Attitudes towards vital signs monitoring in the detection of clinical deterioration: scale development and survey of ward nurses.

Objective To develop and determine the psychometrics properties of an instrument (V-scale) and to explore nurses' attitudes towards vital signs monitoring in the detection of clinical deterioration in general wards. Design Scale development with psychometric testing and a descriptive quantitative survey. Setting Tertiary acute care hospital. Participants A total of 614 general ward nurses. Findings Principal component analysis revealed a 16-item instrument in a five-factor solution (key indicators, knowledge, communication, workload and technology) that explained 56.27% of the variance. The internal consistency was sufficient with Cronbach's alpha of 0.71 and strong item subscale correlations (0.56–0.89). The test–retest reliability was adequate with an Intraclass Correlation Coefficient (ICC) of 0.85. Many nurses (56.9%) erroneously perceived blood pressure changes as the first indicator of deterioration, and 46% agreed that an altered respiratory rate was the least important indicator. Most nurses (59.8%) also reported relying on oxygen saturation to evaluate respiratory dysfunction, and 27.4% indicated that they make quick estimates of the respiratory rate. Current practices for vital signs monitoring were considered to be time consuming (21.0%) and overwhelming (35.3%). Nurses' attitudes were most significantly influenced by whether they had a degree qualification followed by whether they worked in a general ward with a specialty and had >5 years of experience. Conclusions This exploratory study provides evidence for the psychometric properties of the V-scale. It reveals a need for continuous professional development to improve ward nurses' attitudes towards vital signs monitoring. Vital signs monitoring needs to be prioritized in workload planning