Three Years of Continuous Vital Signs Monitoring on the General Surgical Ward: Is It Sustainable? A Qualitative Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Design
2.2. Setting
System for Continuous Monitoring: Visi Mobile
2.3. Participant Selection
2.4. Data Collection
2.4.1. Individual Interviews with Key-User Nurses
2.4.2. Focus Group Interview with Nurses
2.4.3. Individual Interviews with Patients
2.5. Data Analysis
3. Results
3.1. Factors Related to ICT
3.1.1. Design and Technical Concerns
3.1.2. Characteristics of the Innovation
3.2. Individual Factors of Healthcare Professionals
3.2.1. Knowledge
3.2.2. Attitude
3.3. Human Environment
3.3.1. Factors Associated with Patients
3.3.2. Factors Associated with Peers
3.4. Organizational Aspects
3.4.1. Internal Aspects
3.4.2. External Aspects
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Kitson, A.L. The Fundamentals of Care Framework as a Point-of-Care Nursing Theory. Nurs. Res. 2018, 67, 99–107. [Google Scholar] [CrossRef] [PubMed]
- Odell, M.; Victor, C.; Oliver, D. Nurses’ role in detecting deterioration in ward patients: Systematic literature review. J. Adv. Nurs. 2009, 65, 1992–2006. [Google Scholar] [CrossRef]
- Subbe, C.P.; Kruger, M.; Rutherford, P.; Gemmel, L. Validation of a modified Early Warning Score in medical admissions. QJM 2001, 94, 521–526. [Google Scholar] [CrossRef] [PubMed]
- Jarvis, S.W.; Kovacs, C.; Briggs, J.; Meredith, P.; Schmidt, P.E.; Featherstone, P.I.; Prytherch, D.R.; Smith, G.B. Are observation selection methods important when comparing early warning score performance? Resuscitation 2015, 90, 1–6. [Google Scholar] [CrossRef]
- Beaumont, K.; Luettel, D.; Thomson, R. Deterioration in hospital patients: Early signs and appropriate actions. Nurs. Stand. 2008, 23, 43–48. [Google Scholar] [CrossRef]
- Kyriacos, U.; Jelsma, J.; Jordan, S. Monitoring vital signs using early warning scoring systems: A review of the literature. J. Nurs. Manag. 2011, 19, 311–330. [Google Scholar] [CrossRef]
- Ludikhuize, J.; Smorenburg, S.M.; de Rooij, S.E.; de Jonge, E. Identification of deteriorating patients on general wards; measurement of vital parameters and potential effectiveness of the Modified Early Warning Score. J. Crit. Care. 2012, 27, 424.e7–424.e13. [Google Scholar] [CrossRef] [PubMed]
- van Beuzekom, M.; Boer, F.; Akerboom, S.; Hudson, P. Patient safety in the operating room: An intervention study on latent risk factors. BMC Surg. 2012, 12, 10. [Google Scholar] [CrossRef]
- Andersen, L.W.; Kim, W.Y.; Chase, M.; Berg, K.M.; Mortensen, S.J.; Moskowitz, A.; Novack, V.; Cocchi, M.C.; Donnino, M.W.; American Heart Association’s Get With the Guidelines(®)—Resuscitation Investigators. The prevalence and significance of abnormal vital signs prior to in-hospital cardiac arrest. Resuscitation 2016, 98, 112–117. [Google Scholar] [CrossRef]
- Kause, J.; Smith, G.; Prytherch, D.; Parr, M.; Flabouris, A.; Hillman, K.; Intensive Care Society (UK); Austrlian and New Zealand Intensive Care Society Clinical Trials Gropu. A comparison of antecedents to cardiac arrests, deaths and emergency intensive care admissions in Australia and New Zealand, and the United Kingdom-the ACADEMIA study. Resuscitation 2004, 62, 275–282. [Google Scholar] [CrossRef]
- Peerboom, F.; Hafsteinsdottir, T.B.; Weldam, S.W.; Schoonhoven, L. Surgical nurses’ responses to worry: A qualitative focus-group study in the Netherlands. Intensive Crit. Care Nurs. 2022, 71, 103231. [Google Scholar] [CrossRef] [PubMed]
