Nurses Understanding on Overnight Monitoring of RR

The essay sheds light on the importance of overnight monitoring of respiratory rate among patients and the role of nurses in improvising further extensive proactive systems. It critically analyzes two research studies and compares their findings. The essay also reflects on the area of practice within nursing and the need for professional training in monitoring vital signs and RR among patients.

NURSES Understanding on
Overnight Monitoring of RR

TABLE OF CONTENT
INTRODUCTION...........................................................................................................................3
Critical Analysis..............................................................................................................................4
Article 2........................................................................................................................................5
Comparison of the findings..........................................................................................................7
Reflection.........................................................................................................................................9
CONCLUSION................................................................................................................................9
REFRENCES.................................................................................................................................11

INTRODUCTION
Overnight monitoring of respiratory rate is highly essential among nurses to handle
critical cases and improvise fundamental vital signs, which are related to cardiac events and
internal changes coming with cognitive health standards. Overnight monitoring of RR may lead
to sleep disruptions, where four to five hours’ period interval is preferred. Frequency of Vital
signs and RR assessment are less conducted during night than day, which is also essential factor.
Evidence based care issues plays crucial role in examining importance, related to most effective
care by nurses with aim to improvise patient outcomes. Overnight monitoring of respiratory

rates, further plays critical role in analyzing patient health standards and improvising assessment
of patient’s health scenario. The patients are expected to receive most effective care, timely
medical checkup facilities and improvised respiratory treatments being done. Reflecting on
evidence based practices, enhances working learning among nurses within healthcare parameters
which enables to determine long term improvement. Study within recent findings will shed light
on extended importance of Overnight monitoring of respiratory rate, and role of nurses in
improvising further extensive proactive systems (Lauteslager and et.al, 2021).
The Rolfe, Freshwater and Jasper (2001/2011) will be undertaken, for evaluating
reflective practices being done within evidence based practices. Evidence based practices of
various patients, ideally enable to analyze varied strategies which improvises overnight
monitoring of RR among patients. Essay will determine nurse’s role in understanding of
Overnight monitoring of RR, new strategies for improvement. Also research in recent study will
determine focus on conduct of literature review, within development of practice for overnight
monitoring of RR. Study will also further extensively determine analysis of various nursing
practices, extensively analyze strategic improvement within assessment of patients. Nurses
within overnight monitoring of respiratory rate, have varied understanding to further critically
improvise patient care standards and ideally determine best respiratory rate management. Also
recent research will explore importance of overnight monitoring in respiratory rate among
patients by nurses, and how new improvement can be developed effectively (Ryu and et.al,.,
2021). The practical understanding on overnight monitoring of RR, enables to identify factors
where there are issues faced by patients and to improvise extensive diversity further.
Critical Analysis
The title of the paper is “A fundamental conflict of care: Nurses’ accounts of balancing
patients' sleep with taking vital sign observations at night. “ Author – (JoAnna Hope PhD and
et.al, 2017)
Nurses faces conflict of balancing patients sleep with taking vital sign observations at
night, and maintaining effective care standards. Research paper key findings enable to attain
knowledge on nurse’s role in regular vital signs observations, which reduces avoidable
deterioration in hospitals.

Research found that nursing staff working in night shifts experience conflict, between
care tasks of supporting sleep and monitoring patient’s vital signs. Results from study shows
that nurses were less inclined to wake patients to take vital sign observations at night, specially
patients with dementia or chronic conditions. It has been also found that nurses should document
exceptions and discuss long term monitoring facts, prioritizing competing expectations to advise
proper medical treatments further.
CASP analysis
 There was a clear statement of aim. Aim of the study was to explore adherence to vital
sign observations, scheduled by early warning score protocol which reduces at night.
 The qualitative methodology was appropriate for the study. 17 semi- structured
interviews with nursing staff were undertaken, which was based on thematic approach.
 The qualitative design is appropriate to address the aim of research. The qualitative
interpretive design has been undertaken in this research, which has developed
authenticity and validity of information significantly. Information provided in study are
ethically robust, trustworthy as nurses’ results have been evaluated based on evidence
based practices.
 The recruitment strategy is appropriate to the aims of research. Interviewees were
recruited through quantitative survey investigating knowledge, beliefs and attitude
regarding decision making concerning vital signs observations at night.
 The data has been collected in appropriate way, for addressing research issue. The
seventeen semi-structured interviews with nursing staff on yards, has been undertaken for
scheduling vital signs observations.
 Relationship between researcher and participants has been adequately considered in the
article. Nurses use vital signs observations to support clinical intuition, potentially using
pattern recognition of deteriorating patients in specialty area.
 The ethical issues have been effectively taken into considerations by researcher.
Participants were given participant information sheet and assured decision will not affect
professional prospects. Wards name were anonymous; identity of participants was also
omitted from recent finding to maintain anonymity (Valero, and et.al, 2021).

