and a purposive sample. Setting: The study setting included a teaching hospital and a peripheral hospital in a Sydney area health service. Participants: Participants included registered nurses (N = 32) with 5 or more years of experience and a history of calling the medical emergency team (MET). Mean years of experience as a registered nurse was 14 years, and the mean calls to the MET since employed in current hospital was 16 calls. Findings: Primary findings showed that nurses relied on 4 patient characteristics to apply the MET criterion, “seriously worried about a patient.” These 4 characteristics were (1) feeling “not right,” (2) color, (3) agitation, and (4) observations marginally changed or not changed at all. The process used to gather and interpret information to recognize these patients who were deteriorating involved touching, observing, listening, feeling or sensing, and “knowing.” In this process of recognition, nurses relied heavily on past experiences and knowledge to detect differences in patient condition. Conclusions: The 4 characteristics need to be included as an explanation for the MET criterion, “seriously worried about a patient.” Additional validation and refinement of the 4 characteristics of the nonspecific MET criterion, “seriously worried about a patient,” should be carried out. Continuing education programs in health care facilities need to support the use of subjective information in complex situations that result in decisions to call emergency assistance so patients whose conditions are deteriorating can be identified early and responded to rapidly. (Heart Lung® 2000;29:262-8.)

Section snippets

Recognition of patients who need emergency assistance

In nursing practice, decision making is often a complex process.4 Nurses have been shown to recognize patients “at risk” and have claimed they make decisions on the bases of intuition and experience. For example, a nurse, who called the emergency code for a patient who had been assessed as “going sour” just before he had a respiratory arrest, stated that she would have “bet her last paycheck he was going to arrest.”5 Another nurse recalled having “bad feelings” about a patient whose vital signs

Method

This exploratory descriptive study used interviews to investigate the experiences of nurses who had been involved in calling the MET for their patients. The study sites included 4 units in a teaching hospital and 3 units in a peripheral hospital in an area health service. The clinical specialties of these units were medical, surgical, renal, gynecological, coronary care, and orthopedics. These areas all had high numbers of MET calls. Institutional ethics committees of the area health service

Overview

Analysis of the transcripts showed that nurses relied on 4 patient characteristics to apply the MET criterion, “seriously worried about a patient.” These 4 characteristics were not necessarily used independently but were usually combined. Most frequently, nurses detected a difference in the state of the patients compared with what their condition had been previously. The 4 characteristics were feeling “not right”, color, agitation, and observations. These characteristics appeared to alert the

Discussion

Nurses who used the criterion, “seriously worried about a patient,” to call the MET were found to make their decisions on the basis of the recognition of “just not right” or “unwell” as declared by the patient or as recognized by the nurse from the patient’s color, clamminess, and coldness; agitation or observations that were marginally changed; or as a result of nothing unusual. Usually when nurses called the MET on the basis of this criterion, objective physiologic data were not evident. One

Implications and Recommendations

The MET criterion, “seriously worried about a patient,” usually involves 1 or more of the 4 patient characteristics:

  • “Not right” or “unwell” declared by the patient or recognized by the nurse as a difference in the patient

  • Color, clamminess, and coldness with color (quite pale, porcelain pale, pale dusky, and sort of gray) or draining color

  • Agitation

  • Observations that were slightly abnormal or not unusual at all

These identified characteristics provide more specificity to the MET criterion,

Acknowledgements

I thank Ms S. Eagar; Mr C. Thebridge; Mr M. Masso; all the nurses who participated in this study; and all the health professionals who developed and implemented the MET calling system in 1989.

References (17)

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*

Supported by a University of Western Sydney Hawkesbury Internal Research Grant.

**

Reprint requests: Dr Jane Cioffi, Faculty of Health University of Western Sydney Hawkesbury, Locked Bag 1, PO Richmond 2753, New South Wales, Australia.

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