- Douw, G.; Huisman-de Waal, G.; van Zanten, A.R.; van der Hoeven, J.G.; Schoonhoven, L. Nurses’ ‘worry’ as predictor of deteriorating surgical ward patients: A prospective cohort study of the Dutch-Early-Nurse-Worry-Indicator-Score. Int. J. Nurs. Stud. 2016, 59, 134–140. [Google Scholar] [CrossRef]
- Bingham, G.; Fossum, M.; Barratt, M.; Bucknall, T. Clinical review criteria and medical emergency teams: Evaluating a two-tier rapid response system. Crit. Care Resusc. 2015, 17, 167–173. [Google Scholar] [CrossRef] [PubMed]
- Bucknall, T.K.; Jones, D.; Bellomo, R.; Staples, M.; Investigators, R. Responding to medical emergencies: System characteristics under examination (RESCUE). A prospective multi-site point prevalence study. Resuscitation 2013, 84, 179–183. [Google Scholar] [CrossRef] [PubMed]
- Ludikhuize, J.; de Jonge, E.; Goossens, A. Measuring adherence among nurses one year after training in applying the Modified Early Warning Score and Situation-Background-Assessment-Recommendation instruments. Resuscitation 2011, 82, 1428–1433. [Google Scholar] [CrossRef] [PubMed]
- van Galen, L.S.; Struik, P.W.; Driesen, B.E.; Merten, H.; Ludikhuize, J.; van der Spoel, J.I.; Kramer, M.H.H.; Nanayakkara, P.W.B. Delayed Recognition of Deterioration of Patients in General Wards Is Mostly Caused by Human Related Monitoring Failures: A Root Cause Analysis of Unplanned ICU Admissions. PLoS ONE 2016, 11, e0161393. [Google Scholar] [CrossRef] [PubMed]
- Yiu, C.J.; Khan, S.U.; Subbe, C.P.; Tofeec, K.; Madge, R.A. Into the night: Factors affecting response to abnormal Early Warning Scores out-of-hours and implications for service improvement. Acute Med. 2014, 13, 56–60. [Google Scholar] [CrossRef]
- Breteler, M.J.M.; KleinJan, E.; Numan, L.; Ruurda, J.P.; Van Hillegersberg, R.; Leenen, L.P.H.; Hermans, M.; Kalman, C.J.; Blockhuis, T.J. Are current wireless monitoring systems capable of detecting adverse events in high-risk surgical patients? A descriptive study. Injury 2020, 51 (Suppl. 2), S97–S105. [Google Scholar] [CrossRef]
- Leenen, J.P.L.; Leerentveld, C.; van Dijk, J.D.; van Westreenen, H.L.; Schoonhoven, L.; Patijn, G.A. Current Evidence for Continuous Vital Signs Monitoring by Wearable Wireless Devices in Hospitalized Adults: Systematic Review. J. Med. Internet Res. 2020, 22, e18636. [Google Scholar] [CrossRef]
- Weenk, M.; Bredie, S.J.; Koeneman, M.; Hesselink, G.; van Goor, H.; van de Belt, T.H. Continuous Monitoring of Vital Signs in the General Ward Using Wearable Devices: Randomized Controlled Trial. J. Med. Internet Res. 2020, 22, e15471. [Google Scholar] [CrossRef]
- Watkins, T.; Whisman, L.; Booker, P. Nursing assessment of continuous vital sign surveillance to improve patient safety on the medical/surgical unit. J. Clin. Nurs. 2016, 25, 278–281. [Google Scholar] [CrossRef] [PubMed]
- Stellpflug, C.; Pierson, L.; Roloff, D.; Mosman, E.; Gross, T.; Marsh, S.; Willis, V.; Gabrielson, D. Continuous Physiological Monitoring Improves Patient Outcomes. Am. J. Nurs. 2021, 121, 40–46. [Google Scholar] [CrossRef] [PubMed]
- Eddahchouri, Y.; Peelen, R.V.; Koeneman, M.; Touw, H.R.W.; van Goor, H.; Bredie, S.J.H. Effect of continuous wireless vital sign monitoring on unplanned ICU admissions and rapid response team calls: A before-and-after study. Br. J. Anaesth. 2022, 128, 857–863. [Google Scholar] [CrossRef] [PubMed]
