Monitoring vital signs using early warning scoring systems: a review of the literature.

AIM: To evaluate the need for, and the development and utility of, pen-and-paper (Modified) Early Warning Scoring (MEWS/EWS) systems for adult inpatients outside critical care and emergency departments, by reviewing published literature. BACKGROUND: Serious adverse events can be prevented by recognizing and responding to early signs of clinical and physiological deterioration. EVALUATION: Of 534 papers reporting MEWS/EWS systems for adult inpatients identified, 14 contained useable data on development and utility of MEWS/EWS systems. Systems without aggregate weighted scores were excluded. KEY ISSUES: MEWS/EWS systems facilitate recognition of abnormal physiological parameters in deteriorating patients, but have limitations. There is no single validated scoring tool across diagnoses. Evidence of prospective validation of MEWS/EWS systems is limited; neither is implementation based on clinical trials. There is no evidence that implementation of Westernized MEWS/EWS systems is appropriate in resource-poor locations. CONCLUSIONS: Better monitoring implies better care, but there is a paucity of data on the validation, implementation, evaluation and clinical testing of vital signs' monitoring systems in general wards. IMPLICATIONS FOR NURSING MANAGEMENT: Recording vital signs is not enough. Patient safety continues to depend on nurses' clinical judgment of deterioration. Resources are needed to validate and evaluate MEWS/EWS systems in context.

Clinical skills required of ophthalmic nurse practitioners in tertiary level public hospitals in the Western Cape Province.

BACKGROUND: South Africa has a 32-year history of training ophthalmic nurse practitioners (ONPs). The role and required skills and competencies of ONPs are not well documented in the international literature and are also absent from South African publications, including South African Nursing Council publications. AIM: This study aims to inform curriculum development and human resource planning by reporting on the clinical skills expected of ONPs by members of multidisciplinary ophthalmology teams. METHOD: A limited survey was undertaken in the ophthalmology wards and outpatient departments of three tertiary level hospitals in the Western Cape Province. A researcher-designed structured self-completion questionnaire was distributed to 30 ophthalmology practitioners: doctors, nurses and technicians. Respondents were asked to indicate the expected clinical skills of ONPs. FINDINGS: All questionnaires were completed. All respondents favoured ONPs taking histories and performing emergency eye irrigations. There was less support for more complex procedures, such as B-scans. One-third of respondents did not expect ONPs to have skills in eight key areas, including examination of the anterior chamber angle for glaucoma. No statistically significant differences were found between responses of doctors and nurses, with one exception: more nurses (15/18) than doctors (4/10) had confidence in the ONP undertaking basic eye examinations for ocular motility (Fisher's exact test, P = 0.035). CONCLUSION: In the study settings, ONPs are not using their specialist skills to the full. Not all practitioners were receptive to ONPs using the skills that they had acquired during their postgraduate diploma, threatening the educational effectiveness of this initiative.

A nontraditional curriculum for the preparation of nurse educators.

The purpose of this article is to describe a bold and innovative program for the preparation of nurse educators in a developing country. This program was designed to anticipate the competing demands for radical change in both the health care system and the nursing educational system. Consideration was given to the need for a curriculum model that was flexible and broad enough to accommodate the educational and professional needs of a very diverse group of students regarding academic ability, culture, and language. The aim of the curriculum was to achieve the desire for meaningful, lifelong learning and personal growth, while maintaining academic excellence within a transformative and democratizing context.

Attitudes of diploma-prepared and graduate registered nurses. Towards nursing models: a comparative study.

UNLABELLED: Currently, nursing theory is not a South African Nursing Council requirement for pre-registration nursing education curricula. AIM OF THE STUDY: to determine registered nurses' (RNs) attitudes towards nursing models. METHODOLOGY: replication of McKenna's (1994) 20-item Likert-type self-completion questionnaire with adaptations. RESEARCH SETTING: A 1,600-bedded State-funded academic hospital in Cape Town, South Africa. STUDY SUBJECTS: Two groups: RNs who had nursing degrees and RNs who had a traditional diploma training. FINDINGS: Results from the Mann-Whitney U-test for independent samples indicates that at the 0.05 level of significance there was no difference in how each group of RNs responded to 19 statement items so there was not enough evidence to reject the Null Hypothesis for these statements (P < 0.05). However, as a group, the diploma-prepared RNs appeared to have a more positive attitude than the graduate RNs towards nursing models.

Developing nurses' moral reasoning skills.

Analysis of data from a Nursing Dilemma Test administered to 69 registered nurses employed at the Groote Schuur Hospital in Cape Town revealed a pattern of principled thinking in the groups with 5 to 9, 20 to 24, 25 to 29 and 30 to 34 years of clinical experience, whereas the group with the least clinical experience (0 to 4 years) showed no distinguishable pattern of thinking stages in moral judgement development.