Background
Acute care registered nurses (RNs) make clinical judgements and act on emerging threats to patient safety through a process of nursing surveillance. In practice, nursing surveillance is often suboptimal on general wards, increasing the need for patient rescue at the end-point of clinical deterioration with poorer outcomes. The purpose of this research was to evaluate an emancipatory Practice Development (ePD) methodology for strengthening nurse surveillance on a single medical-surgical ward.
Approach
A relationship was established and researcher embedded on a medical-surgical ward around a shared interest of strengthening nursing surveillance. Evaluation began with workplace observation of the context and culture of nursing surveillance. Critical analysis and reflection with staff generated key sites for collective action which informed the year-long ePD journey: nursing assessment was rendered invisible and unimportant by others, and ultimately by nurses themselves; an organisational imperative for efficiency drives nursing practice so that assessment becomes task-focused; communication hierarchies were enabled so that a chain-of-command model distanced the primary RN from decision-making.
Ward engagement with ePD methods of critical reflection, holistic facilitation and active learning was supported through workplace workshops and the formation of an Action Learning Set with a group of ward RNs. Collaborative action cycles emerged as RNs were supported to enable workplace learning and creatively challenge hegemonic practices that weakened nursing surveillance.
Outcomes/results
This ward travelled through a transformative and at times turbulent process of resistance and retreat towards a new learning culture where nursing surveillance is visible and valued. Ward staff developed and sustained innovations to support nursing assessment at the bedside including the “My MET Call series,” a “Shared GCS (Glasgow Coma Scale) initiative” at handover, enhanced “Team Safety Huddle,” and staff-led PD workshops. These new practices affirmed nurses’ agency, asserted their clinical knowledge, claimed their position in the team and humanised care.
Take home message 1
ePD is a methodology that is available to frontline nurses in acute care hospital settings for developing a safety culture.
Take home message 2
Given the opportunity, nurses can collectively and collaboratively challenge taken for granted practices to create workplaces which strengthen nursing surveillance and keep patients safe.