2 nd Annual Nursing Research & Evidence-Based Practice Symposium Promoting Nursing’s Future: Building Bridges from Classrooms to Clinical Settings
An assessment of nursesattitudes towards rapid response teams (2009) Daniel Ampomah, RN, PhD, NE-BC Phillip Eaton, RN, MSN, RRT Rodica Sandor-Scoma, RN, MSHA, MD. Zewdensh Bryant, RN, BSN, MS.
MSET/RRT Data 2005-2007 TOTAL MSETs AND RRTs 2005-2007 299 300TOTAL MSETs 250 200 190 150 100 77 74 44 51 50 30 37 40 23 28 0 0 TOTAL 2005 TOTAL 2006 TOTAL 2007 YEAR CCU NON CCU TOTAL RRT
MSET/RRT Data 2007-2008 2007-2008 MSETs AND RRTs 15 35 30MSETs 25 10 20 RRTs 15 5 10 5 0 0 Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec Jan RRT/ 500 dc 7.704 9.404 13.90 27.77 30.67 22.76 19.72 14.01 23.92 20.58 21.00 29.74 CCU MSET 3 1 4 0 6 2 0 0 0 1 2 4 2 Non CCU 4 2 0 2 2 3 3 2 3 2 2 3 7 RRT/ 500 dc CCU MSET Non CCU
Problem statement In 2005 IMVH Data suggests the RRT has The hospital had established a decreased the no data that rapid response mortality rate from explored the team to provide 2.6% to 2.2% and attitudes of the medical increased the nurses to the intervention at the survival rate of rapid response first signs of a teams patient’s decline. this hospital.
Purpose The purpose of this study was to assess whether nurses valued the RRT service and to determine whether barriers to calling the RRT exist.
Research questionsDo nurses understand the potential benefits of the rapidresponse team system?Do nurses find the rapid response team service useful inmanaging sick patients?Do obstacles exist that restrict nurses from using therapid response team service?
Methodology Research design: Univariate descriptive Population: RNs and LPNs working on nursing units and departments in Inova Mount Vernon Hospital Sample: Convenience sample
Inclusion & exclusion criteria Employed and Working as an Travelers, contract or RN or LPN at agency per diem IMVH nurses working at IMVH
Instruments Nurses Attitudes to Medical Emergency Teams Survey (NAMETS) by Jones, et al. (2006). Permission to use the NAMETS tool for this study was granted by Jones and Bellomo . For this study the tool was referred to as Nurses Attitudes to Rapid Response Team Survey(NARRTS) Demographic data sheet Reliability of NAMETS face validity Reliability of NARRTS α = .60
Data collection & analysis Paper survey Descriptive statistics employing frequencies and percentages was used to answer the research questions.
Characteristics of the sample e Overall response rate was 71% a At the time of the survey 266 nurses were employed at the hospital d A total of 140 of the surveys were b returned. 196 questionnaires were distributed to nurses on day, evening and night c 74% of the accessible target shifts population were surveyed
Sample Matrix Age of Gender Race/Ethnicity Employment Yrs nursing Yearsrespondents status practice worked at IMVH Youngest Male African- Full time 1-5 yrs 1-5yrsrespondent was 13 (9%) American/Black 91 (66%) 24% 85 (62%) 24 years old 63 (46%) Oldest Female Asian/Pacific Islander Part time 6-10yrs 6-10 yrsrespondent was 126 (91%) 18 (13%) 21 (15%) 21% 38 (28%) 65 years oldMean age of the Caucasian/White PRN 11-15yrs Over 10yrssample was 43 47 (34%) 27 (19%) 16% 14 (10%) yrs Hispanic/ Latino 16-20yrs 2 (1%) 18% Other 21-30yrs 8 (6%) 15% 31-47 yrs 7%
Sample Matrix Level of Work shift Specialty of Have you ever called the RRT education practice to manage a patient in your care? Diploma Day shift Psychiatry Yes = 112 (84%) 10 (7%) 71 (52%) 15 (11%)Associate Degree Night shift Oncology No = 22 (16%) 59 (42%) 65 (47%) 12 (9%) Baccalaureate Orthopedics Degree 17 (13%) 62 (45%)Masters in nursing Medical/surgical 6 (4%) 31 (23%) Other Telemetry 7 (1%) 27 (20%) Rehabilitation 32 (24%)
Perception of nurses about patients inthe hospital In all, 96% of the respondents agreed or strongly agreed that patients in the hospital have complex medical problems.
Nurses understanding of thepotential benefits of the RRT 90% of the nurses agreed95% of the nurses agreed or strongly agreed that the or strongly agreed that RRT can be used to RRT prevents unwell prevent a minor problem patients from having an from becoming a major arrest. problem.
Usefulness of the RRT for thenursing staff96% of the nurses agreed or strongly agreed thatRRT allowed them to seek help in managing apatient they are worried about89% of the nurses disagreed or stronglydisagreed when asked if they thought that theRRT is not helpful in managing sick patients.72% disagreed or strongly disagreed when askedif they thought that the RRT was overused in themanagement of hospital patients.
Obstacles to the nurses using theRRT serviceWhen asked if they were reluctant to make a RRT call on apatient for fear of criticism if the pt was not that unwell, 82%disagreed or strongly disagreed, only 13% agreed.94% of the nurses strongly disagreed or disagreed whenquestioned whether they do not like making RRT calls becausethey will be criticized for not looking after their patients well.86% disagreed or strongly disagreed that using the RRT systemincreases their workload when caring for sick patients.
Under what conditions do nurses make or not make RRT call?52% of the nurses agreed or strongly agreed that they 67% strongly agreed orwould call the house doctor agreed that they would callbefore the RRT when one of the RRT if they could not their pt was sick. 28% contact the house doctor disagreed and 20% were about a sick patients. unsure.
Under what conditions do nurses make or not make RRT call? When asked if they would 74% agreed or strongly not make a RRT call on a pt agreed that they would who fulfilled the RRT criteria make a RRT call on a pt but did not look unwell, 81% they were worried about strongly disagreed or even if their vital signs were disagreed,13% were unsure, normal. and 6% agreed.
Effect of nurses ability to managesick patients wellAlmost 96% of the nurses 68% agreed or strongly disagreed or strongly agreed that the RRTdisagreed about whether teaches them how to they thought the RRT better manage sick reduced their skills in patients in their care. managing sick patients.
Conclusion The researchers found that: Regardless, 52% of the nurses still said Most respondents they would call the indicated that they house doctor value the RRT before calling RRT service. for a sick pt. Nurses in this RRT was useful in hospital value the the management of use of clinical judge hospital pts in decision making. RRT was not overused in the management of hospital pts