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首页> 外文期刊>International journal of nursing studies >Explaining transgression in respiratory rate observation methods in the emergency department: A classic grounded theory analysis
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Explaining transgression in respiratory rate observation methods in the emergency department: A classic grounded theory analysis

机译：呼吸速率观测方法中的迁移在急诊部门中解释：经典基础理论分析

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Abstract 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.
机译：摘要背景异常呼吸率是急诊部（ED）患者的第一个临床恶化指标之一。尽管呼吸率观察的重要性，但这种重要标志往往在ED观察图表中记录，损害了患者安全性。同时，有缺乏研究报告为什么发生这种现象。目的制定实质性理论，解释ED注册护士的推理，当错过或误报呼吸率观察时。设计本研究项目采用了定性数据的经典接地理论分析。参与者：目前在澳大利亚的EDS工作的七十九注册护士。收集的数据包括各个访谈和在线问卷的公开响应的详细响应。方法采用经典接地理论（CGT）研究方法，因此编码是数据抽象的核心及其作为理论的重新融入。使用CGT方法的常量比较是用于代码数据。这种方法有助于确定参与者的主要关注点，并在产生理论上的援助解释参与者如何处理此问题。结果确定的主要担忧是，ED注册护士不相信在每一轮观测结果中收集所有患者的准确呼吸率是一个要求，但组织要求通常决定每次呼吸率的价值包括在每次生命体征中都包括呼吸率的价值收集。理论“合理化违规”解释了参与者如何不断解决这个问题。研究发现，尽管感到专业冲突，但护士经常错误地记录呼吸率观察，然后通过采用调整组织要求的重要性的策略来合理化这种行为。这些策略包括;赔偿，当护士认为他们通过提高患者的结果来补偿错误的行为;当护士认为患者的结果没有任何不同，如果他们记录了准确的呼吸率和没有;琐碎，一种制裁疏忽行为的策略，当护士削减角落“完成工作时发生。护士用这些策略滴定与错误行为相关的术语不足的水平，从而合理化违规结论本研究表明，尽管持续有关呼吸率收集的金标准指南的持续教育，但百货业务仍在继续。理想情况下，为了解决这一违法，必须在护士对可接受的做法方法的理解时发生文化转变。护士必须以一种方式接受教育，这种方式渗透着他们对准确呼吸率观察和最佳患者结果之间的常规收集关系的理解。

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