Nursing observation and assessment of patients in the acute medical unit

Title: Nursing Observation and Assessment of patients in the Acute Medical UnitObjectives: To generate knowledge and understanding of the observation and assessment of patients in the acute medical unit, where patient acuity and activity is unpredictable and length of stay for patients is brief.Background: Time and temporality pose challenges for the nursing observation and assessment of patients because unlike other hospital wards, the acute medical unit is a dedicated acute short-stay facility, admitting patients with highly complex medical illness on a 24-hour basis. Over the past fifteen years, political drivers for improved efficiency of hospital beds, combined with recent austerity measures, have resulted in shorter length of stay in hospital for patients. The implications of these for nursing practice and the observation of patients have not previously been investigated. Method: An ethnographic approach was applied to explore the nursing observation and assessment of patients admitted to an acute medical unit. Data were collected from seven nurse participants using participant observation and qualitative interviews over a six-month period. A thematic analysis was undertaken.Results: The brevity of nurse-patient relationships combined with a problematic ward layout resulted in adaptations to practice to ensure safe monitoring of patients, including frequent visual and verbal assessments of patients. Nurses observed for facial colour, expression, appearance and verbal response. Nurses employed explicit, tacit and intuitive knowledge to interpret observations of patients and safely managed highly complex care despite the challenge of limited time. Nurses demonstrated expertise despite having limited experience.Recommendations: Layout of the acute medical unit must consider ease of visibility for patient observation and impact upon nursing workload. Recognition of nurses' ability to safely observe patients is essential, rather than relying upon the use of paper-based observation tools. Acute medical nursing must be recognised as a distinct specialism, with appropriate standardisation