Intensive and Critical Care Nursing (2013) 29, 297—299
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.elsevier.com/iccn
EDITORIAL
Leadership and excellence in the early recognition of critical illness: A call for papers The onset of critical illness refers to the stage when the person’s clinical state becomes physiologically unpredictable and unstable. It can result in incapacity or death within minutes or hours (Frost & Wise, 2007). Several conditions can lead to sudden and/or unexpected deterioration of patients, and nurses must possess knowledge and clinical experience of specific critical illness states to be able to identify key early warning signs and symptoms indicating physiological deterioration (Endacott et al., 2007). Examples of these conditions include sepsis, haemorrhage, raised intracranial pressure, post-surgical haemorrhage, multi-organ failure, infection and changes in cognitive functioning. They can manifest in patients in acute, critical care, pre-hospital, primary and community care contexts. Excellence in the leadership, management and organisation of intensive and critical care nursing is key to the safe and effective care of critically ill patients (Dunn et al., 2000; Endacott et al., 2008; Ulrich et al., 2007). Our global health services are faced with ever-increasing demands to care for very ill and physiologically unstable patients (Adhikari et al., 2010). Nurses are required to recognise signs of clinical deterioration, identify cases of critical illness, activate rapid response teams, and take action to stabilise the patient’s clinical condition alongside medical colleagues (DeVita et al., 2006; Massey et al., 2010). However, there are notable gaps in the literature on rapid response teams, particularly, their formal evaluation, and the further exploration of reasons for non-activation and their under-use by ward based nursing staff (Massey et al., 2010). Frost & Wise (2007) argue that the lack of systematic approaches to assessment and treatment, poor staffing levels, and omissions in education and training, may account for the late recognition of critical illness in pre- and post-ICU environments. The availability of sufficient staff with the appropriate levels of skill is an important consideration for all critical care managers as it impacts on the quality of care delivered and patient outcomes. Aiken et al. (2003) demonstrated that where more registered nurses with graduate 0964-3397/$ — see front matter © 2013 Published by Elsevier Ltd. http://dx.doi.org/10.1016/j.iccn.2013.10.001
level education were on duty, this was positively correlated with a reduction in failure to rescue events in post-surgical patients. In March 2012 the RN4CAST consortium published the findings of a large cross sectional survey of nurses and patients in 12 countries in Europe and the United States (Aiken et al., 2012). They found that locations with improved work environments and reduced ratios of patients-to-nursing staff were positively correlated with increased care quality and job satisfaction. There is also evidence about the fragmented nature of hospital nurses’ work reported in the findings of a prospective longitudinal observational study conducted in two wards in an Australian teaching hospital, where the average duration of direct patient care tasks lasted only 55 seconds (Westbrook et al., 2011), clearly reducing opportunities for in-depth patient assessment and monitoring of changes in clinical states. Further research is needed on the application of optimal scoring systems for detecting critical illness across different settings, including in pre-hospital environments. Rattray et al. (2011) used a factorial survey design using paper-based vignettes, to assess ward-based nurses’ judgements of patient acuity and the likelihood of the patients being referred for further review. They found that nurses’ application of an early warning score was the biggest predictor in their study for patients being referred for further review. Limitations associated with the use of paper-based vignettes rather than actual patient settings are noted, and the authors argue that future studies could increase fidelity for this type of research by converting the use of vignettes to clinical simulation models. They also recommend that post-registration education should focus more on developing clinical experience and expertise rather than knowledge acquisition alone. In another study Fullerton et al. (2012) undertook a large retrospective observational cohort study of consecutive cases presenting to one emergency department (ED) in the UK. Caution is needed in the interpretation of the results due to the retrospective nature of the research design. Where the Modified Early Warning Score (MEWS) was applied