- van Gemert-Pijnen, J.E.; Nijland, N.; van Limburg, M.; Ossebaard, H.C.; Kelders, S.M.; Eysenbach, G.; Seydel, E. A holistic framework to improve the uptake and impact of eHealth technologies. J. Med. Internet Res. 2011, 13, e111. [Google Scholar] [CrossRef] [PubMed]
- Becking-Verhaar, F.L.; Verweij, R.P.H.; de Vries, M.; Vermeulen, H.; van Goor, H.; Huisman-de Waal, G.J. Continuous Vital Signs Monitoring with a Wireless Device on a General Ward: A Survey to Explore Nurses’ Experiences in a Post-Implementation Period. Int. J. Environ. Res. Public Health 2023, 20, 5794. [Google Scholar] [PubMed]
- O’Brien, B.C.; Harris, I.B.; Beckman, T.J.; Reed, D.A.; Cook, D.A. Standards for reporting qualitative research: A synthesis of recommendations. Acad. Med. 2014, 89, 1245–1251. [Google Scholar] [CrossRef]
- World Medical, A. World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA 2013, 310, 2191–2194. [Google Scholar]
- Elo, S.; Kyngas, H. The qualitative content analysis process. J. Adv. Nurs. 2008, 62, 107–115. [Google Scholar] [CrossRef]
- Graneheim, U.H.; Lindgren, B.M.; Lundman, B. Methodological challenges in qualitative content analysis: A discussion paper. Nurse Educ. Today. 2017, 56, 29–34. [Google Scholar] [CrossRef]
- Gagnon, M.P.; Desmartis, M.; Labrecque, M.; Car, J.; Pagliari, C.; Pluye, P.; Fremont, P.; Gagnon, J.; Tremblay, N.; Legare, F. Systematic review of factors influencing the adoption of information and communication technologies by healthcare professionals. J. Med. Syst. 2012, 36, 241–277. [Google Scholar] [CrossRef]
- Weller, R.S.; Foard, K.L.; Harwood, T.N. Evaluation of a wireless, portable, wearable multi-parameter vital signs monitor in hospitalized neurological and neurosurgical patients. J. Clin. Monit. Comput. 2018, 32, 945–951. [Google Scholar] [CrossRef]
- Verrillo, S.C.; Cvach, M.; Hudson, K.W.; Winters, B.D. Using Continuous Vital Sign Monitoring to Detect Early Deterioration in Adult Postoperative Inpatients. J. Nurs. Care Qual. 2019, 34, 107–113. [Google Scholar] [CrossRef]
- Haveman, M.E.; van Melzen, R.; Schuurmann, R.C.L.; Hermens, H.J.; Tabak, M.; de Vries, J.P.M. Feasibility and patient’s experiences of perioperative telemonitoring in major abdominal surgery: An observational pilot study. Expert. Rev. Med. Devices. 2022, 19, 515–523. [Google Scholar] [CrossRef]
- Schoville, R.R.; Titler, M.G. Guiding healthcare technology implementation: A new integrated technology implementation model. Comput. Inform. Nurs. 2015, 33, 99–107, quiz E1. [Google Scholar] [CrossRef]
- Jeskey, M.; Card, E.; Nelson, D.; Mercaldo, N.D.; Sanders, N.; Higgins, M.S.; Shi, Y.; Michaels, D.; Miller, A. Nurse adoption of continuous patient monitoring on acute post-surgical units: Managing technology implementation. J. Nurs. Manag. 2011, 19, 863–875. [Google Scholar] [CrossRef]
- Leenen, J.P.L.; Rasing, H.J.M.; van Dijk, J.D.; Kalkman, C.J.; Schoonhoven, L.; Patijn, G.A. Feasibility of wireless continuous monitoring of vital signs without using alarms on a general surgical ward: A mixed methods study. PLoS ONE 2022, 17, e0265435. [Google Scholar] [CrossRef]
- Buchanan, C.; Howitt, M.L.; Wilson, R.; Booth, R.G.; Risling, T.; Bamford, M. Predicted Influences of Artificial Intelligence on the Domains of Nursing: Scoping Review. JMIR Nurs. 2020, 3, e23939. [Google Scholar] [CrossRef]
- Van Bulck, L.; Couturier, R.; Moons, P. Applications of artificial intelligence for nursing: Has a new era arrived? Eur. J. Cardiovasc. Nurs. 2022, 22, e19–e20. [Google Scholar] [CrossRef]
