General Ward Nurses Detection and Response to Clinical Deterioration in Three Hospitals at the Kenyan Coast: A Convergent Parallel Mixed Methods Study

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dc.contributor.authorNickcy, Mbuthia
dc.contributor.authorNancy, Kagwanja
dc.contributor.authorMoses, Ngari 
dc.contributor.authorMwanamvua, Boga
dc.date.accessioned2024-01-11T07:47:43Z
dc.date.available2024-01-11T07:47:43Z
dc.date.issued2023-03
dc.descriptionResearch paperen_US
dc.description.abstractBackground In low and middle-income countries like Kenya, critical care facilities are limited, which means acutely ill patients are managed in the general wards. Nurses in these wards are expected to detect and respond to patient deterioration to prevent cardiac arrest or death. This study examined nurses' vital signs documentation practices during clinical deterioration and explored factors inuencing their ability to detect and respond to clinical deterioration. Methods This convergent parallel mixed-methods study was conducted in the general medical and surgical wards of three hospitals in Kenya's coastal region. Quantitative data on the extent to which the nurses monitored and documented the patients' vital signs 24 hours before a cardiac arrest (death) occurred was retrieved from patients' medical records. Additionally, in-depth, semi-structured interviews were conducted with twenty-four purposefully drawn registered nurses working in the three hospitals' adult medical and surgical wards. Results This study reviewed 405 patient records and found that most of the documentation of the vital signs was done in the nursing notes and not the vital signs observation chart. During the 24 hours prior to death, respiratory rate was documented the least in only 1.2% of the records. Only a very small percentage of patients had any vital event documented for all six-time points. Thematic analysis of the interview data identied ve broad themes related to detecting and responding promptly to deterioration. These were insucient monitoring of vital signs, availability of equipment and supplies, stang conditions and workload, lack of training and guidelines, and communication and teamwork constraints among healthcare workers. Conclusion The study showed that nurses did not consistently monitor and record vital signs in the general wards. The nurses worked in suboptimal ward environments characterised by inadequate and malfunctioning monitoring equipment, high workload due to staff shortages, communication and teamwork gaps, and little training on handling patient deterioration at the ward level; factors that negatively impact patient safety and outcomes. The ndings provide an opportunity for future research to test interventions to improve nurses' assessment and management of clinical deterioration in general wards.en_US
dc.identifier.citationMbuthia, Nickcy & Kagwanja, Nancy & Ngari, Moses. (2023). General Ward Nurses Detection and Response to Clinical Deterioration in Three Hospitals at the Kenyan Coast: A Convergent Parallel Mixed Methods Study. 10.21203/rs.3.rs-2633455/v1.en_US
dc.identifier.otherDOI: https://doi.org/10.21203/rs.3.rs-2633455/v1
dc.identifier.urihttps://ir-library.ku.ac.ke/handle/123456789/27254
dc.language.isoenen_US
dc.publisherResearch squareen_US
dc.subjectClinical deteriorationen_US
dc.subjectvital signsen_US
dc.subjectnurse documentationen_US
dc.subjectpatient safetyen_US
dc.subjectmedical surgical nursingen_US
dc.subjectrecognisingen_US
dc.subjectrespondingen_US
dc.titleGeneral Ward Nurses Detection and Response to Clinical Deterioration in Three Hospitals at the Kenyan Coast: A Convergent Parallel Mixed Methods Studyen_US
dc.typeArticleen_US
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