الفهرس 
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Abstract
Critically ill patients are at high risk for clinical deterioration. The majority of deterioration develops gradually over many hours and are associated with the early presence of physiologic parameter changes. Physiologic parameters are essential to detect patients’ deterioration. Lack of timely recognition of physiologic parameter changes during monitoring often results in poor clinical decision making, inadequate response, serious adverse events, and increased morbidity. Critical care nurses (CCNs) have a significant role in detecting physiologic parameter changes and providing immediate adequate response to prevent adverse events. Critical care nurses (CCNs) response to physiologic parameter changes is classified into assessment, notification, nursing intervention, evaluation and documentation. Recognition and response processes aim to ensure that all patients whose condition deteriorates receive a timely and appropriate management.
Aim of the study
• The aim of this study was to identify critical care nurses’ response to physiologic changes in critically ill patients.
Research design
A descriptive research designs.
Settings
• This study was carried out in general ICUs namely; (unit I, unit II, and unit III) at the Alexandria Main University Hospital.
Sampling
• A convenience sample of 60 nurses who were working in general ICUs was needed to assess adequate nurses’ response to physiologic parameter changes of critically ill patients.
• Nurses who provide direct care to patients with a modified early warning score (MEWS) ≥5 were included in this study.
Tool
To accomplish the aim of the current study; One tool ”Response to physiologic changes observation sheet” was used for data collection. Response to physiologic changes observation sheet was developed by the researcher after reviewing the related literature.
Data collection
• An official letter from the faculty of nursing was delivered to the hospital authorities in the Main University Hospital and approval to conduct this study was obtained after providing explanation of the aim of the study. An informed consent was obtained from the head nurse of the unit for observation. It included the aim of the study, potential benefits, risks and discomforts from participation and the right to refuse participation in the study. The anonymity, privacy of the nurses and confidentiality of the collected data.
• The developed tool was tested for content validity by five experts in the field of the study. A pilot study was carried to assess the clarity and applicability of the tool and the necessary modifications were done prior to data collection. The reliability of tool two was tested using Cronbach’s Alpha test and result was 0.886 which is accepted. This value indicates that the data collection tool is reliable.
• Critically ill patients in the ICU were assessed by the researcher using MEWS to determine patients who have a score equal to or more than 5.
• Nurses who were assigned to those patients were enrolled in this study. Nurses’ socio-demographic data including age, sex, marital status, qualifications, years of ICU working experience and job-related data including attendance of workshops about nurses’ response to physiologic parameter changes and nurse to patient ratio were obtained and recorded using part I of the tool.
• The baseline physiologic parameters of the patients whose nurses were enrolled in this study were assessed and recorded by the researcher using part II of the tool.
• In the first observation (morning shift), the researcher obtained and recorded the physiologic parameter that were measured and noted in the charts by nurses using part II of the tool.
• According to the measurements of physiologic parameters that changed from the baseline, the researcher observed nurses’ response and nurses’ response time to physiologic parameter changes using part III of the tool.
• After that, the researcher observed the same nurses who were assigned to the same patients in the second observation (evening shift). Therefore, the total numbers of observations conducted by the researcher for 60 nurses were 120 observations.
Results of the study
• Approximately three quarter of studied nurses were female. Two third of studied nurses aged 20- 30 years. About more than half of them are married. Half of the studied nurses had less than five years experience in ICU. Half of the studied nurses were interning nurses. All studied nurses didn’t attend workshops about nurses’ response to physiologic parameters changes. As regards nurse to patient ratio, more than half of the ratio was 1:1 in the first observation while less than three quarter of the ratio was 1:2 in the second observation.
• There was a statistically significant difference of respiratory rate, oxygen saturation, heart rate, systolic blood pressure, diastolic blood pressure and temperature from baseline reading (p=0.037, <0.001, 0.042, <0.001, <0.001, 0.047 respectively).Also, there was a statistically significant difference between timing of nurse response according to respiratory, cardiovascular and metabolic changes (p= 0.004,<0.001,0.047 respectively).
• Regarding nurses’ response to physiologic parameter changes, there was a statistically significant difference between nurses’ response adequacy to each body system alteration (p=0.020).
• Also, there was a statistically significant difference between assessment, notification, intervention, evaluation, documentation adequacy to each body system alteration (p=<0.001, 0.045, 0.001, <0.001, 0.031 respectively).
• Regarding relation between nurses’ response adequacy and factors affecting nurses’ response, there was a statistically significant relation between the nurse response adequacy with years of the ICU experience, qualification and nurse to patient ratio in the first observation (p= <0.001, 0.007, 0.022 respectively) and the second observation (p=<0.001, 0.042, 0.001 respectively).Moreover, there was no statistically significant relation between nurses’ response adequacy and the modified early warning score, in the first and second observation (p= 0.510,0.743 respectively).
Conclusion
Eight physiologic parameters are very important to identify early deterioration and adverse events. Recognition of physiologic parameter changes can assist in the recognition of patients from minutes to hours before the occurrence of serious adverse events. Critical care nurses (CCNs) in the current study didn’t adequately assessed urine output / hr, pain and level of consciousness. The findings of this study revealed that immediate response of CCNs to bradycardia was more than other physiologic parameter changes while delayed response of CCNs to hyperthermia was more than other physiologic parameter changes. Also, CCNs adequately respond to metabolic changes was more than other body system alterations while they inadequately respond to cardiovascular changes was more than other body system alterations. Nurses’ Qualifications, nurses’ patient ratio, years of ICU experience of nurses are factors affecting nurses’ response.
Recommendations
- Conduction of teaching programs to increase awareness and understanding of CCNs towards the importance of performing adequate assessment to all physiologic parameter, in particular, urine output, pain and level of consciousness.
- Incorporate nurses’ response adequacy to physiologic parameter changes in the curricula of undergraduate nursing students and graduate nurse programs in both theory and practice.
- Evaluate the effect of inadequate nurse response on patients’ safety.
- Incorporate nurses’ response to physiologic parameter changes that include assessment, notification, nursing intervention, evaluation and documentation into daily practice nursing records.
- Evaluate nurses’ assessment skills to address gaps in interpretations of physiologic parameter values and understanding of pathophysiological changes associated with cardio respiratory dysfunction.