By Louise Rose, PhD, RN, and
Sean P. Clarke, PhD, RN, FAAN
Vital Signs
No longer a nursing priority?
ital sign monitoring
V is a fundamental
component of nurs-
ing care. Were
taught in nursing
school that a patients pulse, res-
pirations, blood pressure, and
body temperature are essential in
identifying clinical deterioration
and that these parameters must
be measured consistently and
recorded accurately.
These ought to be the most
reliable data in a patients chart
but theyre not. Abundant re-
search indicates that vital signs
arent consistently assessed, re-
corded, or interpreted. These
lapses interfere with appropriate
and timely interventions for dete-
riorating patients. All too often
physiologic abnormalities that
develop up to 24 hours prior to
death are either undocumented or
unrecognized, as evidenced by a
well-publicized case in which a
patient died from hemorrhagic
shock after major abdominal sur-
gery, either because blood pres-
sure wasnt monitored or changes
in vital signs werent interpreted
properly.
Vital sign monitoring is a re-
petitive, time-consuming task.
The average nurse measures and
documents thousands of normal
vital signs during the course of
her or his career. Have nurses
come to see this task as tedious
and unprofitable, despite its po-
tential to identify significant ad-
verse consequences? Or are nurses
neglecting vital sign monitoring
because theyre trying to balance
their workloads with the need
for greater documentation?
In some settings, nonnursing
personnel are responsible for this
ajn@wolterskluwer.com
task, in others, automated devices application of these monitoring
do it. Whether or not theyre ac-
tually taking the measurements,
nurses are always responsible for
overseeing vital sign monitoring
and interpreting the data. They
skills. Nurses are under heavy
time constraints and overloaded
with information about many
assessment parameters. Perhaps
we need to reduce and focus the
physical assess-
ment and exami-
A lack of nation skills
taught to under-
knowledge graduate students.
We should also
isnt the main devote attention
to individually
problem. targeting and tai-
loring the meas-
Louise Rose Sean P. Clarke
urement of vital
signs and better
must be alert to trends and abnor- equipping nurses to interpret the
mal values. information vital signs provide,
Our profession has yet to ade- which can be achieved through
quately study and address nurses continuing professional educa-
failure to reliably measure, record, tion.
and interpret vital signs. Possible Nurses bring a wide skill and
reasons for this include excessive knowledge base to the service of
workloads, failure to recognize the public, but theres no excuse
the importance of vital signs for neglecting the most funda-
(particularly respiratory moni- mental tools at our disposal. The
toring), and unclear delineation longer we wait to acknowledge,
of accountability for decision discuss, and research this situa-
making. Nursing practice lead- tion, the greater the risk of a
ers and researcherspreferably serious reengineering of our work,
working collaborativelymust which could shift the responsibil-
learn more about why so many ity of vital sign assessment away
nurses fail to monitor these pa- from nursesa move thats un-
rameters effectively and propose likely to benefit patients or our
evidence-based solutions. profession.
Education programs that teach
nurses to recognize and manage Louise Rose is the Lawrence S. Bloomberg
acute patient deterioration may limited term professor of critical care
helpto the extent that they nursing, Lawrence S. Bloomberg Faculty
of Nursing, University of Toronto,
strongly emphasize the need for Ontario, Canada. Sean P. Clarke is the
extra vigilance in vital sign mon- Royal Bank of Canada chair in cardio-
itoring. But a lack of knowledge vascular nursing research, Lawrence S.
isnt the main problem. Our years Bloomberg Faculty of Nursing, University
of observing clinical practice and of Toronto and University Health Net-
work, Toronto, Ontario, Canada. Contact
studying the literature lead us to author: Louise Rose, louise.rose@
believe the problem is in the utoronto.ca.
AJN May 2010 Vol. 110, No. 5 11