Australian Healthcare Context

Endacott, R, Kidd, T, Chaboyer, W, & Edington, J 2007, 'Recognition and communication of patient deterioration in a regional hospital: a multi-methods study', Australian Critical Care, 20, 3, pp. 100-105, CINAHL Complete, EBSCOhost, viewed 26 July 2015.

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This article assesses the cues that the ward nurses and doctors use to determine the health situation of the patients. The article also aims to examine the communication of the deterioration in patients on acute wards of regional hospitals. The researchers used the mixed methods case study design in a regional hospital that contained 220 beds. Interviews were conducted with fourteen doctors, 11 nurses and seventeen patients ICU admission records were reviewed. The researchers found out that identification of patients deterioration is dependent on the significant signs for nurses and doctors. Consequently, the researchers found out that inadequate communication between all the stakeholders in the regional hospital affects the timely management of the patients situations when they deteriorate. More so, regional hospital staffs who are not familiar with the regional hospitals culture affects the recognition of patients situation hence its immediate response. The researchers also found out that the most appropriate strategy that can bridge this gap between patients deterioration is enhanced communication among the regional hospital staffs.

Hosking, J, Considine, J, & Sands, N 2014, 'Recognizing clinical deterioration in emergency department patients', Australasian Emergency Nursing Journal, 17, 2, pp. 59-67, CINAHL Complete, EBSCOhost, viewed 23 July 2015.

In this article, the researchers were fueled into conducting the research by the realization that use of rapid response systems such as Medical Emergency Team (MET) enhances recognition and response to clinical deterioration in patients. There was, however, no enough evidence to support these arguments. The main aim of the research was to scrutinize the frequency, nature and the results of the clinical deterioration. The researchers also intended to compare the hospitals utility MET calling the criteria with ED specific Clinical Instability Criteria (CIC) for recognition of patients. The explanatory descriptive design was used to conduct this study. Vital data signs were collected from 200 patients all receiving ED care in the regional and publicly funded health services in Victoria Australia. According to their investigation, 2% of the patients assess fulfilled the MET criteria. Those that fulfilled the ED CIC criteria were 7.5%. 5% of the patients died while in the hospital within 30 days of ED attendance. This finding affects the implementation and evaluation of rapid response systems. In order to enhance the recognition of deteriorating patients, new rapid response systems ought to be implemented that are specifically designed for emergency care context.

Scott, B, Considine, J, & Botti, M 2015, 'Unreported clinical deterioration in emergency department patients: A point prevalence study', Australasian Emergency Nursing Journal, 18, 1, pp. 33-41, CINAHL Complete, EBSCOhost, viewed 23 July 2015.

This article explores the features of Emergency Department (ED) that may increase the risk of unrecognized and unreported clinical deterioration. The researchers aimed to examine the frequency and the nature of unreported clinical deterioration in emergency care. Exploratory Descriptives design was used. Data were collected during from nine point prevalence surveys (PPS) in May-June 2009 at the urban district hospital in the Melbourne Australia. The findings indicated that unreported clinical deterioration occurred in 12.9% of patients. The unreported clinical deterioration was more widespread in circumstances where patients were aged more than 65 years. These patients comprised of more than 50% of the patients. Moreover, the patients requiring treatment within 30 minutes was greater than 50% of the total Emergency Department. These findings have consequences on the quality indicator of emergency care. However, these effects as the researchers suggest have not been properly explored and therefore hence more investigation is needed. As this study found out, the age and clinical urgency of the Emergency Department (ED) have great influence the prevalence of the unreported clinical deterioration.

Conclusion

The finding that older people especially those older than 65 years are the ones that are more affected are significant in nursing practice because it can help them enhance specific patient management, diagnosis and patient identification systems designed for the aged. Furthermore, the findings by Scott, Considine & Botti (2015) that the greatest unreported clinical deterioration occurred during the night shifts can help the nurses can help them to increase the number of Emergency Department (ED) attendances over the 24 hours. The findings of their research are however limited because the sample used cannot be used in making a decision that might affect the whole nursing discipline. Furthermore, their research did not access the nurses decision making within the hospital. The research is, however, commendable as a stepping stone for further investigation since the sources used were up to date and they were all relevant to the topic because they were within ten years since the article was published.

The article by Hosking, Considine & Sands (2014) can be used in cooperation with Unreported Clinical Deterioration in Emergency Department by Scott, Considine & Botti, (2015) because the former addresses the unreported clinical deterioration while the latter addresses the recognition of clinical deterioration in emergency department patients. The MET and CIC criteria used in the identification of clinical deteriorating in emergency department proved useful because it produced similar results to those of the previous research. It is significant in nurses practice because the two criteria can be applied to the daily working of the nurses to recognize the clinical deterioration. This could help in enhancing the responsiveness hence reducing the unreported clinical deterioration. Even though the findings of this research were in line with most concepts of the previous study on unreported clinical deterioration in emergency department, its findings cannot be trusted fully in decision making because the sample used was not sufficient to make credible decision. The investigation was only conducted in one site hence the sample population was poorly distributed. Also, some of the sources used in this study were more than ten years old at the time they were published and the time this article was published.

The article by Endacott, Kidd, Chaboyer & Edington (2007) advances the research on recognizing clinical deterioration on the emergency department. It advances this further by including a communication aspect to it. The findings of this study are important to nurses because they indicate that the current model used in emergency departments may put patients at risk. It can be used to improve the clinical deteriorating by employing the suggested model of rotating nurses staffs through medical and surgical words and interdisciplinary training of nurses and junior medical workers. Such a model can be perfectly applicable in regional hospitals that are attempting to develop new nursing practices within the existing practices. Most of the sources used are within the period of ten years since by the time this article was published. In all the articles analyzed, the topic of clinical deterioration was explored. Each of the articles finding cannot however be used in making a critical decision because the sample population was now well spread.