Nurses’ role in detecting deterioration in ward patients: systematic literature review
Article first published online: 11 SEP 2009
© 2009 The Authors. Journal compilation © 2009 Blackwell Publishing Ltd
Journal of Advanced Nursing
Volume 65, Issue 10, pages 1992–2006, October 2009
How to Cite
Odell, M., Victor, C. and Oliver, D. (2009), Nurses’ role in detecting deterioration in ward patients: systematic literature review. Journal of Advanced Nursing, 65: 1992–2006. doi: 10.1111/j.1365-2648.2009.05109.x
- Issue published online: 11 SEP 2009
- Article first published online: 11 SEP 2009
- Accepted for publication 12 June 2009
- nursing observations;
- rapid response;
- systematic review;
- vital signs;
- ward patients
Title. Nurses’ role in detecting deterioration in ward patients: systematic literature review.
Aim. This paper is a report of a review conducted to identify and critically evaluate research investigating nursing practice in detecting and managing deteriorating general ward patients.
Background. Failure to recognize or act on deterioration of general ward patients has resulted in the implementation of early warning scoring systems and critical care outreach teams. The evidence of effectiveness of these systems is unclear. Possible mechanisms for low effectiveness may be inconsistent recording of patient observations by ward staff, or inconsistent application of ‘calling criteria’ for outreach teams, even when observations have been recorded.
Methods. The literature was searched between 1990 and 2007 using four sources: electronic databases, reference lists, key reports and experts in the field. Three broad search categories were used: nursing observations, physiological deterioration and general ward patients. All research designs describing nursing observations (vital signs) on deteriorating adult patients in general hospital wards were included.
Results. Fourteen studies met the inclusion and quality criteria. The findings were grouped into four main themes: recognition; recording and reviewing; reporting; and responding and rescuing. The main findings suggest that intuition plays an important part in nurses’ detection of deterioration, and vital signs are used to validate intuitive feelings. The process is highly complex and influenced by many factors, including the experience and education of bedside nurses and their relationship with medical staff.
Conclusion. Greater understanding of the context within which deterioration is detected and reported will facilitate the design of more effective education and support systems.