 The data analysis has been found to be sufficiently rigorous. It also contributes authentic
findings to wider global clinical community, based on patients with chronic conditions
are under monitored at night by nurses.
 Findings have been presented in clear statement, which signifies validity and authenticity
of data analyzed within research which precisely will enable further improvement among
role of nurses in monitoring Vital signs and RR among patients.
Article 2
The title of study is relationships between healthcare staff characteristics and conduct of vital
signs observations at night, results of survey and factor analysis. (Authors -Alejandra Recio
Saucedo and et.al, 2018)
Research found that online survey has summarized experienced nurses, have competent
potentiality to conduct vital signs observations among patients at night. Student nurses and
midwives were working with higher propensity to follow protocols for conducting observations.
The respondents working at night shifts were exclusive perceived to have professional
knowledge, of monitoring vital signs in patients.
CASP analysis
 The study has addressed clear focused issue, based on association of healthcare staff
relevant to perform observations at night.
 The cohort study was recruited in an acceptable way, were participants met inclusion
criteria of working at least 1-night shift within past year. Cohort study was done in
specific format; as online survey was conducted.
 The exposure was not accurately measured to minimize bias. Questions worded format
was done online, where design and structure within survey was not appropriate, which
increased risk of responder based on ability to respond accurately (Valero and et.al,
2021).
 The outcome was not accurately done and measured to minimize bias. It has lacked
development of reliable system for detecting all cases effectively.

 The researcher has identified all cofounding factors, which can be analyzed as workload
and resources, prioritization, safety culture and responsibility with control. Yes,
cofounding factors I design and analysis has been taken into account.
 Follow up of subjects has been long enough, where resercher has presented dynamic
coohrot procedures done among results.
 The results are based on understanding among patient’s surveillance during night shift
within acute hospitals and to identify associations in timely completion of vital signs
observed following EWS protocol.
 The results of research are precise and informative, which enables to pertain focus on
authentic findings precisely among role of nurses to attain vital signs among patients.
 Results attained form research are effective towards optimum accuracy benchmarks, as
aim was to improve understanding within patient surveillance during night shift within
acute hospital (Evidence-Based Nursing).
 The results can be applied to local population, as design of survey was done to analyze
staff knowledge, staff in monitoring patient’s vital signs during night.
 The results of study are fit with other available evidence, as authenticity and effective
validity has been focused on.
 Implications for this study of practice are nurses with greater experience have optimum
capacity to monitor vital signs of patients at night. It will enable new findings to be
analyzed within further research, to determine extended improvement in monitoring of
vital signs.
Comparison of the findings
Comparison of both studies enables to analyze detailed criteria based on relevance findings,
within clinical practices. Study “A fundamental conflict of care: Nurses’ accounts of balancing
patients' sleep with taking vital sign observations at night” is more authentic and discusses
relevance of finings. Findings of article are that nurses are less inclined to wake patient for vital
signs observations at night has been focused on. As patient risk to safety, particular patients
having dementia or chronic conditions need to be prioritized (Wheatley, 2018).
. Information attained is done in effective format considering ethical standards of research,
by maintaining anonymity factor among patients and prioritizing efficiency standards.

