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Why are nurses sometimes skipping a potentially vital task?

Published:19 July 2017

CQUniversity doctoral researcher Tracy Flenady.

In a high-tech hospital, there’s still one vital sign that nurses should be checking themselves.

They can rely on machines to observe their patients’ blood pressure, heart rate, oxygen saturation and pulse rate.

However, another reliable indicator of clinical deterioration - the respiratory rate - is usually collected manually.

It’s supposed to be observed for a full minute in a way that does not force the patient to focus on their breathing, in case this affects the reading.

CQUniversity doctoral researcher Tracy Flenady explains that nurses often pretend to be checking the pulse while actually observing the patient’s breathing rate.

However, Tracy has found a range of reasons why nurses, who are busy with other tasks in the emergency department, can be known to skip the respiratory check or give it only a cursory glance.

Her interest in the research was sparked during her own experience as an emergency department registered nurse.

“I was a member of a resuscitation team that saved the life of an acutely ill man … but we almost didn’t identity he was deteriorating until it was nearly too late to save him,” Tracy says.

“Why did his vital signs look consistently within range all night, and then escalate so radically in the morning?

“Looking over the patient’s usual medications provided clues to his apparently benign sign recordings. 

“It turns out the only vital sign that would have persisted as a reliable indicator of clinical decline was the respiratory rate, and the charts showed it within a normal range all night … however it was collected manually.

“I couldn’t validate the respiratory rate observations that had been recorded overnight, because no machine had recorded them; a person had counted them. Or had they?”

Tracy says that, while abnormal respiratory rates are accurate, early indicators of clinical decline, previous studies indicated that this vital sign is often missing from emergency department observation charts.

That’s why her PhD journey has focused on understanding the behaviours of emergency department registered nurses when they fail to adequately collect and record respiratory rates.

“I looked into how nurses who skip some of their respiratory rate checks can rationalise their transgression.

“Sometimes they believe they are compensating for errant behaviour by adding value to the patient’s outcome with other tasks.

“In some cases, they think their lack of respiratory checks will have minimal effects and in other situations, nurses trivialise the importance of the respiratory rate, and cut corners to get their job done.”

Tracy is currently juggling her research with work in the Education and Research Department of Rockhampton Base Hospital.

She is also the project manager for a research grant team focused on ‘Preparing undergraduate nurses for the workforce in the context of patient safety through innovative simulation’. This is also known as the ‘Tag Team Patient Safety Simulation’ project.