Surveillance as an intervention in the care of stroke patients

Background: The term surveillance describes nurses' cognitive work to identify and prevent patient complications. Surveillance involves frequent assessment of patients, attention to cues, and recognition of complications. Surveillance serves to prevent the phenomenon ''failure to rescue,'' which is defined as the inability to recognize a complication that results in the loss of a patient's life. Previous research has focused on differences between novices and experts during simulated tasks such as developing a plan of care. More recently, attention has focused on the early recognition of patient complications. Little research has been conducted on surveillance, especially with respect to the intervention during the delivery of care. Purpose: The purpose of this study was to explore the nursing intervention of surveillance in the care of stroke patients. Methods and Design: A descriptive exploratory design using think-aloud was employed. The study focused on 10 nurses working on a medical neurology unit and their patients in a large Midwestern academic health center. While providing care to a stroke patient, the nurse was prompted to think aloud as they (1) received report, (2) performed an initial assessment of the patient, and (3) concluded the work shift. Data analysis was conducted using content analysis to define the cues and information processing strategies used by these nurses during the delivery of care to stroke patients. Findings and Conclusion: The findings suggest that nurses in this study used surveillance. Using cues from change-of-shift handoff information, a mental image of what the patient would look/be like was formed. This mental image served as a baseline for the evaluation of the patient's current state.