A review of educational strategies to improve nurses' roles in recognizing and responding to deteriorating patients


Sok Ying Liaw, National University of Singapore, National University Health System, Level 2, Clinical Research Centre, Block MD11 10 Medical Drive, Singapore 117597; Tel: (65)-65167451; Fax: (65)-67767135; E-mail: nurliaw@nus.edu.sg.


LIAW S.Y., SCHERPBIER A., YOBAS P. & RETHANS J.-J. (2011) A review of educational strategies to improve nurses' roles in recognizing and responding to deteriorating patients. International Nursing Review58, 296–303

Background:  Physiological instability leading to clinical deterioration often precedes cardiopulmonary arrest. Nurses, who have the most frequent patient contact and responsibility for ongoing monitoring of patients, play a crucial role in recognizing and responding to clinical deterioration. The importance of education in supporting such a role has been addressed in numerous studies.

Aim:  This study aimed to identify nurses' educational needs and explore educational strategies to enhance their ability in recognizing and managing wards with deteriorating patients.

Methods:  A literature search from databases (2000–2010) was undertaken to include papers that identified the educational needs of ward nurses and existing educational programmes related to the care of deteriorating patients.

Findings:  Twenty-six papers were included in this review. Findings identified the educational need to empower nurses with the appropriate knowledge and skills in recognizing, reporting and responding to patient deterioration. The review of existing educational programmes and their outcomes identified valuable teaching information and strategies, and areas that could be improved in meeting nurses' educational needs.

Conclusion:  The review has highlighted important aspects of patient safety in clinical deterioration that could be further addressed by educational strategies targeting the role of ward nurses. These strategies include: utilizing clinical decision-making models to develop nurses' decision making skills; developing a standardized tool for systematic nursing assessment and management of clinical deterioration; incorporating training in clinical deterioration as a core competence of pre-registered nursing education; providing vital signs training to nursing assistants; and conducting more rigorous studies to evaluate the effectiveness of the educational programmes.