298 to the data retrospectively more ‘adverse events’ were correctly identified than by paramedics’ clinical judgement alone (i.e. sensitivity was improved). However specificity was reduced resulting in resource implications for the service, and it was concluded that further work to develop an optimal score for this setting was required (Fullerton et al., 2012). It is recognised that increasing severity of illness in some patient groups, such as medical (non-trauma) cases, can be missed by pre-hospital paramedic staff using their clinical judgement and experience alone. MEWS is known to be inaccurate in some medical emergencies where patients can have pathological critical illness conditions but physiological derangements have yet to occur, such as in some myocardial ischaemia, head injury and spinal injury cases (Fullerton et al., 2012). Clearly, clinical judgement and, in particular, nurses’ diagnostic judgements about the clinical state of the patient, are extremely important areas for investigation that can draw on robust theoretical and clinical conceptual frameworks (Coulter-Smith et al., 2013), and early warning scoring systems continue to provide a complementary and important safety net for unrecognised critical illness (NPSA, 2007). Education is crucial to the enhancement of nurses’ knowledge, clinical reasoning, and practical skills, for the complex tasks associated with the early recognition and initial management of critical illness and for safe and effective multidisciplinary team working. A wide range of learning, teaching and assessment methods are available to critical care educators. Clinical simulation offers nursing students and qualified staff opportunities to learn high stakes clinical skills under safe and controlled educational conditions (Nickless, 2011; Abe et al., 2013). Ford et al. (2010) in a US prospective observational study, using a before and after design to examine simulation-based learning compared to traditional teaching methods, demonstrated a reduction of medication error rates for critically ill patients. Two different groups of nurses were studied (n = 24) (Coronary Critical Care and Medical ICU), and despite limitations in the research design, simulation-based learning appeared to offer significant advantages over traditional methods of education. Repeated scenario clinical simulation was also found to be particularly effective for developing clinical competence in the recognition of critical illness states and team working in cardiovascular critical care nurses (Abe et al., 2013). Equally, advances in technology enhanced learning are stimulating education innovations in the critical care context (Arora & Chachra 2012; MacDonald, 2013). Education programmes alongside targeted interventions, such as the introduction of improved MEWS observation charts, can increase qualified staff’s adherence to recommended best practice in the recording of patients’ vital signs in the 24 hour post-ICU discharge period, although this particular study found that the frequency of vital signs recordings for unplanned admissions to ICU was not statistically significantly improved (Hammond et al., 2013). Furthermore, new developments in professional lifelong learning, and the interdisciplinary discipline of the Learning Sciences (Lave & Wenger, 1991; Moon, 1999; Sawyer, 2006; Bradbury et al., 2010), all offer exciting opportunities for transformative and student centred learning ultimately leading to improved patient care in critical illness.
Editorial As technological advances are made in ‘Point of Care Testing’ (PoCT), specific educational interventions can be designed by teams, including laboratory staff, expert nurses and nurse administrators, to ensure that practitioners are competent in their use (Liikanen and Lehto, 2012). PoCT is expanding rapidly and includes glucose monitoring for people with diabetes mellitus in a range of settings (Blake and Nathan, 2004) through to testing for rare but potentially fatal conditions such as spontaneous rectus sheath haematoma using abdominal ultrasonography (Shokoohi et al., 2013). The ICCN Editorial Board is committed to publishing evidence based clinical and research articles and are planning a special issue of ICCN to be published in December 2014 focusing on leadership and excellence in the early recognition of critical illness. We wish to invite the submission of manuscripts focusing on this topic. We would particularly welcome reports on research studies focusing on patient assessment and management of specific clinical states leading to critical illness, systematic evaluations of education programmes focusing on developing critical illness, specific education interventions such as the application of clinical simulation, and/or quality improvement initiatives or clinical audit to address aspects of the organisation and safe delivery of critical care. We will also consider clinical reports or case studies focusing on the presentation of less frequently occurring critical illness states, and/or literature review papers focusing on leadership and excellence in developing critical illness. Contributors should submit their full manuscripts for consideration to Intensive & Critical Care Nursing by 14th March 2014. Papers should be submitted by selecting the option Special Issue —– Early Recognition from the online submission system at http://ees.elsevier.com/iccn/ where full guidance on the preparation of papers for submission can also be found. All papers will be subject to the usual double-blind peer review and editorial processes of the journal. We look forward receiving a wide range of submissions for this special edition and also to facilitating the sharing of research, developments and experience relating to this important topic.
