Monitoring cardiorespiratory instability: Current approaches and implications for nursing practice

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• 作者：Eliezer Bose ; ^{elb93@pitt.edu" class="auth_mail" title="E-mail the corresponding author} ; ^{eliezerbose@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Leslie Hoffman ^{lhof@pitt.edu" class="auth_mail" title="E-mail the corresponding author} ; Marilyn Hravnak ^{mhra@pitt.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Vital signs ; Physiologic monitoring ; Cardiorespiratory instability ; Early warning scores ; Rapid response systems ; Medical emergency team ; Nursing surveillance
• 刊名：Intensive and Critical Care Nursing
• 出版年：2016
• 出版时间：June 2016
• 年：2016
• 卷：34
• 期：Complete
• 页码：12-19
• 全文大小：1568 K

文摘

Unrecognised in-hospital cardiorespiratory instability (CRI) risks adverse patient outcomes. Although step down unit (SDU) patients have continuous non-invasive physiologic monitoring of vital signs and a ratio of one nurse to four to six patients, detection of CRI is still suboptimal. Telemedicine provides additional surveillance but, due to high costs and unclear investment returns, is not routinely used in SDUs. Rapid response teams have been tested as possible approaches to support CRI patients outside the intensive care unit with mixed outcomes. Technology-enabled early warning scores, though rigorously studied, may not detect subtle instability. Efforts to utilise nursing intuition as a means to promote early identification of CRI have been explored, but the problem still persists. Monitoring systems hold promise, but nursing surveillance remains the key to reliable early detection and recognition. Research directed towards improving nursing surveillance and facilitating decision-making is needed to ensure safe patient outcomes and prevent CRI.