The Scope of Nurses' Assessment of Deteriorating Patients in Coronary Care Units: A Mixed Methods Study

Background

Despite the high acuity of coronary care unit (CCU) patients and their risk of deterioration, little is known about how nurses assess them.

Aim

Increase understanding of the scope of nurses' assessments of deteriorating CCU patients.

Design

Online mixed methods survey.

Methods

The mRAPIDS (modified Rescuing a Patient in Deteriorating Situations) tool was used to measure assessment scope in responses to a patient vignette with a higher mRAPID score signalling broader scope (maximum score 24). Reflections on day-to-day practice were collected concurrently and thematically analysed. Themes were integrated with scores using a joint display table and organised into domains. Comparing ‘fit’ between data showed expansion (overlap with broader nonoverlapping findings) and disconcordance (contradictory findings).

Results

Thirty-four nurses responded, and scope of assessment was found to be narrow (median mRAPIDS 5). Two domains were identified that helped explain this finding ‘the act of assessment’ and ‘education and experience’. Participants emphasised the importance of education and experience, neither increased assessment scope.

Conclusion

This study showed that participant assessments were generally narrower than widely accepted best practice (ABCDE assessment).

Implications

Participant assessments did not reflect gold standard A-E assessment, which may partly reflect a need for assessment frameworks that are more compatible with real-world practice. Further research is required to understand the role of healthcare assistants in the care of deteriorating CCU patients. Clinical judgement is important, but not yet well understood in rapid response systems.

Impact

This study offers preliminary understanding of nurses' assessments of deteriorating patients in CCUs.

Reporting Method

American Psychological Association, Mixed Methods Standards.

Patient or Public Contribution

Reviewed protocol, aided result interpretation and shared ideas for future research.