BACKGROUND:Abnormal respiratory rates are one of the first indicators of clinical deterioration in emergency department(ED) patients. Despite the importance of respiratory rate observations, this vital sign is often inaccurately recorded on ED observation charts, compromising patient safety. Concurrently, there is a paucity of research reporting why this phenomenon occurs. OBJECTIVE:To develop a substantive theory explaining ED registered nurses' reasoning when they miss or misreport respiratory rate observations. DESIGN:This research project employed a classic grounded theory analysis of qualitative data. PARTICIPANTS:Seventy-nine registered nurses currently working in EDs within Australia. Data collected included detailed responses from individual interviews and open-ended responses from an online questionnaire. METHODS:Classic grounded theory (CGT) research methods were utilised, therefore coding was central to the abstraction of data and its reintegration as theory. Constant comparison synonymous with CGT methods were employed to code data. This approach facilitated the identification of the main concern of the participants and aided in the generation of theory explaining how the participants processed this issue. RESULTS:The main concern identified is that ED registered nurses do not believe that collecting an accurate respiratory rate for ALL patients at EVERY round of observations is a requirement, and yet organizational requirements often dictate that a value for the respiratory rate be included each time vital signs are collected. The theory 'Rationalising Transgression', explains how participants continually resolve this problem. The study found that despite feeling professionally conflicted, nurses often erroneously record respiratory rate observations, and then rationalise this behaviour by employing strategies that adjust the significance of the organisational requirement. These strategies include; Compensating, when nurses believe they are compensating for errant behaviour by enhancing the patient's outcome; Minimalizing, when nurses believe that the patient's outcome would be no different if they recorded an accurate respiratory rate or not and; Trivialising, a strategy that sanctions negligent behaviour and occurs when nurses 'cut corners' to get the job done. Nurses' use these strategies to titrate the level ofemotional discomfort associated with erroneous behaviour, thereby rationalising transgression CONCLUSION: This research reveals that despite continuing education regarding gold standard guidelines for respiratory rate collection, suboptimal practice continues. Ideally, to combat this transgression, a culture shift must occur regarding nurses' understanding of acceptable practice methods. Nurses must receive education in a way that permeates their understanding of the relationship between the regular collection of accurate respiratory rate observations and optimal patient outcomes.

译文

背景:呼吸频率异常是急诊科(ED)患者临床恶化的首批指标之一。尽管进行呼吸频率观察很重要,但这种生命体征常常不准确地记录在ED观察图上,从而损害了患者的安全性。同时,很少有研究报告这种现象发生的原因。
目的:建立一个实质性的理论来解释急诊室注册护士错过或误报呼吸频率观察值时的推理。
设计:该研究项目对定性数据进行了经典的扎根理论分析。
参与者:目前在澳大利亚的急诊室工作的九十九名注册护士。收集的数据包括个人访谈的详细答复和在线调查表的开放式答复。
方法:由于采用了经典的扎根理论(CGT)研究方法,因此编码对于数据的抽象及其作为理论的重新整合至关重要。与CGT方法同义的常量比较用于编码数据。这种方法有助于确定参与者的主要关注点,并有助于产生解释参与者如何处理此问题的理论。
结果:确定的主要问题是,急诊科注册护士并不认为需要在每一轮观察中为所有患者收集准确的呼吸频率,但是组织要求经常要求每次重要时都应包括呼吸频率值收集迹象。 “合理化违法行为”理论解释了参与者如何持续解决这一问题。研究发现,尽管感到职业上有矛盾,但护士经常会错误地记录呼吸频率的观察结果,然后通过采用可调整组织要求重要性的策略来合理化这种行为。这些策略包括:补偿:当护士认为他们通过提高患者的治疗效果来补偿错误的行为时;当护士认为患者记录正确的呼吸频率与否时,结局没有什么不同,并且最小化;琐事化是一种惩罚过失行为的策略,当护士“偷工减料”完成工作时就会发生。护士使用这些策略来减轻与错误行为有关的情绪不适水平,从而使过犯合理化。结论:本研究表明,尽管继续接受有关呼吸频率收集的金标准指南的教育,但最佳实践仍在继续。理想情况下,为了应对这种违法行为,必须在护士对可接受的练习方法的理解上发生文化转变。护士必须接受一定程度的教育,以使他们了解定期收集的准确呼吸频率观察值与患者最佳结局之间的关系。

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