Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2024 Oct;21(5):505-513.
doi: 10.1111/wvn.12745. Epub 2024 Sep 7.

Improving recognition of early clinical decline: Determining reliability and validity of the Garvey clinical warning curves

Paula K Garvey  1 , Hannah Himes  2 , Marlene Sampson  3 , Molly McNett  1
Affiliations
Observational Study

Improving recognition of early clinical decline: Determining reliability and validity of the Garvey clinical warning curves

Paula K Garvey et al. Worldviews Evid Based Nurs. 2024 Oct.

Abstract

Background: New graduate nurses have difficulty recognizing and managing the early signs of clinical decline, resulting in a Failure to Rescue (FTR) event and preventable patient death. To address this gap, Garvey developed a series of Clinical Warning Curves as an instructional tool for new graduate nurses in an academic medical center. The Garvey Clinical Warning Curve models depict the progression of clinical changes in six body systems that occur before cardiac arrest.

Aims: The purpose of this study was to establish the content validity, reliability, and usability of the Garvey Clinical Warning Curves among healthcare experts and new-graduate nurses.

Methods: The current study was a cross-sectional, observational, validation survey design. Content experts used the content validity index (CVI) to evaluate the Curves.

Results: All but the temperature curves were rated as "acceptable" (CVI >0.60) for relevance, clarity, and ambiguity. The new graduate nurses who reviewed the case studies and placed patients onto the Clinical Warning Curves did so similarly, generating high intraclass correlation (ICC) scores. The usability survey components measured the perceptions of acceptability, appropriateness, and feasibility for the use of the six Clinical Warning Curves in practice settings. All components of the Curves had an average score of 4.0 or greater except for the level of complexity which scored 3.88.

Linking evidence to action: The Garvey Clinical Warning Curves emerged as valid and reliable tools that aid new graduate nurses in recognizing subtle signs of clinical decline. Because timely recognition and communication of clinical decline are key to preventing FTR events and avoiding patient deaths, it would be beneficial to provide the Clinical Warning Curves as a bedside resource for new graduate nurses during their orientation to the unit or within a nurse residency program.

Keywords: clinical decline; clinical warning curves; failure to rescue; new graduate nurses.

PubMed Disclaimer

References

REFERENCES

    1. Barmparas, G., Martin, M. J., Wiegmann, D. A., Catchpole, K. R., Gewertz, B. L., & Ley, E. J. (2016). Increased age predicts failure to rescue. The American Surgeon, 82, 1073–1079.
    1. Chua, W. L., Legido‐Quigley, H., Jones, D., Hassan, N. B., Tee, A., & Liaw, S. Y. (2020). A call for better doctor‐nurse collaboration: A qualitative study of the experiences of junior doctors and nurses in escalating care for deteriorating ward patients. Australian Critical Care, 33, 54–61. https://doi.org/10.1016/j.aucc.2019.01.006
    1. Chua, W. L., Legido‐Quigley, H., Ng, P. Y., McKenna, L., Hassan, N. B., & Liaw, S. Y. (2019). Seeing the whole picture in enrolled and registered nurses' experiences in recognizing clinical deterioration in general ward patients: A qualitative study. International Journal of Nursing Studies, 95, 56–64. https://doi.org/10.1016/j.ijnurstu.2019.04.012
    1. Cull, J., Brevetta, R., Gerac, J., Kothari, S., & Blackhurst, D. (2023). Epic sepsis model inpatient predictive analytic tool: A validation study. Critical Care Explorations, 5(7), 1–10. https://doi.org/10.1097/CCE.0000000000000941
    1. Dennison, R. D. (2018). Pass CCRN! (5th ed.). Mosby.

Publication types

LinkOut - more resources