Registered nurses’ practicing in the emergency department: ‘attitudes and practices’ towards vital sign monitoring in Gauteng

Abstract

The practices of standard vital signs (blood pressure, heart rate, respiratory rate, temperature and oxygen saturation) monitoring in the clinical setting were based on the most part on tradition “the way it has been done in the past” and were undertaken as historical routines and rituals rather than directed by clinical judgement and contemporary knowledge. In the literature the first step in challenging these traditional practices was to understand the attitudes, practices of the emergency nurses in order to implement evidence-based practices that are patient centred. The purpose of this study was to describe the attitudes and practices of the registered nurses towards vital signs monitoring in the emergency department of a central hospital in Gauteng in order to provide recommendations for clinical practice and nursingeducation for registered nurses working in the emergency department. A quantitative, descriptive and cross sectional study design using a questionnaire was used in this study. A developed questionnaire named “Practices and attitudes of vital signs instrument for emergency nurses” (PAVSI-EN) tool was used for data collection. This developed questionnaire tool (PAVSI-EN) consisted of two sections. Section one was the demographic section which consisted of 5 questions and section two consisted of 20 statements which needed to be completed according to a likert scale. The 20 statements were divided into eleven statements with regards to practices and nine statements with regards to attitudes. A Convenience sampling method, which included all the registered nurses working in the emergency department of one central hospital in Gauteng was used in this study. The total population for this study was also used (N=70), but only (n=66) participated. The statistical program that was used for this study was descriptive, comparative and multiple linear regression. A statistician was consulted to assist in analysing the data collected for this study. The variables were correlated using the spearman statistician. Results: A total of 66 registered nurses participated in this current research, all of which were working at the emergency departments. Participants were mainly females and between the ages of 25 to 60 years. Majority of the registered nurses working in the emergency departments had a diploma as the highest qualification in nursing and mostly had less than five years of work experience in the emergency department. Attitudes are the beliefs and feelings that the registered nurses have concerning vital sign monitoring in the emergency department. The beliefs explored whether vital signs reflected a patient`s condition and whether vital signs were done according to evidence-based practices, Whereas the feelings concerning vital signs monitoring explored whether the registered nurses felt that regular vital sign monitoring was necessary for different patients or it was time consuming and if a case to case or universal protocol for the frequency of monitoring vital signs should be devised. In this study attitude response concerning vital signs taken in triage was denied by the majority of the participants (82 %) to be an accurate reflection of a patient`s condition. The majority of the participants (90.91%) disagreed or strongly disagreed that vital signs taken in the emergency department are performed according to evidence-based practice guidelines. Practices are referred to as reviewing and repeating of vital signs at various times during the patient`s admission to the emergency department. The various times are not only when the initial assessment is done but prior to evaluating the patient, giving the medication, developing a nursing care plan and on discharge. Related to practices, the majority of participants reviewed triage vital signs most of the time prior to evaluating the patient (95.45%), but to a lesser degree, use those vital signs in developing initial plan of care (78.79 most of the time, 13.64% sometimes). Similarly, respondents only sometimes (78%) often (25%) or most of the time (92.42%) used them in altering the plan of care. For non-critically ill patients, the lesser of the participants (37.88%) sometimes repeated vital signs as part of their initial assessment compared to 93,94% that repeated them most of the time for critically ill patients. Conclusion: Studies that examine the practices and attitudes of vital sign by registered nurses that work in emergency departments in hospitals in South African health care facilities are scarce. However, the findings of this study support the conclusions of the majority of studies conducted overseas that reported and highlighted practices and attitudes of vital sign monitoring as a problem amongst registered nurses working in hospitals.