Aim. The aim of this paper is to present a study of how ward-based staff use vital signs and the Early Warning Score to package physiological deterioration effectively to ensure successful referral to doctors.

Background.  The literature tends to emphasize the identification of premonitory signs in predicting physiological deterioration. However, these signs lack sensitivity and specificity, and there is evidence that nurses rely on subjective and subtle indicators. The Early Warning Score was developed for the early detection of deterioration and has been widely implemented, with various modifications.

Method.  The data reported here form part of a larger study investigating the practical problems faced by general ward staff in detecting physiological deterioration. During 2002, interviews and observations were carried out using a grounded theory approach, and a total of 44 participants were interviewed (30 nurses, 7 doctors and 7 healthcare support workers).

Findings.  Participants reported that quantifiable evidence is the most effective means of referring patients to doctors, and the Early Warning Score achieves this by improving communication between professionals. Rather than reporting changes in individual vital signs, the Early Warning Score effectively packages them together, resulting in a much more convincing referral. It gives nurses a precise, concise and unambiguous means of communicating deterioration, and confidence in using medical language. Thus, nurses are empowered and doctors can focus quickly on identified problems.

Conclusion.  The Early Warning Score leads to successful referral of patients by providing an agreed framework for assessment, increasing confidence in the use of medical language and empowering nurses. It is essential that nurses and nursing students are supported in its use and in developing confidence in using medical language by continued emphasis on physiology and pathophysiology in the nursing curriculum.

Packaging: a grounded theory of how to report physiological deterioration effectively

Background. Pharmacology education in nursing has become increasingly important as nurses’ roles in administering, prescribing and educating patients about their medications have grown. Some authors have expressed concern at the lack of science teaching in nurse education, and others have suggested that there is a theory–practice gap in this area of the curriculum.

Aim.  This paper reports a study to explore nurses’ pharmacology education needs by identifying nursing roles that require pharmacology knowledge, and nurses’ preparation for practice from preregistration pharmacology education.

Method.  A qualitative approach was used to collect data from a purposive sample of 10 qualified nurses from an emergency admissions unit in a city in the north of England. Semi-structured interviews were transcribed verbatim and categorized using Burnard's 14 stages.

Findings.  This study revealed a limited understanding of the subject, and dissatisfaction with the teaching of pharmacology, with resulting anxiety on qualifying. Nursing roles identified as requiring pharmacology knowledge included drug administration, patient assessment, nurse prescribing, and patient medication education.

Conclusion.  The findings suggest that, although nurses have a limited understanding of pharmacology, they recognize the need for pharmacology knowledge in practice. Improved pharmacology teaching might increase nurses’ confidence in performing drug administration, patient education, and nurse prescribing, and decrease anxieties related to these roles.

Nurses' perceptions of their pharmacology educational needs.

https://bura.brunel.ac.uk/bitstream/2438/1534/1/appproaches%20to%20teaching.pdf

Approaches to teaching: current opinions and related research.

This study used a curriculum inquiry framework to investigate the perceptions of 184 nursing students and nurse educators in relation to bioscience in the nursing curriculum. These participants’ attitudes to science and bioscience, self-efficacy in bioscience and perceptions of bioscience were investigated using scales based on previous research. Nursing students were found to have significantly more positive attitudes to bioscience in nursing education than nurse educators, and nurse educators were not found to have significantly better self-efficacy in bioscience than the students, although this might have been expected. The results of focus group discussions, used to investigate this in more depth, suggested that some nurse educators and clinical preceptors may not have sufficient science background or bioscience knowledge, to help nursing students apply bioscience knowledge to practice. As a result of this, it is suggested that the aims of the intended and prescribed nursing curricula are not being fulfilled in the implemented curriculum. Because of the increasing acuity of illness in hospitals, the fact that nurses are becoming more autonomous in their practice and the increasing expectation that nurses, in some cases, will be able to prescribe as well as administer medications, bioscience knowledge is becoming even more important. The teaching of bioscience and its application to clinical practice needs to improve if nurses are to be credible members of the multi-disciplinary team.

Learning bioscience in nursing education: perceptions of the intended and the prescribed curriculum

What is provided and what the registered nurse needs — bioscience learning through the pre-registration curriculum

Concerns have been expressed that bioscience education is not meeting the needs of nursing students in the UK. This paper explores the situation further by comparing student perceptions with those of experienced practitioners (Part One of the study) and also evaluates the confidence of staff nurses in explaining the rationale for care applied to a common but specific disorder (influenza; Part Two). Questionnaires were used. Responses were elicited from DipHE Nursing (Project 2000) adult/child branch students (n=153) from two universities and from adult/child care staff from their local clinical placements (n=171 in Part One of study; n=266 in Part Two). The questions asked followed two themes: (1) confidence in understanding biological science and (2) issues of teaching and learning. Most questions utilized a rating scale from 1 to 10; this scale provides no central value and a vertical line was drawn to encourage respondents to identify which half of the scale their responses came under (basically, a negative or positive viewpoint). The significance of the data distribution either side of the midline was analysed statistically (simple sign test), as were any differences in distribution between the groups (chi-square test). Median values were also determined. The data do not provide support for views that the biosciences are being significantly diminished by modern curricula, but also show no evidence for a great improvement in the bioscience knowledge base in recent years. What was surprising was the lack of confidence expressed by staff nurses: one illuminating finding was the lack of confidence in articulating their knowledge to patients and, even less so, to other health professionals. The paper reiterates a need for a national teaching and learning strategy for pre- and postregistration education in the biosciences. In particular, a means to raise the level of understanding of staff nurses must be identified urgently so that the mentoring of students in these subjects is improved.

Getting it right? An exploration of issues relating to the biological sciences in nurse education and nursing practice.

Introduction to human physiology and homeostasis levels of organization 1 - the cell - "the basic unit of life" levels of organization 2 - "the chemical basis of life" levels of organization 3 - tissues intracellular and extracellular fluids nutrition the digestive system the cardiovascular system 1 - the blood the cardiovascular system 2 - heart and circulation the lymphatic and immunity system the respiratory system the kidneys - excretion and body fluid homeostasis co-ordination 1 - the nervous system co-ordination 2 - the senses co-ordination 3 - hormones skeletomuscular systems - control of posture and movement the skin - regulation of body temperature reproduction human development - conception of death inheritance the subjectivity of pain the subjectivity of stress circadian rhythms.

Physiology & anatomy : a homeostatic approach

Written by experienced nurse lecturers and a theatre nurse, Perioperative Practice highlights and explains the biological processes which can be disrupted by a major surgical procedure. Using the concept of homeostasis as a framework, the authors look at issues common to all surgical procedures such as the influence of anaesthesia on the nervous system or perioperative pain management. Individual chapters cover:

the human body and principles of homeostasis
the surgical approach and endoscopic procedures
perioperative influences on body fluid homeostasis
perioperative influences on immunological homeostasis and wound healing
perioperative influences on cardiovascular homeostasis 
perioperative influences on respiratory homeostasis 
anaesthesia, stress and surgery
pain and pain relief in the perioperative patient.
Generously illustrated in colour and black and white, the text features further learning activities and useful summaries of key points. It provides an important resource and supporting text for all nurses undertaking courses in theatre work or related areas or already working in such areas.

Andrew McVicar

Papers

Getting it right? An exploration of issues relating to the biological sciences in nurse education and nursing practice.

Physiology & anatomy : a homeostatic approach

Perioperative Practice: Fundamentals of Homeostasis