NU263 Unit 10 Early Warning Seminar Reflection Example

She Is Not Herself, Four Hours Early: Closing Seminar Notes in Reflection, by a Composite Student Who Counted Only Numbers as Evidence of Deterioration, Until a Husband's Remark and Research on Nurses' Worry Made Concern a Finding

[Student Name]

Purdue University Global

NU263: Medical-Surgical Nursing III

Unit 10 Seminar Reflection

[Instructor Name]

[Date]

The seminar scenario and classmates are composite; the reflection discusses early recognition of deterioration in general terms.

The Belief I Brought

I believed that a patient's deterioration shows up in numbers: heart rate, breathing rate, blood pressure, oxygen, urine, labs. That belief had served me well this term. I learned to read pulse pressure in a woman bleeding into her thigh and filling pressures in a man with tamponade. When a classmate said she had "a bad feeling" about a patient, I privately thought a feeling was not something you could report.

The Scenario

The seminar described [Mrs. G.], 64, day two after bowel surgery. At [1400] her husband told the nurse, "She's not herself. She's too quiet. She usually does the crossword." Her vital signs were normal. The nurse documented the comment and planned to recheck at the next scheduled time. At [1800] Mrs. G. had a heart rate of [124], a temperature of [38.9] C and a falling blood pressure, and was found to have an anastomotic leak. Her husband had noticed the change four hours earlier.

Her husband knew her normal; the monitor only knew the population's.

Research on a Nurse's Worry

The instructor shared a systematic review of nurses' worry or concern as a sign of deterioration. It drew together eighteen studies and found that nurses' worry was built from recognizable signs, such as changes in mental status, breathing, skin color, and the patient or family saying something was wrong, and that it sometimes appeared while vital signs were still normal (Douw et al., 2015). Worry was not a mood; it was a pattern of observations that numbers had not caught yet.

Families as a Trigger

Some hospitals allow patients and families to call the rapid response team themselves. A systematic review of that practice found few studies of its clinical effect, but families did not overwhelm teams with calls, although some calls were about concerns other than deterioration (Albutt et al., 2017). For me, the more important point was simpler: a family member's sense that something has changed is information a nurse can use, not just a feeling to reassure.

Back Through the Term

Rereading my own case papers, I found that in nearly every one, something other than a number came first: a woman after hip surgery who wanted to go home, a man after bypass surgery who was restless, a woman who pointed to her head during her stroke treatment. In each case I had written the number as the turning point and the behavior as background. The behaviors were the early signs (Harding et al., 2023).

What My Classmates Added

A classmate who works as a nursing assistant said that families on her unit often tell the assistants first, because the assistants are in the room most, and that those comments do not always reach the nurse. Another said her unit's early warning score has a box for nurse concern that adds points even when the numbers are normal. Both comments made the point practical: concern needs a route to the person who can act, and some systems already build that route in.

Why I Held the Old Belief

Numbers are easy to report and hard to argue with. Worry felt subjective, and I did not want to call a provider with "she's just not right." I now think the solution is not to drop the numbers but to describe the worry in observations: quiet when she is usually talkative, not doing her crossword, according to her husband who knows her.

How I Would Have Reported It

If I had been Mrs. G.'s nurse at [1400], my report could have been: "Her vital signs are normal, but her husband says she is much quieter than usual and has stopped her crossword. She is day two after bowel surgery. I would like you to see her, and I'd like to recheck her in an hour rather than four." That report contains no abnormal number and is still specific, sourced and actionable.

A Concern Written Down

In my next course, when I or a family member notice a change without a number, I will write it down in observable terms, report it to my nurse, and ask for an earlier recheck rather than waiting for the scheduled time. I will treat "not herself" as a finding, with the name of the person who said it.

Open Questions

I cannot yet say how I should weigh family concern when the family is anxious about everything, or how to describe my own worry to a provider who wants numbers.

References

Albutt, A. K., O'Hara, J. K., Conner, M. T., Fletcher, S. J., & Lawton, R. J. (2017). Is there a role for patients and their relatives in escalating clinical deterioration in hospital? A systematic review. Health Expectations, 20(5), 818-825. https://doi.org/10.1111/hex.12496

Douw, G., Schoonhoven, L., Holwerda, T., Huisman-de Waal, G., van Zanten, A. R. H., van Achterberg, T., & van der Hoeven, J. G. (2015). Nurses' worry or concern and early recognition of deteriorating patients on general wards in acute care hospitals: A systematic review. Critical Care, 19, Article 230. https://doi.org/10.1186/s13054-015-0950-5

Harding, M. M., Kwong, J., Hagler, D., & Reinisch, C. (2023). Lewis's medical-surgical nursing: Assessment and management of clinical problems (12th ed.). Elsevier.