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Surveillance as an Intervention in the Care of Stroke Patients

Rhudy, Lori M.; Androwich, Ida

Journal of Neuroscience Nursing: October 2013 - Volume 45 - Issue 5 - p 262–271
doi: 10.1097/JNN.0b013e31829db987

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.

Questions or comments about this article may be directed to Lori M. Rhudy, PhD RN CNRN ACNS-BC, at She is a Clinical Nurse Researcher at the Department of Nursing and an Assistant Professor at College of Medicine, Mayo Clinic, Rochester, MN, and she is a Clinical Assistant Professor at University of Minnesota School of Nursing, Minneapolis, MN.

Ida Androwich, PhD RNC FAAN, is Professor and Director, Health Systems Management, Marcella Niehoff School of Nursing, Loyola University Chicago, Maywood, IL.

The authors declare no conflicts of interest.

© 2013 American Association of Neuroscience Nurses