References Abe BY, Kawahara C, Yamashina A, Tsuboi R. Repeated scenario simulation to improve competency in critical care: a new approach for nursing education. Am J Crit Care 2013;22:33—40. Adhikari NKJ, Fowler RA, Bhagwanjee S, Rubenfield GD. Critical care and the global burden of critical illness in adults. Lancet 2010;376:1339—46. Aiken LH, Sermeus W, Van den Heede K, Sloane DM, Busse R, McKee M, Bruyneel L, Rafferty AM, Griffiths P, Moreno-Casbas MT, Tishelman C, Scott A, Brzostek T, Kinnunen J, Schwendimann R, Heinen M, Zikos D, Strømseng Sjetne I, Smith HL, Kutney-Lee A. Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 counties in Europe and the United States. Brit Med J 2012;344., http://dx.doi.org/10.1136/bmj.e1717 (accessed 20.09.13). Aiken LH, Clarke SP, Cheung RB, Sloane DM, Silber JH. Education levels of hospital nurses and surgical patient mortality. JAMA 2003;290(12):1617—23.
Leadership and excellence in the early recognition of critical illness: A call for papers Arora VK, Chachra V, Virtual ICU. Virtual ICU and e-learning tools: scope in critical care medicine in India. Indian J Crit Care Med 2012;16:148—50. Blake DR, Nathan DM. Point-of-care-testing for diabetes. Crit Care Nurs 2004;27(2):150—61. Bradbury H, Frost N, Kilminster S, Zukas M, editors. Beyond Reflective Practice. New Approaches to Professional Lifelong Learning. London: Routledge; 2010. Coulter-Smith MA, Smith P, Crow R. Critical review: a combined conceptual framework of severity of illness and clinical judgement for analysing diagnostic judgement in critical illness. J Clin Nurs 2013., http://dx.doi.org/10.1111/jocn.e12463 (Accepted for publication 16.07.13). DeVita MA, Bellomo R, Hillman K, Kellum J, Rotondi A, Teres D, Auerback A, Chen W, Duncan K, Kenward G, Bell M, Buist M, Chen J, Bion J, Kirkby A, Lighthall G, Ovreveit J, Braithwaite RS, Gosbee J, Milibrandt E, Peherdy M, Savitz L, Young L, Harvey M, Galhotra S. Findings of the first consensus conference on medical emergency teams. Crit Care Med 2006;34:2463—78. Dunn SV, Lawson D, Robertson S, Underwood M, Clark R, Valentine T, Walker N, Wilson-Row C, Crowder K, Herewane D. The Development of Standards for Specialist Critical Care Nurses. J Adv Nurs 2000;31:339—46. Endacott R, Boulanger C, Chamberlain W, Hendry J, Ryan H, Chaboyer W. Stability in shifting sands: contemporary leadership roles in critical care. J Nurs Manag 2008;16:837—45. Endacott R, Kidd t, Chaboyer W, Edington J. Recognition and communication of patient deterioration in a regional hospital: a multi-methods study. Aust Crit Care 2007;20:100—5. Ford DG, Seyber AL, Smithburger PL, Kobulinsky LR, Samosky JT, Kane-Gill SL. Impact of simulation-based learning on medication error rates in critically ill patients. Int Care Med 2010;36:1526—31. Frost P, Wise MP. Recognition and early management of the critically ill ward patient. Brit J Hosp Med 2007;68(Iss. Sup 10):M180—3. Fullerton JN, Price CL, Silvey NE, Brace SJ, Perkins GD. Is the Modified Early Warning Score (MEWS) superior to clinician judgement in detecting critical illness in the pre-hospital environment? Resuscitation 2012;83:557—62. Hammond NE, Spooner AJ, Barnett AG, Corley A, Brown P, Fraser JF. The effect of implementing a modified early warning scoring (MEWS) system on the adequacy of vital sign documentation. Aust Crit Care 2013;26:18—22.
