Managing patients at risk of deterioration in rural hospitals: A qualitative study


Ruth Endacott, School of Health and Environment, La Trobe University, PO Box 199, Bendigo, Victoria 3552, Australia. Email:


Objective: This paper examines strategies used by nurses to manage patients at risk of deterioration in smaller rural hospitals in Victoria, Australia.

Design: A two-stage design comprising a postal questionnaire (n = 20) and case studies (n = 7). Case study participants were interviewed and their practice was observed for one shift.

Setting: Smaller rural hospitals in Victoria.

Participants: Registered Nurses (Division 1).

Main outcome measure: Observed and reported strategies used to manage deteriorating patients.

Results: Nurses in this study used clinical strategies and communication strategies when managing patients who might deteriorate. These strategies were adapted to suit the individual rural context. The ability to anticipate patient requirements and confidence to act on clinical presentation were central. Nurses also had to learn the art of referral and they tailored communication according to their perception of the knowledge and skills of medical colleagues. Strategies were also influenced by staffing patterns and expectations of the community and health service.

Conclusions: We conclude that rural nurses play an essential role in assessing and managing risk of deterioration across a range of patient presentations and often in challenging situations. Strategies used by nurses required an understanding of the rural context of care delivery.