- Douw, G.; Huisman-de Waal, G.; van Zanten, A.R.H.; van der Hoeven, J.G.; Schoonhoven, L. Surgical ward nurses’ responses to worry: An observational descriptive study. Int. J. Nurs. Stud. 2018, 85, 90–95. [Google Scholar] [CrossRef]
- Downey, C.L.; Brown, J.M.; Jayne, D.G.; Randell, R. Patient attitudes towards remote continuous vital signs monitoring on general surgery wards: An interview study. Int. J. Med. Inform. 2018, 114, 52–56. [Google Scholar] [CrossRef]
- Wiechula, R.; Conroy, T.; Kitson, A.L.; Marshall, R.J.; Whitaker, N.; Rasmussen, P. Umbrella review of the evidence: What factors influence the caring relationship between a nurse and patient? J. Adv. Nurs. 2016, 72, 723–734. [Google Scholar] [CrossRef] [PubMed]
- Castro, E.M.; Van Regenmortel, T.; Vanhaecht, K.; Sermeus, W.; Van Hecke, A. Patient empowerment, patient participation and patient-centeredness in hospital care: A concept analysis based on a literature review. Patient Educ. Couns. 2016, 99, 1923–1939. [Google Scholar] [CrossRef] [PubMed]
- van Goor, H.M.R.; Breteler, M.J.M.; Schoonhoven, L.; Kalkman, C.J.; van Loon, K.; Kaasjager, K.A.H. Interpretation of continuously measured vital signs data of COVID-19 patients by nurses and physicians at the general ward: A mixed methods study. PLoS ONE 2023, 18, e0286080. [Google Scholar] [CrossRef]
- Leenen, J.P.L.; Dijkman, E.M.; van Hout, A.; Kalkman, C.J.; Schoonhoven, L.; Patijn, G.A. Nurses’ experiences with continuous vital sign monitoring on the general surgical ward: A qualitative study based on the Behaviour Change Wheel. BMC Nurs. 2022, 21, 60. [Google Scholar] [CrossRef]
Dimension | Indicator |
---|---|
Factors related to ICT | Design and technical concerns Characteristics of the innovation System reliability Interoperability Legal issues Validity of the resources Cost issues |
Individual factors of healthcare professionals | Knowledge Attitude Socio-demographic characteristics |
Human environment | Factors associated with patients Factors associated with peers |
Organizational aspects | Internal environment External environment |
Indicator | Respondent | Citation |
---|---|---|
Design and technical concerns | P4 | “The device of the Visi Mobile is unfriendly for patients because the battery is too rude, and heavy. It never fits well, turns around my wrist and slides back and forth. It is not comfortable.” |
R2 | “In the future, there may be a possibility to apply artificial intelligence to handle and cluster the data overload.” | |
Characteristics of the innovation | R1 | “From a distance, you can estimate how your patient is doing, to some extent. Also, if your patient does not feel well, and you really want to be in the room all the time, which is not possible in a nursing ward, you feel you can better monitor your patient. So yes, it provides me a safe feeling.” |
R3 | “Recently, we had transferred a patient from the ICU to our unit, having a MEWS 6 and respiratory unstable. In that case, it would be great if there is someone who keep an extra eye on that patient, because I cannot constantly look to the display, and do not get an alarm on my pager.” | |
P3 | “Tonight, a nurse entered my room because my oxygen level was too low. I understand the use of continuous monitoring and I think that the need differs for each ward. For me, this was not a minor operation, so I think this is perfect, for me, but also for them [nurses].” | |
