Nurses' information processing related to surveillance as an intervention in the care of stroke patients
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Abstract
Background. The phenomena 'failure to rescue', defined as the inability to recognize a complication and consequently to save a patient's life, has recently received much attention. Surveillance is a term describing a nursing intervention that involves nurses' cognitive work to identify and prevent patient complications. Surveillance is characterized by frequent assessment of patients, attention to cues, and recognition of complications. Previous research focused on novice/expert differences during simulated tasks such as developing a plan of care but more recently attention has focused on early recognition of patient complications. Despite this focus on early recognition, there is a paucity of research related to surveillance, and in particular, during the delivery of care.
Purpose. The purpose of this study was to explore the nursing intervention of surveillance from an information processing framework. Research questions addressed how surveillance was expressed by nurses during the care of stroke patients and the relationship of cues identified to the focus of care.
Methods and design. A descriptive, exploratory design was employed. Data were collected by think aloud and the resulting text analyzed with content analysis. Participants were ten nurses working on a medical neurology unit in a large Midwestern academic health center and ten patients in the first three days of hospitalization following stroke. While providing care to a stroke patient, the nurses were prompted to think aloud as they (1) received report; (2) performed an initial assessment/initial interaction with patient; and (3) concluded the shift.
Findings and conclusion. Surveillance by medical neurology nurses in this study was expressed as forming a mental image of the patient which was subsequently used as the basis for evaluation of the patient's status. The overall theme representing the relationship of cues to the focus of nursing care was creating a vision. Cognitive processes used included understanding the past, observing the patient, looking back, and forming an impression. Looking ahead was the second theme identified and included making a plan, anticipating discharge, seeking information, and communicating needs.
Implications for these findings include opportunities in both education and practice arenas for the development and use of communication skills to convey an accurate picture of the patient, especially, the importance of handoff communication in creating an accurate vision of the patient that is used for early recognition of complications.
Description
This dissertation has also been disseminated through the ProQuest Dissertations and Theses database. Dissertation/thesis number: 3280698; ProQuest document ID: 304848145. The author still retains copyright.
Repository Posting Date
2020-04-15T17:57:15Z
Notes
This item has not gone through this repository's peer-review process, but has been accepted by the indicated university or college in partial fulfillment of the requirements for the specified degree.
Type Information
Type | Dissertation |
Acquisition | Proxy-submission |
Review Type | None: Degree-based Submission |
Format | Text-based Document |
Category Information
Evidence Level | Descriptive/Correlational |
Research Approach | Qualitative Research |
Keywords | Stroke Patients; Patient Care; Theory of Cognition |
CINAHL Subject(s) | Stroke--Therapy; Cognition; Disease Surveillance; Nursing Practice; Stroke |
Degree Information
Grantor | Loyola University Chicago |
Advisor | Androwich, Ida |
Level | PhD |
Year | 2007 |
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