Patterns of behaviour in nursing staff actioning the afferent limb of the rapid response system (RRS): A focused ethnography

To improve understanding of afferent limb behaviour in acute hospital ward settings, to define and specify who needs to do what differently and to report what afferent limb behaviours should be targeted in a subsequent multi-phase, theory-based, intervention development process.Focused ethnography was used including direct observation of nursing staff enacting afferent limb behaviours and review of vital signs charts.An observation guide focused observation on "key moments" of the afferent limb. Descriptions of observations from between 7 January 2019-18 December 2019 were recorded in a field journal alongside reflexive notes. Vital signs and early warning scores from charts were reviewed and recorded. Field notes were analysed using structured content analysis. Observed behaviour was compared with expected (policy-specified) behaviour.Observation was conducted for 300 hr. Four hundred and ninety-nine items of data (e.g., an episode of observation or a set of vital signs) were collected. Two hundred and eighty-nine (58%) items of data were associated with expected (i.e. policy-specified) afferent limb behaviour; 210 (42%) items of data were associated with unexpected afferent limb behaviour (i.e. alternative behaviour or no behaviour). Ten specific behaviours were identified where the behaviour observed deviated (negatively) from policy or where no action was taken when it should have been. One further behaviour was seen to expedite the assessment of a deteriorating patient by an appropriate responder and was therefore considered a positive deviance.Afferent limb failure has been described as a problem of inconsistent staff behaviour. Eleven potential target behaviours for change are reported and specified using a published framework.Clear specification of target behaviour will allow further enquiry into the determinants of these behaviours and the development of a theory-based intervention that is more likely to result in behaviour change and can be tested empirically in future research.目的: 强化对急症医院病房中传入支行为的理解,定义并指定相关人员采取不同的措施,并报告在随后的多阶段、基于理论的干预开发过程中,应针对哪些传入支行为进行研究。 设计: 焦点民族志包括直接观察护理人员确定传入支和回顾生命体征图表等行为。 方法: 根据观察指南,应集中观察传入支的“关键时刻”。记录并描述2019年1月7日至2019年12月18日的观察结果,将所记录的观察结果载于现场日志中,并随附参考注释。回顾并记录生命体征和早期预警评分。应用结构化内容分析法,以便对现场笔记进行分析。将观察到的行为与预期的(政策中所载)行为进行比较。 结果: 观察时间为300小时。共收集四百九十九项数据(例如,一个观察事件或一组生命体征)。其中两百八十九项(58%)数据与预期(即政策中所载)传入支行为相关;而剩余两百一十项(42%)数据与意外传入支行为(即替代行为或无行为)相关。目前,已确定十种具体的行为,并且这些行为都是在观察到行为偏离(消极)或在应该采取行动时却没有采取行动时做出。此外,存在另一种行为,且人们认为该行为加快对病情恶化患者的评估,因此应视为存在积极偏差。 结论: 人们认为,传入支失效是由员工行为不一致造成。现已使用发布的框架,报告并规定11种潜在的目标行为。 影响: 明确目标行为规范的制定将有助于进一步探究这些行为的决定因素,开发更可能导致行为改变的理论干预措施,并可在未来的研究中进行实证检验。.