Qualitative interpretative design has been undertaken, which enhanced working findings done in
competent ways to ensure best results and findings are attained.
There have been seventeen semi-structured interviews conducted with nursing staff, working
under varying levels of adherence to schedule vital sign observations. Thematic analysis
approach has been used, which has made research analysis informative with latest observations
of patients undertaken. Patients with chronic conditions are under monitored at night, while
patients requiring palliative care risk are being over monitored under early warning score
protocol. Research being qualitative interpretive design presents authentic, valid information
(Kerr and et.al, 2021). Also research done in study highlights major concerns of patients, within
monitoring of Vital signs in overnight aspect which develops technical improvement.
Another study “Relationships between healthcare staff characteristics and conduct of vital
signs observations at night, results of survey and factor analysis” has been summarizing staff
experience and role associated in conducting surveillance tasks. The findings are based on
workload and resources, prioritization on safety culture and responsibility control parameters.
Responses of nurses have showed propensity to follow protocols for conducting observations,
where professional knowledge tasks have been undertaken. However, there is lack of exposure
was not accurately measure to minimize biasness (Critical thinking and writing for nursing
students, Price, Bob , 2011). The questions format was done in format of online survey, in which
design and structure was not appropriate which increased risk of respondents based on ability to
respond. Study was developed in online survey format, which made results less bias free, and
also less reliable to further proceed with accurate working criteria goals.
As compared to this study, there is less adherence developed within factors of authenticity and
relevance which has found to be major parameter. Study done in “A fundamental conflict of
care: Nurses’ accounts of balancing patients' sleep with taking vital sign observations at night”
specifies authentic, valid findings done in effective format where researcher has also precisely
taken focus on optimum factors of ethical procedures (Joshi and et.al,2021).
As per the views of Cao and et.al, (2022), overnight monitoring of vital signs among
patient’s increases sleep interruptions which causes increased mortality, high stress hormones
and hypertension along with weakened immunity. Research done by author also explains that
overnight vital signs, specifies that overnight vital signs monitoring, and respiratory rate

measures lead to varied sleep disruptions in patients specifically having dementia. There is four
or five hours’ interval most preferred, which enables frequency of routine vs observations are
less worked on during night majorly. Role of nurses is to control body temperature, manage
breathing and sleep support to be maintained effectively for strengthening patients care safety
parameters. Research by author also significantly shed focus on fact that nurses should be
professionally experienced, trained in handling patients within monitoring of Vital signs and RR.
As noted by Hawthorne and et.al, (2022), nurses are required to control body
temperature, keep patients safe under care scenarios where fundamental roles conflict in
monitoring of care standards are done precisely. There has to be specific focus adhered on
ideally analyzing various risks factors, and RR monitoring patient care outcomes for diverse new
scale efficacy goals competencies. This further plays crucial role for developing optimized
improvement in monitoring RR level and vital signs, among patient’s healthcare standards.
Respiration rate and vital signs should be monitored when patient is at rested state, precisely
keeping focus on counting number of breaths for one minute by counting number of chest rise
(Nursing Research : Principles, Process and Issues, Kader, 3rd editon). NHS aims to adopt best
policies in monitoring of RR vital signs, among patients by experienced professional nurses
which enables to determine accurate results. This enables to optimally enhance patient recovery
from diseases, and ideally improvise monitoring of patient vital signs within longer time period
efficiently within longer time period (Hussain and et.al, 2021). NHS nurses further aim to adhere
towards extensive new scale priorities among patient care standards, which shapes optimized
wellness diversely and generates strategic growth goals for improvised nursing care within
longer time frame.
Reflection
Reflecting on area of practice within nursing, enables to improvise wider scale expansion
based on diverse parameters for effective learning. Various skills, attitude and performance,
parameters further plays critical role for evolving wider knowledge and enhance operative
criteria within field of area diversely.
The Rolfe, Freshwater and Jasper (2001/2011) specifies three stages in reflective
analysis, which are as follows:

 What: Overnight monitoring of RR vital signs in patients is one of the most specific
significant area of practice among nurses, where there has to be adherence done to major
parameters. My experience enabled me to analyze that patient undergo issues such as
hypertension, weakened immunity and cognitive impairment when nurses monitor vital
signs. Recent research studies done in area specifies importance of correlating towards
overnight monitoring of RR vitals among patient, which is one of the most essential area
for patient’s healthcare improvement (Rolfe, Freshwater and Jasper (2001/2011).
 So what: Evidences from research studies specifies that nurses must be professionally
trained in the practice area of monitoring vital signs RR among patients, as it enables to
develop wider scale improvement. Things which I could have done differently are to
critically examine more authentic research studies, and gain practical supervision from
experienced professionals within healthcare (He and et.al, 2022). The studies done are
informative, and authentic to develop optimum knowledge based on specific research
area within nursing.
 Now what: As student of nursing associate, the area of practice based on overnight
monitoring of RR vitals among patients will enable me to contribute more effectively
within my working areas. I have enabled to develop optimum knowledge, based on this
area of practice as per recent medical and nursing advancement for delivering more
authentic work goals within longer time period. Skills such as competent analytical
knowledge based on analytical skills, attitude of prioritizing latest research findings and
attributes such as time management will enable me to handle patients more effectively.
For meeting new needs of service user patients concern in future, I aim to improvise my
skills and technically shape extensive developed knowledge towards monitoring RR
vitals.
CONCLUSION
The research done in recent study summarized key facts about overnight monitoring of
RR vital signs, where patients faces sleep interruptions and experiences such as Increased
mortality, High stress hormones, hypertension and weakened immunity. Recent findings also
concluded studies done among nursing field within major area of practices, where nurses

experience in handling patients must be done in effective format. Study has compared authentic
findings within 2 studies done in area of practice, where in depth findings have been summarized
for timely improvement to be worked on in monitoring RR vital signs among patients. There has
to be practical adherence developed on vital signs, health issues check and improvement which
needs to be followed up in longer run. Research done in study has optimized authentic findings
where patient’s cognitive impairment and environmental factors are major signs which have to
be analyzed within longer term, for more prioritized patients care. Recent study has also
summarized reflective analysis, where nurses learning and care has to be also worked on
effectively as per recent medical and healthcare standards for best care. Overnight monitoring of
patients vital signs RR, has to be done precisely by experienced professional nurses within
medical and healthcare services.

REFRENCES
Books and Jorunals
Cao, R and et.al, 2022. Accuracy Assessment of Oura Ring Nocturnal Heart Rate and Heart Rate
Variability in Comparison With Electrocardiography in Time and Frequency
Domains: Comprehensive Analysis. Journal of medical Internet
research, 24(1), p.e27487.
Critical thinking and writing for nursing students, Price, Bob (2011)
Evidence-Based Nursing : An Introduction Nicky Cullum, Donna Ciliska, Brian Haynes, and
Susan Marks-2013
Hawthorne, G and et.al, 2022. Usability of Wearable Multiparameter Technology to
Continuously Monitor Free-Living Vital Signs in People Living With Chronic
Obstructive Pulmonary Disease: Prospective Observational Study. JMIR
Human Factors, 9(1), p.e30091.
He, C., and et.al, 2022. A Smart Flexible Vital Signs and Sleep Monitoring Belt Based on
MEMS Triaxial Accelerometer and Pressure Sensor. IEEE Internet of Things
Journal.
Hussain, Z and et.al, 2021. A Review of the Non-Invasive Techniques for Monitoring Different
Aspects of Sleep. arXiv preprint arXiv:2104.12964.
Joshi, M., and et.al,., 2021. Short-term wearable sensors for in-hospital medical and surgical
patients: mixed methods analysis of patient perspectives. JMIR perioperative
medicine, 4(1), p.e18836.
Kerr, E. and et.al, 2021. Human vital sign determination using tactile sensing and fuzzy triage
system. Expert Systems with Applications, 175, p.114781.
Lauteslager, T., and et.al, 2021. Validation of a New Contactless and Continuous Respiratory
Rate Monitoring Device Based on Ultra-Wideband Radar
Technology. Sensors, 21(12), p.4027.
Nursing Research : Principles, Process and Issues, Kader Parahoo, 3rd edition
Rolfe, Freshwater and Jasper (2001/2011)
Ryu, D and et.al,., 2021. Comprehensive pregnancy monitoring with a network of wireless, soft,
and flexible sensors in high-and low-resource health settings. Proceedings of
the National Academy of Sciences, 118(20).
Valero, M., and et.al, 2021. Health and sleep nursing assistant for real-time, contactless, and non-
invasive monitoring. Pervasive and Mobile Computing, 75, p.101422.

Wheatley I (2018) Respiratory rate 3: how to take an accurate measurement. Nursing Times
[online] 114; 7, 21-22