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Lave J, Wenger E. Situated Learning: Legitimate Peripheral Participation. Cambridge: Cambridge University Press; 1991. Liikanen E, Lehto L. Training of nurses in point-of-care testing: a systematic review of the literature. J Clin Nurs 2012;22:2244— 52. MacDonald M. Enhancing orientation for graduate nurses to critical care through the use of a wiki. Can J Nurs Inf 2013, http://www.cjni.net/journal/?p=2884 (Accessed 20th September 2013). Massey D, Aitken LM, Chaboyer W. Literature review: do rapid response systems reduce the incidence of major adverse events in the deteriorating ward patient? J Clin Nurs 2010;19:3260— 73. Moon JA. Reflection in Learning & Professional Development. Theory & Practice. London: Routledge Falmer; 1999. Nickless LJ. The use of clinical simulation to address the acute care skills deficit in pre-registration nursing students: a clinical skill perspective. Nurse Educ Pract 2011;11:199—205. NPSA. Recognising and Responding Appropriately to Early Signs of Deterioration in Hospitalised Patients. London: NHS National Patient Safety Agency; 2007. Rattray JE, Lauder W, Ludwick R, Johnstone C, Zeller R, Winchell J, Myers E, Smith A. Indicators of acute deterioration in adult patients nursed in acute wards: a factorial survey. J Clin Nurs 2011;20:723—32. Sawyer RK, editor. The Cambridge Handbook of The Learning Sciences. Cambridge: Cambridge University Press; 2006. Shokoohi H, Boniface K, Taheri MR, Pourmand A. Spontaneous rectus sheath hematoma diagnosed by point-of-care ultrasonography. CJEM 2013;15(2):119—22. Ulrich BT, Woods D, Hart KA, Lavandero R, Leggett J, Taylor D. Critical care nurses’ work environments value of excellence in beacon units and magnet organizations. Crit Care Nurse 2007;27:68—77. Westbrook JI, Duffield C, Ling L, Creswick NJ. How much time do nurses have for patients? A longitudinal study quantifying hospital nurses’ patterns of task time distribution and interactions with health professionals. BMC Health Serv Res 2011;11:319 http://www.biomedcentral.com/1472-6963/11/319
Guest Editors Margaret C. Smith, PhD Geraldine Lyte, PhD
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.elsevier.com/iccn
EDITORIAL
Leadership and excellence in the early recognition of critical illness: A call for papers The onset of critical illness refers to the stage when the person’s clinical state becomes physiologically unpredictable and unstable. It can result in incapacity or death within minutes or hours (Frost & Wise, 2007). Several conditions can lead to sudden and/or unexpected deterioration of patients, and nurses must possess knowledge and clinical experience of specific critical illness states to be able to identify key early warning signs and symptoms indicating physiological deterioration (Endacott et al., 2007). Examples of these conditions include sepsis, haemorrhage, raised intracranial pressure, post-surgical haemorrhage, multi-organ failure, infection and changes in cognitive functioning. They can manifest in patients in acute, critical care, pre-hospital, primary and community care contexts. Excellence in the leadership, management and organisation of intensive and critical care nursing is key to the safe and effective care of critically ill patients (Dunn et al., 2000; Endacott et al., 2008; Ulrich et al., 2007). Our global health services are faced with ever-increasing demands to care for very ill and physiologically unstable patients (Adhikari et al., 2010). Nurses are required to recognise signs of clinical deterioration, identify cases of critical illness, activate rapid response teams, and take action to stabilise the patient’s clinical condition alongside medical colleagues (DeVita et al., 2006; Massey et al., 2010). However, there are notable gaps in the literature on rapid response teams, particularly, their formal evaluation, and the further exploration of reasons for non-activation and their under-use by ward based nursing staff (Massey et al., 2010). Frost & Wise (2007) argue that the lack of systematic approaches to assessment and treatment, poor staffing levels, and omissions in education and training, may account for the late recognition of critical illness in pre- and post-ICU environments. The availability of sufficient staff with the appropriate levels of skill is an important consideration for all critical care managers as it impacts on the quality of care delivered and patient outcomes. Aiken et al. (2003) demonstrated that where more registered nurses with graduate 0964-3397/$ — see front matter © 2013 Published by Elsevier Ltd. http://dx.doi.org/10.1016/j.iccn.2013.10.001
