Clinical Vigilance and Decision-Making Practices in Hospital Respiratory Therapy

Abstract

This study addressed the need to understand how clinical vigilance shaped decision-making practices in hospital respiratory therapy at Cagayan Valley Medical Center. Using a vignette-supported analytic cross-sectional design, the research assessed respiratory therapy personnel’s vigilance in recognizing respiratory deterioration, monitoring treatment response, anticipating clinical risk, communicating concerns, and documenting patient-related actions. It also examined decision-making practices in terms of assessment-based judgment, prioritization, protocol use, escalation, interprofessional coordination, and clinical documentation. Data were gathered through a validated researcher-made questionnaire with clinical vignettes and analyzed using descriptive statistics, reliability testing, measurement model assessment, and Partial Least Squares Structural Equation Modeling. Findings showed high levels of clinical vigilance and decision-making practices, particularly in recognizing abnormal breathing patterns, monitoring oxygen response, assessing airway concerns, and selecting interventions based on bedside findings. However, the results also revealed practice gaps in reassessment after intervention, escalation of unresolved respiratory concerns, endorsement during handoffs, and completeness of documentation. The vignette results further showed that decision-making was stronger in familiar airway-related situations but less consistent in complex cases requiring escalation and continuity of care. Structural model findings confirmed that clinical vigilance significantly predicted decision-making practices and vignette-based decision performance. The study concluded that respiratory therapy personnel demonstrated strong bedside awareness and generally sound clinical judgment, but continuity processes after initial intervention required further strengthening. Standardized reassessment protocols, clearer escalation pathways, structured handoff tools, documentation audits, and case-based simulation training were recommended to improve patient safety and respiratory care accountability.