Should you wake patients at 2am to measure vital signs? We posed this question last week in Behind the Rituals and the debate is still going on in Twitterland.
Why did we ask? A few of you thought this was a stupid question. @firstilast gave me the biggest laugh of the week “No, let’s not carry out clinically indicated observations. That way patients get to sleep… for a very long time”.
Good point, but for others the issue is less clear cut.
If a decision has been made to carry out 4-hourly obs then surely nurses are obliged to do them?
As a student nurse I remember making a list of patients who should have their obs done in the middle of the night. Clinical judgement was used and usually involved patients who had just had surgery or were critically ill. Everyone else was left to sleep – which begs the question why 4-hourly obs were needed in the first place.
@AshDuffyHayes suggested the positives of waking patients outweigh the negatives, but others voiced concerns about loss of sleep. @JuliePacker highlighted the effect of disturbed sleep in ITU and this was reinforced by @AgencyNurse who said “it’s all about clinical judgement and should be individual to the patient. Routine obs [can] wait until the pt wakes”.
Many nurses commented on the expertise of the nurse making the decision, using terms such as instinct, clinical judgement, intuition and knowing your patient. Perhaps this is where the answer to the question lies.
Rigorous adherence to 4-hourly observations is probably a good idea for the novice nurse who is still learning and developing skills. In the hands of the expert nurse informed decisions can be taken to prioritise sleep over recording observations. As David Jones noted in his expert comment, nurses should be able to carry out an “end-of-bed” observation without waking a sleeping patient… but they should also trust their instinct and if they feel the patient is deteriorating the question they should ask themselves should be whether four-hourly observation is enough”.
Nurses have to balance competing priorities when caring for patients and the patient’s best interest has to be at the heart of this process. As @ShannonsideTrng says “It depends on the competence of the nurse to judge, therein lies the art and science of nursing!”