Title : Registered nurses use of a national early warning score: An Interpretative hermeneutic phenomenological study
In 2012, Hogan et al. reported that 5.2% of hospital deaths have a 50% or greater chance of being preventable? This represents 11,859 adult preventable deaths in NHS acute hospitals each year. 31% of those were attributed to poor monitoring. This data was reported in 2012 and to date we have nothing to indicate that this situation has improved.
In the UK the National Early Warning Score (NEWS) was developed by the Royal College of Physicians in 2012 to identify acutely ill or deteriorating patients. NEWS is a system for scoring six physiological measurements, a score allocated to each parameter and clinical response protocol which identifies the trigger thresholds for a clinical response and/or escalation.
The RCP specify that NEWS is an aid for clinical assessment and not a substitute for clinical judgement, however evidence suggests this is not the case. The aim of this study was to explore the experiences and perceptions of Registered Nurses using NEWS in their clinical practice to develop a deeper understanding of the interaction between NEWS and clinical judgement. This was undertaken through an interpretative hermeneutic phenomenological approach guided by the philosophy of Hans-George Gadamer.
16 RNs from an acute NHS trust explored their experiences and perceptions through in-depth dialogue, fusing their horizons with my own, going backwards and forwards to gain understanding. Through use of the Gadamerian spiral, these fused horizons, the written texts and the existing literature, with the researcher at the heart of the study, new understanding was obtained constantly challenging old knowledge and pre-understandings to reveal new knowledge in the form of a final horizon, underpinned by a story of using NEWS.
Embedding of NEWS into nursing care within an acute NHS trust appears to have affected Registered Nurses’ full use of all four stages of clinical judgement. The study revealed a blindness to unrecognised risks in the practice of using NEWS. Three points of risk were revealed. Failure at one point may be detrimental to patient safety, failure at all 3 may lead to a serious adverse event. The study reveals implications for practice and makes two recommendations which aim to minimise the risks associated with the pinch points. This study is unique in that it explores the perceptions and experiences of nurses – the mains users of NEWS to understand the interaction with clinical judgment.
Audience Take Away Notes:
• Insight into nurses perceptions and experience of using NEWS as the main users of the tool.
• Gain greater understanding of the use of NEWS in clinical practice and the implications on registered Nurses’ clinical judgement Explain how the audience will be able to use what they learn?
• Consider the implication of the research findings for clinical practice and ongoing use of NEWS.
• Explore the recommendations for clinical practice to improve recognition and management of patient deterioration.