Knowledge | R1 | “Nine out of ten times you do not have to respond to a false alarm, but you just wait a few seconds before breathing frequency or saturation will improve. I have the idea we are on the right track in recognizing false alarms.” |
Attitude | FGR | “How skeptical we were about continuous monitoring… And now, three years later we cannot work without it.” |
R1 | “Some patients will be discharged soon, for example today or tomorrow. Why should you still monitor all vital signs and check trends?” | |
FGR | “Sometimes, a saturation drops during the night as it also does at home. We check on the patient because of this saturation drop and then the patient seems to be okay.” | |
Factors associated with patients | P2 | “I like the idea of knowing my own vital signs, so that I know what I can expect. Firstly, I looked very often, but that became gradually less often.” |
Internal aspects | R2 | “I think, for example, during evening and nightshifts we are much of our time present in the nursing office. During that shift, we do not need a dedicated nurse. During day shifts, when everyone is at the patient’ rooms, I think a dedicated nurse is necessary. The question rises if you can deploy the dedicated nurse in patient care, and that he also receives all alarms, so that he can respond to the alarms.” |
FGR | “I would like to maintain continuous monitoring, but I would also like to retain total care for my patients, without shifting tasks. That is very important to me”. | |
R3 | “If the dedicated nurse signals a certain trend, and the nurse is not yet at the patient, then he [dedicated nurse] must inform me, so that I can visit the patient. If I [as nurse] do not get out, I can call the dedicated nurse to monitor trends.” | |
Factors associated with peers | R4 | “We can say that connecting the device can be a task for nurse assistants. It will give a nice touch to their job profile. It seemed that some nurse assistants do really like that, and they see it as a challenge.” |
External aspects | R3 | “The difference between a high care ward and our general ward is getting smaller using this system. Subsequently, it is difficult to set boundaries, and to frame, between what you should do and not do.” |
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van Noort, H.H.J.; Becking-Verhaar, F.L.; Bahlman-van Ooijen, W.; Pel, M.; van Goor, H.; Huisman-de Waal, G. Three Years of Continuous Vital Signs Monitoring on the General Surgical Ward: Is It Sustainable? A Qualitative Study. J. Clin. Med. 2024, 13, 439. https://doi.org/10.3390/jcm13020439
van Noort HHJ, Becking-Verhaar FL, Bahlman-van Ooijen W, Pel M, van Goor H, Huisman-de Waal G. Three Years of Continuous Vital Signs Monitoring on the General Surgical Ward: Is It Sustainable? A Qualitative Study. Journal of Clinical Medicine. 2024; 13(2):439. https://doi.org/10.3390/jcm13020439
Chicago/Turabian Stylevan Noort, Harm H. J., Femke L. Becking-Verhaar, Wilmieke Bahlman-van Ooijen, Maarten Pel, Harry van Goor, and Getty Huisman-de Waal. 2024. "Three Years of Continuous Vital Signs Monitoring on the General Surgical Ward: Is It Sustainable? A Qualitative Study" Journal of Clinical Medicine 13, no. 2: 439. https://doi.org/10.3390/jcm13020439
APA Stylevan Noort, H. H. J., Becking-Verhaar, F. L., Bahlman-van Ooijen, W., Pel, M., van Goor, H., & Huisman-de Waal, G. (2024). Three Years of Continuous Vital Signs Monitoring on the General Surgical Ward: Is It Sustainable? A Qualitative Study. Journal of Clinical Medicine, 13(2), 439. https://doi.org/10.3390/jcm13020439