The doctoral dissertation in the field of Nursing Science will be examined at the Faculty of Health Sciences at the Kuopio Campus.
What is the topic of your doctoral research?
The doctoral research is about nurses’ competence in rapid response system (RRS) for managing deteriorating patients. RRS is used as a generic term referring to the emergency assistance that is offered by a highly specialized team in response to patients’ deterioration at acute hospitals outside of the Intensive Care Unit (ICU) ward. RRS function is based on early recognition of a patient’s worsening condition to help the patient recover and avoid preventable death.
The RRS was introduced more than twenty years ago in health care to improve patient safety and to avoid preventable hospital mortality. Despite of the importance of RRS, nurse activation for RRS remains inconsistent, with one-third of RRS cases not being activated by nurses. These statistics may indicate nurses’ lack of competency in RRS activation along with other possible reasons.
What are the key findings or observations of your doctoral research?
The study findings are important for improving nurses’ clinical competencies in managing deteriorating patients and providing nurses with information that could help them to transition into the expert stage. Findings advocate that a conscious effort is required to educate nurses on timely RRS activation. The findings are important in promoting awareness of nurses’ attitudes regarding RRS which could encourage or prohibit nurses’ RRS activation. For instance, nurses’ attitudes regarding intuition and physician influence require enhancement via continuing clinical competence. Although in-service education was proven to be crucial for enhancing nurses’ clinical competence in managing deteriorating patients, the study uncovered the remaining barriers to RRS activation after in-service education that need to be improved such as nurses’ low confidence, fear of criticism, and delays caused by hospital routines and culture.
Furthermore, this study uncovered teamwork and communication skills of RRS that are in need of improvement such as skills regarding decision-making and conflict resolution, appreciating team members’ contribution, and leadership skills. These findings may play a role in improving teamwork skills, thereby optimizing RRS function and improving management of deteriorating patients.
How can the results of your doctoral research be utilised in practice?
Development of continuing clinical competency and in-service education on the RRS should be a priority in acute care hospitals. Hospital managers, nurse managers, and educators should promote nurses’ continuing clinical competency development, focusing on enhancing nurses’ confidence and the role of physician influence in nurses’ RRS activation.
There is a blind spot in acute hospitals and RRS models regarding facing stable (normal vital signs) but worrisome patients, and often a failure to allocate instruction for nurses on how to handle such situations. Analytic mechanisms of RRS should further consider this issue and offer clear evidence-based guidelines in RRS models on how to act in these circumstances.
At wards, nurse managers should openly discuss physicians’ negative responses to nurses for RRS activation to reduce the sociocultural barriers and improve RRS activation. Furthermore, nurse managers should establish a no-blame culture, actively remove unnecessary hospital culture and routines, and facilitate development of in-service education regarding recognizing and managing deteriorating patients and enhancing nurses’ confidence.
Hospital managers, nurse managers, and educators should consider implementation of the TeamSTEPPS curricula in hospital settings to train ICU nurse, as well as RRS simulation-based team training programs, to improve teamwork competencies. Additionally, governance and administrative structures of RRS should consider practicing shared mental models to improve nurses’ involvement in RRS decision-making processes and further valuing RRS members.
Please describe the process of your doctoral research.
This was a comparative cross-sectional correlational study. Sub-studies 1–3 were carried out as comparative studies in acute tertiary care hospitals in Finland and in the UK, but sub-study 4 was conducted in an acute hospital in Finland only. For sub-studies 1–3, registered nurses from medical and surgical wards were recruited by random sampling.
The applied data collection instruments were questionnaires adopted from the literature with an established content validity and modified based on the aim of this study.
A total of 180 nurses responded to the paper-based questionnaire for sub-studies 1–2 (Total: N = 180; Finland: n = 94; UK: n = 86), and 179 nurses responded to the paper-based questionnaire for sub-study 3 (Total: N= 179; Finland: n= 93; UK: n= 86). For sub-study 4, 50 ICU nurses who were MET members responded to the paper-based questionnaire (Finland: n = 50).
The doctoral dissertation on Mina Azimirad, MNSc, entitled Nurses’ competencies in rapid response systems for managing deteriorating patients: A comparative cross-sectional study between Finnish and British nurses will be examined at the University of Eastern Finland. The Opponent in the public examination will be Professor Kristina Mikkonen of the University of Oulu, and the Custos will be Professor Hannele Turunen of the University of Eastern Finland. The public examination will be held in English and it will be streamed online.
For further information, please contact:
Mina Azimirad, mina.azimirad (a) uef.fi, 0417193144