level education were on duty, this was positively correlated with a reduction in failure to rescue events in post-surgical patients. In March 2012 the RN4CAST consortium published the findings of a large cross sectional survey of nurses and patients in 12 countries in Europe and the United States (Aiken et al., 2012). They found that locations with improved work environments and reduced ratios of patients-to-nursing staff were positively correlated with increased care quality and job satisfaction. There is also evidence about the fragmented nature of hospital nurses’ work reported in the findings of a prospective longitudinal observational study conducted in two wards in an Australian teaching hospital, where the average duration of direct patient care tasks lasted only 55 seconds (Westbrook et al., 2011), clearly reducing opportunities for in-depth patient assessment and monitoring of changes in clinical states. Further research is needed on the application of optimal scoring systems for detecting critical illness across different settings, including in pre-hospital environments. Rattray et al. (2011) used a factorial survey design using paper-based vignettes, to assess ward-based nurses’ judgements of patient acuity and the likelihood of the patients being referred for further review. They found that nurses’ application of an early warning score was the biggest predictor in their study for patients being referred for further review. Limitations associated with the use of paper-based vignettes rather than actual patient settings are noted, and the authors argue that future studies could increase fidelity for this type of research by converting the use of vignettes to clinical simulation models. They also recommend that post-registration education should focus more on developing clinical experience and expertise rather than knowledge acquisition alone. In another study Fullerton et al. (2012) undertook a large retrospective observational cohort study of consecutive cases presenting to one emergency department (ED) in the UK. Caution is needed in the interpretation of the results due to the retrospective nature of the research design. Where the Modified Early Warning Score (MEWS) was applied
298 to the data retrospectively more ‘adverse events’ were correctly identified than by paramedics’ clinical judgement alone (i.e. sensitivity was improved). However specificity was reduced resulting in resource implications for the service, and it was concluded that further work to develop an optimal score for this setting was required (Fullerton et al., 2012). It is recognised that increasing severity of illness in some patient groups, such as medical (non-trauma) cases, can be missed by pre-hospital paramedic staff using their clinical judgement and experience alone. MEWS is known to be inaccurate in some medical emergencies where patients can have pathological critical illness conditions but physiological derangements have yet to occur, such as in some myocardial ischaemia, head injury and spinal injury cases (Fullerton et al., 2012). Clearly, clinical judgement and, in particular, nurses’ diagnostic judgements about the clinical state of the patient, are extremely important areas for investigation that can draw on robust theoretical and clinical conceptual frameworks (Coulter-Smith et al., 2013), and early warning scoring systems continue to provide a complementary and important safety net for unrecognised critical illness (NPSA, 2007). Education is crucial to the enhancement of nurses’ knowledge, clinical reasoning, and practical skills, for the complex tasks associated with the early recognition and initial management of critical illness and for safe and effective multidisciplinary team working. A wide range of learning, teaching and assessment methods are available to critical care educators. Clinical simulation offers nursing students and qualified staff opportunities to learn high stakes clinical skills under safe and controlled educational conditions (Nickless, 2011; Abe et al., 2013). Ford et al. (2010) in a US prospective observational study, using a before and after design to examine simulation-based learning compared to traditional teaching methods, demonstrated a reduction of medication error rates for critically ill patients. Two different groups of nurses were studied (n = 24) (Coronary Critical Care and Medical ICU), and despite limitations in the research design, simulation-based learning appeared to offer significant advantages over traditional methods of education. Repeated scenario clinical simulation was also found to be particularly effective for developing clinical competence in the recognition of critical illness states and team working in cardiovascular critical care nurses (Abe et al., 2013). Equally, advances in technology enhanced learning are stimulating education innovations in the critical care context (Arora & Chachra 2012; MacDonald, 2013). Education programmes alongside targeted interventions, such as the introduction of improved MEWS observation charts, can increase qualified staff’s adherence to recommended best practice in the recording of patients’ vital signs in the 24 hour post-ICU discharge period, although this particular study found that the frequency of vital signs recordings for unplanned admissions to ICU was not statistically significantly improved (Hammond et al., 2013). Furthermore, new developments in professional lifelong learning, and the interdisciplinary discipline of the Learning Sciences (Lave & Wenger, 1991; Moon, 1999; Sawyer, 2006; Bradbury et al., 2010), all offer exciting opportunities for transformative and student centred learning ultimately leading to improved patient care in critical illness.
