Nurses’ use of monitors in patient surveillance: an ethnographic study on a coronary care unit

BACKGROUND: Physiological monitors are increasingly used for patient surveillance. Although nurses play a vital role in the observation, analysis and use of information obtained from these devices, difficulties in their use, coupled with the high frequency of false and nuisance monitor alarms, can lead to negative working conditions and threaten patient safety. AIM: With the purpose of promoting effective monitor use and ensuring patient safety, the aim was to explore both how cardiovascular nurses use monitors in patient surveillance and the effect that the monitors have on the nurses' work. METHODS: A qualitative ethnographic design with semi-structured interviews and a field observation conducted at a 35-bed coronary care unit. A purposive sample was used in selecting participants. Data were analysed using systematic text condensation. RESULTS: Eight registered nurses, all women, aged 27-49 years, were participants. The themes helping device, competence development and distractions and strain reflected both the knowledge on which the nurses drew in working with monitors and their influence on the nurses' work. False security and collaboration and teamwork discussed how the nurses trust and depend on each other during monitor surveillance and how poor work conditions and unclear responsibility undermine surveillance. CONCLUSIONS: Monitors enable nurses to observe critically ill cardiac patients closely and respond quickly to life-threatening changes in their condition. Current work arrangements and limited training diminish the reliability of monitor surveillance. It is imperative to revise the structure of the surveillance and improve education in monitor surveillance to enhance nurses' clinical competence and patients' safety.