Issues in Critical CareRecognition of patients who require emergency assistance: A descriptive study*,**
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:
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“Not right” or “unwell” declared by the patient or recognized by the nurse as a difference in the patient
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Color, clamminess, and coldness with color (quite pale, porcelain pale, pale dusky, and sort of gray) or draining color
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Agitation
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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.
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2020, Journal of Pediatric NursingCitation Excerpt :Situation awareness, clinical knowledge, and experience enhanced their ability to interpret assessment findings (Brady & Goldenhar, 2014; Doman et al., 2004; Gawronski et al., 2018; Thrasher et al., 2017). Nurses in other practice venues identify changes through sensory data; objective findings; intuitive feelings based on knowledge of their patients; patients' physical, cognitive, and behavioral changes from baseline; nurses' knowledge of usual condition patterns and illness trajectory; and input from medical records, handoff reports, and parents (Andrews & Waterman, 2005; Cioffi, 2000; Minick & Harvey, 2003). How these indices are used in pediatric nursing surveillance are topics for future study.
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Supported by a University of Western Sydney Hawkesbury Internal Research Grant.
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Reprint requests: Dr Jane Cioffi, Faculty of Health University of Western Sydney Hawkesbury, Locked Bag 1, PO Richmond 2753, New South Wales, Australia.