Editorial As technological advances are made in ‘Point of Care Testing’ (PoCT), specific educational interventions can be designed by teams, including laboratory staff, expert nurses and nurse administrators, to ensure that practitioners are competent in their use (Liikanen and Lehto, 2012). PoCT is expanding rapidly and includes glucose monitoring for people with diabetes mellitus in a range of settings (Blake and Nathan, 2004) through to testing for rare but potentially fatal conditions such as spontaneous rectus sheath haematoma using abdominal ultrasonography (Shokoohi et al., 2013). The ICCN Editorial Board is committed to publishing evidence based clinical and research articles and are planning a special issue of ICCN to be published in December 2014 focusing on leadership and excellence in the early recognition of critical illness. We wish to invite the submission of manuscripts focusing on this topic. We would particularly welcome reports on research studies focusing on patient assessment and management of specific clinical states leading to critical illness, systematic evaluations of education programmes focusing on developing critical illness, specific education interventions such as the application of clinical simulation, and/or quality improvement initiatives or clinical audit to address aspects of the organisation and safe delivery of critical care. We will also consider clinical reports or case studies focusing on the presentation of less frequently occurring critical illness states, and/or literature review papers focusing on leadership and excellence in developing critical illness. Contributors should submit their full manuscripts for consideration to Intensive & Critical Care Nursing by 14th March 2014. Papers should be submitted by selecting the option Special Issue —– Early Recognition from the online submission system at http://ees.elsevier.com/iccn/ where full guidance on the preparation of papers for submission can also be found. All papers will be subject to the usual double-blind peer review and editorial processes of the journal. We look forward receiving a wide range of submissions for this special edition and also to facilitating the sharing of research, developments and experience relating to this important topic.
References Abe BY, Kawahara C, Yamashina A, Tsuboi R. Repeated scenario simulation to improve competency in critical care: a new approach for nursing education. Am J Crit Care 2013;22:33—40. Adhikari NKJ, Fowler RA, Bhagwanjee S, Rubenfield GD. Critical care and the global burden of critical illness in adults. Lancet 2010;376:1339—46. Aiken LH, Sermeus W, Van den Heede K, Sloane DM, Busse R, McKee M, Bruyneel L, Rafferty AM, Griffiths P, Moreno-Casbas MT, Tishelman C, Scott A, Brzostek T, Kinnunen J, Schwendimann R, Heinen M, Zikos D, Strømseng Sjetne I, Smith HL, Kutney-Lee A. Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 counties in Europe and the United States. Brit Med J 2012;344., http://dx.doi.org/10.1136/bmj.e1717 (accessed 20.09.13). Aiken LH, Clarke SP, Cheung RB, Sloane DM, Silber JH. Education levels of hospital nurses and surgical patient mortality. JAMA 2003;290(12):1617—23.
