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Theoretical Framework
Conceptual Framework
Hypothesis
Definition of Terms
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23
Population Frame
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Sampling Technique
23
Setting
24
Research Instrumentation
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Ethical Consideration
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References
29
Chapter I
PROBLEM AND ITS BACKGROUND
Introduction
General adult patients in hospitals can have unexpected physiological
deterioration that if left unrecognized, can lead to critical illness, intensive care
unit (ICU) admission, cardiac arrest and/or death. Early identification of the
sickest patients may allow earlier intervention, thus potentially improving their
outcome. This problem was the subject of numerous critical care studies and
since there are very limited local studies regarding the same topic, the
researchers have decided to pave the way in exploring this topic.
As there is an upsurge of critically ill patients, the interest in formulating
strategies for detecting at-risk patients also increases. Resuscitation Council
(2010) added that regular monitoring and effective treatment of seriously ill
patients appear to improve clinical outcomes, thus the basis for monitoring
patients vital signs. Abnormal physiology is common in adult care wards, yet the
important physiological observations of patients are considered and recorded
less frequently than is desirable.
Scoring systems have been developed in answer to an increased
importance on the evaluation and monitoring of health services. These systems
enable comparative and evaluative research of intensive care. (M. Rao, 2008)
One of the most reliable tools used in scoring is the Early Warning System
(EWS) tool, which was introduced by the American Department of Health (2000)
of the adult care section of San Juan de Dios Educational Foundation, Inc.
(Hospital).
Theoretical Framework
The Helping Art of Clinical Nursing was produced by Ernestine
Wiedenbach. It characterized nursing as the act of recognizing a patient's need
for help through proper recognition of symptoms and behaviour, recognizing the
cause of the distress, recognizing whether the patient has a need of assistance
from the nurse or the health care team. Being able to identify the degree of the
need for help of each patient allows nurses to provide holistic care. Prevention of
complications and promotion of comfort are the nursing goals of the theory.
(Weidenbachs Helping Art of Clinical Nursing, 2013).
Wiedenbach elaborates that clinical judgement of the nurses based on
actual existence and based on the analysis the causes and effects can lead to
good decision-making. Sound judgement is the capacity to assess situations or
circumstances clearly and to draw sound conclusions that enhances through
time, that increases the clarity of professional purpose. In this theory, nursing
skills are done to accomplish a patient-focused purpose instead of the fulfilment
of the skill itself being the finished objective. Skills are composed of different
activities that are defined as the unity of action, accuracy and the productive use
of self.
Conceptual Framework
The studys main purpose is to appraise the impact of utilizing the Early
Warning System Tool in assessing physiological deterioration in a unit of the
adult care section of San Juan de Dios Educational Foundation, Inc. (Hospital).
The first receptacle encompasses the demographic data of the respondents.
The second receptacle represents the Early Warning System tool. The connector
between the first and second receptacle is the utilization of the tool, which will
yield the output of the study: the impacts of utilizing the Early Warning System
tool. The connector between the first and third receptacle signifies the
relationship between the demographic data of respondents and impact of using
the EWS tool.
Hypothesis
H1: There is a significant relationship between the demographic data of
the respondents and the impacts of utilizing the Early Warning System tool.
Scope and Delimitation
The descriptive study aims to focus on evaluating the impact of utilizing
the Early Warning Systems (EWS) Tool. This will be used on patients admitted in
the Adult Care Unit (La Milagrosa Unit) of San Juan de Dios Educational
Foundation Inc (Hospital).
An instructional video from the website of Wellington Hospital will be
utilized as a means of orienting the nurses about the Early Warning System
Secondly, it will be implemented on the unit then, nurses from the unit will be
asked to give scores per determinant depending on degree of abnormality of
retrieved data on the EWS tool.One month will be allotted time for the data
gathering and the implementation of the tool in the unit. Lastly, an evaluation tool
will be provided to determine the impact of utilizing the EWS tool as an
assessment tool in determining early signs of deterioration
The population frame will be 25staff nurses of a unit of the adult care
section. All nurses who met the inclusion criteria will be invited to be the
participants of the study. The regulation parameters are as follows: (1) Nurses
under probationary and regular employment, (2) Nurses of both gender and of
any age will be included in the study, and (3) nurses assigned in La Milagrosa
Unit. One month will be allotted time for the data gathering. The EWS tool will be
used only for assessment and will not recommend any specific intervention.
CHAPTER II
REVIEW OF RELATED LITERARTURE
Critically Ill patients
Critical illness can be defined as any disease that leads to physiological
instability, where in the patient is at risk of death or disability within a short
amount of time. (British Journal of Hospital Medicine, 2007) According to Society
of Critical Care Medicine, critically ill patients have increased to 5 million in the
United States alone. Multi-organ failure and sepsis were recorded to have
highest occurrence with regard to critical illness and cardiac arrest as the leading
cause of death. Aside from late detection of physiological deterioration, one other
reason for the high rate of critically ill deaths is the late transfers to Intensive
Care Units. This may be because of late recognition of need for transfer or
unavailability of ICU beds. As these findings are presented, the search for
interventions that may lead to better clinical outcomes or prevention of any
untoward effect is also on the rise. (Robertson, Al-Haddad, 2012) Some of the
interventions tested in other countries to cope up with the statistics are (1)
creation of outreach teams, which comprises of nurses and doctors trained
specifically in resuscitative management of critically ill patients and (2) creating
Early Warning System tools to aid in identifying at risk patients. (Nursing Times,
2002)
patients that are at risk for being critically ill and to enhance equity in care that
guarantees early recognition of patients with potential or known to be critical ill
and treat the patients effectively and appropriately. The EWS can be summed up
with six physiological parameters (respiratory rate, heart rate, systolic blood
pressure, temperature, neurological status and oxygen saturations) scored
between 0 - 3 with an total score of three or more triggering the start of the study
of Early Warning Score System (EWS) .
