Patient Safety: Who Guards the Patient?
I am writing in response to Meyer and Lavin's article, "Vigilance: The Essence of Nursing,'' published under the Patient Safety topic. In the first paragraph, the authors assert that vigilance is the essence of caring in nursing. Unfortunately, they fail to support their claim with empirically-based evidence and seem unaware of research findings to the contrary (e.g., Sherwood, 1997).
Thereafter, they submit that vigilance constitutes the essence of nursing practice and support this contention based on historical and theoretical anecdotes and data generated from a study of migraine headache suffers' personal experiences (Meyer, 2002). The authors indicate that vigilance consists of: (a) attaching meaning to what is, (b) anticipating what might be, (c) calculating the risk, (d) and staying ready to act. Although these attributes may apply to migraine headache suffers, the authors do not draw a convincing link between them and nursing practice.
Meyer and Lavin's assertions have prompted me to ask the question, "How is vigilance the same or different from assessment and evaluation?" Nursing's lexicon is replete with overlapping terms such as caring, presence, vigilance, support, and therapeutic use of self. Sadly, this proliferation of terms diminishes the ability of nurses to clearly communicate among themselves and with other health care providers. Prior to asserting that vigilance is the essence of nursing practice, it seems prudent to more clearly define and differentiate the concept.
The authors close by suggesting that based on their findings regarding vigilance, a second type of nursing diagnosis should be added to the NANDA lexicon. This category is dubbed "surveillance diagnoses" and includes conditions in which nurses do not have sole responsibility for the interventions or outcomes. They offer the example, "risk for orthostasis." Although this is a perfectly reasonable nursing inference, to date, there is no compelling reason to call this diagnostic process vigilance rather than assessment and evaluation.
Deborah Finfgeld-Connett, PhD, APRN, BC
Sinclair School of Nursing
University of Missouri-Columbia