Leadership and excellence in the early recognition of critical illness: A call for papers Arora VK, Chachra V, Virtual ICU. Virtual ICU and e-learning tools: scope in critical care medicine in India. Indian J Crit Care Med 2012;16:148—50. Blake DR, Nathan DM. Point-of-care-testing for diabetes. Crit Care Nurs 2004;27(2):150—61. Bradbury H, Frost N, Kilminster S, Zukas M, editors. Beyond Reflective Practice. New Approaches to Professional Lifelong Learning. London: Routledge; 2010. Coulter-Smith MA, Smith P, Crow R. Critical review: a combined conceptual framework of severity of illness and clinical judgement for analysing diagnostic judgement in critical illness. J Clin Nurs 2013., http://dx.doi.org/10.1111/jocn.e12463 (Accepted for publication 16.07.13). DeVita MA, Bellomo R, Hillman K, Kellum J, Rotondi A, Teres D, Auerback A, Chen W, Duncan K, Kenward G, Bell M, Buist M, Chen J, Bion J, Kirkby A, Lighthall G, Ovreveit J, Braithwaite RS, Gosbee J, Milibrandt E, Peherdy M, Savitz L, Young L, Harvey M, Galhotra S. Findings of the first consensus conference on medical emergency teams. Crit Care Med 2006;34:2463—78. Dunn SV, Lawson D, Robertson S, Underwood M, Clark R, Valentine T, Walker N, Wilson-Row C, Crowder K, Herewane D. The Development of Standards for Specialist Critical Care Nurses. J Adv Nurs 2000;31:339—46. Endacott R, Boulanger C, Chamberlain W, Hendry J, Ryan H, Chaboyer W. Stability in shifting sands: contemporary leadership roles in critical care. J Nurs Manag 2008;16:837—45. Endacott R, Kidd t, Chaboyer W, Edington J. Recognition and communication of patient deterioration in a regional hospital: a multi-methods study. Aust Crit Care 2007;20:100—5. Ford DG, Seyber AL, Smithburger PL, Kobulinsky LR, Samosky JT, Kane-Gill SL. Impact of simulation-based learning on medication error rates in critically ill patients. Int Care Med 2010;36:1526—31. Frost P, Wise MP. Recognition and early management of the critically ill ward patient. Brit J Hosp Med 2007;68(Iss. Sup 10):M180—3. Fullerton JN, Price CL, Silvey NE, Brace SJ, Perkins GD. Is the Modified Early Warning Score (MEWS) superior to clinician judgement in detecting critical illness in the pre-hospital environment? Resuscitation 2012;83:557—62. Hammond NE, Spooner AJ, Barnett AG, Corley A, Brown P, Fraser JF. The effect of implementing a modified early warning scoring (MEWS) system on the adequacy of vital sign documentation. Aust Crit Care 2013;26:18—22.
299
Lave J, Wenger E. Situated Learning: Legitimate Peripheral Participation. Cambridge: Cambridge University Press; 1991. Liikanen E, Lehto L. Training of nurses in point-of-care testing: a systematic review of the literature. J Clin Nurs 2012;22:2244— 52. MacDonald M. Enhancing orientation for graduate nurses to critical care through the use of a wiki. Can J Nurs Inf 2013, http://www.cjni.net/journal/?p=2884 (Accessed 20th September 2013). Massey D, Aitken LM, Chaboyer W. Literature review: do rapid response systems reduce the incidence of major adverse events in the deteriorating ward patient? J Clin Nurs 2010;19:3260— 73. Moon JA. Reflection in Learning & Professional Development. Theory & Practice. London: Routledge Falmer; 1999. Nickless LJ. The use of clinical simulation to address the acute care skills deficit in pre-registration nursing students: a clinical skill perspective. Nurse Educ Pract 2011;11:199—205. NPSA. Recognising and Responding Appropriately to Early Signs of Deterioration in Hospitalised Patients. London: NHS National Patient Safety Agency; 2007. Rattray JE, Lauder W, Ludwick R, Johnstone C, Zeller R, Winchell J, Myers E, Smith A. Indicators of acute deterioration in adult patients nursed in acute wards: a factorial survey. J Clin Nurs 2011;20:723—32. Sawyer RK, editor. The Cambridge Handbook of The Learning Sciences. Cambridge: Cambridge University Press; 2006. Shokoohi H, Boniface K, Taheri MR, Pourmand A. Spontaneous rectus sheath hematoma diagnosed by point-of-care ultrasonography. CJEM 2013;15(2):119—22. Ulrich BT, Woods D, Hart KA, Lavandero R, Leggett J, Taylor D. Critical care nurses’ work environments value of excellence in beacon units and magnet organizations. Crit Care Nurse 2007;27:68—77. Westbrook JI, Duffield C, Ling L, Creswick NJ. How much time do nurses have for patients? A longitudinal study quantifying hospital nurses’ patterns of task time distribution and interactions with health professionals. BMC Health Serv Res 2011;11:319 http://www.biomedcentral.com/1472-6963/11/319
Guest Editors Margaret C. Smith, PhD Geraldine Lyte, PhD