Hence, the goal of using Early Warning Systee (EWS) is to prevent harm,
reduce in-hospital cardiac arrests and mortality rates, and facilitate appropriate
use of Critical Care resources, through early recognition and treatment of the
deteriorating patient.
measure vital signs accurately but also to interpret and analyze data in the
context of the patients illness and medical treatment (Garcea et al, 2010).
A helpful tool, Early Warning Signs (EWS) was designed to overcome
deterioration in early recognition of shifting of condition of patients from acute to
critical (Goldhill and McNarry, 2004). The data interpretation from assessments is
vital in identifying the level of care a patient requires, providing treatment and
preventing a patient deteriorating from an untoward event(Wheatley, 2006). In
relation to patient outcomes, an early warning system when combined with rapid
response appears to have the potential to reduce cardiac arrests and unplanned
ICU admissions. In a research by University of York (2015), it has been found
that precision of data recording and the calculation of early warning scores can in
turn impact on the accuracy in detecting a patients deterioration whereas
inaccuracies of data can lead to delays in identifying patients at risk or critically
ill.
As patients in hospital today are sicker than in the past, nurses can no
longer rely on the traditional five vital signs to determine clinical changes in their
patients. Nurses must not only know how to measure these vital signs accurately,
they must also know how to interpret and act on them. In addition, they must
incorporate additional vital signs when performing assessments of their patients.
In conclusion, it is highly recommended that nurses should use a tool or
method should be used to ensure that nothing is overlooked that may result in a
missed diagnosis or a delay in treatment.
Reliability Test: Critical Utilization of Early Warning System (C.U.E.W.S.)
The Scoring of the EWS on admission to ICU is the same with the Simplified
Acute Physiology Score III and the Sequential Organ Failure Assessment score
on admission. The result of the study reveals that EWS is a useful tool in
assessing patient in the ICU on a 30 day stay and mortality. (Reini et al, 2012)
Studies also suggest that clinical deterioration of patients on general
hospital wards is often preceded by changes in physiological observations that
are recorded by clinical staff six to 24 hours prior to a serious adverse event
(Kause, 2004). In the study by National Patient Safety Agency (2007), Of the 64
cases of patient deterioration identified in 2005 in acute hospital settings, it was
reported that in 14 cases, no observations were made for a prolonged period
prior to death and changes in vital signs were not detected. While in 30 cases,
despite the recording of vital signs, it was reported that there was no recognition
of clinical deterioration and/or no action taken. And the rest of the cases,
deterioration were recognized and assistance was sought.
marker referral tool or Early Warning System (EWS) it is important to explore the
healthcare teams perception, attitudes, and perceived understanding of the
implemented tool to assist in the early identification of unstable patients. Overall,
the responses of the healthcare team were positive to the clinical marker tool or
Early Warning System (EWS), offering clear guidelines for staff to respond to the
patient's clinical condition and contact the medical staff and the ICU liaison team
as appropriate.
using the Early Warning System with regard to its effect on clinical decisionmaking and helping to identify problems in clinical practice. While it was
considered to enhance the nurses role in clinical decision-making, participants
used it to supplement rather than replace clinical judgment. As experienced
nurses, they know that NEWS has limitations.
CHAPTER III
METHODOLOGY
This chapter presents the procedures and processes through which this
study is instituted. This chapter covers the research design, sample, research
instruments, the data gathering procedures and statistical tools applied.
Research Design
This study will assess the impact of utilizing the Early Warning System
(EWS) tool in the practice of nurses in La Milagrosa Unit at San Juan de Dios
Educational Foundation, Inc. (Hospital). It will utilize the quantitative nonexperimental, descriptive correlational research design.
A descriptive research gathers pertinent data that can be used for
statistical conclusion on the target audience through data analysis. Correlational
type of descriptive research design seeks to determine the extent of relationship
The variables of the study are quantifiable for the reason that the
investigators will utilize a checklist tool, which is the Early Warning System and
an evaluation tool to determine the impact of utilizing the Early Warning System
tool.
Setting
The study shall take place in San Juan De Dios Educational Foundation
Hospital, under the Adult Care Section, specifically, La Milagrosa Unit.
Research Instrumentation
The research instrument that will be utilized in this study is the Early Warning
System Checklist. There are five (5) parameters for the Early Warning System
checklist namely: Respiratory Rate, Systolic Blood Pressure, Heart Rate, 4 Hour
Urine Output, and Level of Consciousness. For each parameter, a score from 0-3
may be given depending how far from the normal range the data gathered is. The
researchers of this study took into consideration in asking for permission of the
author via email correspondence regarding the use of the tool.
The research instrument that will be used as the evaluation tool composes of 17
questions that will determine the impact of utilizing the Early Warning System tool
in the nursing practice.The researchers of this study will again take into
consideration asking for permission from the author via email correspondence
regarding the use of the tool.
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