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dc.contributor.authorSmith, Duncan
dc.contributor.authorSekhon, Mandeep
dc.contributor.authorFrancis, Jill J
dc.contributor.authorAitken, Leanne M
dc.date.accessioned2019-11-07T01:15:33Z
dc.date.available2019-11-07T01:15:33Z
dc.date.issued2019
dc.identifier.issn0962-1067
dc.identifier.doi10.1111/jocn.15005
dc.identifier.urihttp://hdl.handle.net/10072/388328
dc.description.abstractBackground: To optimise care of deteriorating patients, healthcare organisations have implemented rapid response systems including an “afferent” and “efferent” limb. Afferent limb behaviours include monitoring vital signs and escalating care. To strengthen afferent limb behaviour and reduce adverse patient outcomes, the National Early Warning Score was implemented in the UK. There are no published reports of how National Early Warning Score guidance has translated into trust-level deteriorating patient policy and whether these documents provide clear, actionable statements guiding staff. Aim: To identify how deteriorating patient policy documents provide “actionable” behavioural instruction for staff, responsible for actioning the afferent limb of the rapid response system. Design: A structured content analysis of a national guideline and local policies using a behaviour specification framework. Methods: Local deteriorating patient policies were obtained. Statements of behaviour were extracted from policies; coded using a behaviour specification framework: Target, Action, Context, Timing and Actor and scored for specificity (1 = present, nonspecific; 2 = present, specific). Frequencies and proportions of statements containing elements of the Target, Action, Context, Timing and Actor framework were summarised descriptively. Reporting was guided by the COREQ checklist. Results: There were more statements related to monitoring than escalation behaviour (65% vs 35%). Despite high levels of clear specification of the action (94%) and the target of the behaviour (74%), context, timing and actor were poorly specified (37%, 37% and 33%). Conclusion: Delay in escalating deteriorating patients is associated with adverse outcomes. Some delay could be addressed by writing local protocols with greater behavioural specificity, to facilitate actionability. Relevance to clinical practice: Numerous clinical staff are required for an effective response to patient deterioration. To mitigate role confusion, local policy writers should provide clear specification of the actor. As the behaviours are time-sensitive, clear specification of the time frame may increase actionability of policy statements for clinical staff.
dc.description.peerreviewedYes
dc.languageEnglish
dc.language.isoeng
dc.publisherWiley
dc.relation.ispartofpagefrom4139
dc.relation.ispartofpageto4149
dc.relation.ispartofissue21-22
dc.relation.ispartofjournalJournal of Clinical Nursing
dc.relation.ispartofvolume28
dc.subject.fieldofresearchNursing
dc.subject.fieldofresearchPublic Health and Health Services
dc.subject.fieldofresearchPsychology
dc.subject.fieldofresearchcode1110
dc.subject.fieldofresearchcode1117
dc.subject.fieldofresearchcode1701
dc.subject.keywordscritical care outreach
dc.subject.keywordsdocumentation
dc.subject.keywordsnurse's responsibilities
dc.subject.keywordsorganisational behaviour
dc.subject.keywordspolicy
dc.titleHow actionable are staff behaviours specified in policy documents? A document analysis of protocols for managing deteriorating patients
dc.typeJournal article
dc.type.descriptionC1 - Articles
dcterms.bibliographicCitationSmith, D; Sekhon, M; Francis, JJ; Aitken, LM, How actionable are staff behaviours specified in policy documents? A document analysis of protocols for managing deteriorating patients, Journal of Clinical Nursing, 2019, 28 (21-22), pp. 4139-4149.
dcterms.dateAccepted2019-06-21
dc.date.updated2019-10-14T00:52:45Z
dc.description.versionAccepted Manuscript (AM)
gro.rights.copyright© 2019 John Wiley & Sons Ltd. This is the peer reviewed version of the following article: How actionable are staff behaviours specified in policy documents? A document analysis of protocols for managing deteriorating patients, Journal of Clinical Nursing, Volume 28, Issue 21-22, November 2019, Pages 4139-4149, which has been published in final form at 10.1111/jocn.15005. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving (http://olabout.wiley.com/WileyCDA/Section/id-828039.html)
gro.hasfulltextFull Text
gro.griffith.authorAitken, Leanne M.


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