Student nurses' recognition of early signs of abnormal vital sign recordings

Nurse Educ Today. 2015 Sep;35(9):e11-8. doi: 10.1016/j.nedt.2015.04.013. Epub 2015 May 7.


Background: There is increasing urgency for nurses to recognize early signs of deterioration in patients and to take appropriate action to prevent serious adverse effects.

Objectives: To assess respondents' ability to identify abnormal recordings for respiratory and heart rate, oxygen saturation level, systolic blood pressure, level of consciousness, urinary output and normal temperature.

Design: A descriptive observational survey.

Setting: A nursing college in Cape Town, South Africa.

Participants: A sample of 77/212 (36.3%) fourth year students.

Methods: A self-administered adapted questionnaire was employed to collect demographic data and respondents' selections of recorded physiological values for the purpose of deciding when to call for more skilled help.

Results: The median age for 62/77 (80.5%) of the respondents was 25years; 3/76 (3.9%) had a previous certificate in nursing. Most respondents were female (66/76, 85.7%). Afrikaans was the first language preference of 33 (42.9%) respondents, followed by isiXhosa (31/77, 40.3%) and English (10/77, 13.0%). Most respondents (48/77, 62.3%) recognized a normal temperature reading (35-38.4°C). However, overall there would have been delays in calling for more skilled assistance in 288/416 (69.2%) instances of critical illness for a high-score MEWS of 3 and in 226/639 (35.4%) instances at a medium-score MEWS of 2 for physiological parameters. In 96/562 (17.1%) instances, respondents would have called for assistance for a low-score MEWS of 1.

Conclusions: Non-recognition of deterioration in patients' clinical status and delayed intervention by nurses has implications for the development of serious adverse events. The MEWS is recommended as a track-and-trigger system for nursing curricula in South Africa and for implementation in practice.

Keywords: Clinical decision-making; Early warning scoring (EWS) system; Patient safety; Vital sign monitoring.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Critical Illness
  • Education, Nursing, Baccalaureate
  • Female
  • Humans
  • Male
  • Monitoring, Physiologic* / adverse effects
  • Monitoring, Physiologic* / methods
  • Physical Examination / adverse effects
  • South Africa
  • Students, Nursing*
  • Surveys and Questionnaires
  • Time Factors
  • Vital Signs / physiology*