What factors influence ward nurses' recognition of and response to patient deterioration? An integrative review of the literature.
Debbie Massey, Wendy Chaboyer, Vinah Anderson
PMID 28078095WHAT IT FOUND
Ward nurses' recognition and escalation of deterioration was associated with vital-sign assessment, knowing the patient, training, teamwork, and support; fear and anxiety delayed response.
Key findings
01Recognition themes were assessing the patient, knowing the patient, education, and equipment.
02Response themes were non-technical skills, access to support, and negative emotional responses.
03Negative emotions, including anxiety, fear and panic, delayed escalation of care.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The review included only 17 studies, and many primary studies had small samples, single locations, and minimal reporting of reliability or rigor. Study quality varied widely, from 25% to 100% on the appraisal tool, and low-quality studies were kept rather than excluded. The included studies mostly enrolled nurses or staff, not patients or families, so the review describes nurses' experiences and perceptions rather than patient outcomes. The search was limited to English-language studies from 1999 to 2014, so relevant work may have been missed. Findings were synthesized as themes, not pooled as effects, so no overall effect size can be given.
The easy way to misread this
Do not read this as evidence that training, teamwork or culture changes improve patient outcomes. It synthesizes 17 mostly qualitative and small studies of ward nurses' experiences, perceptions and simulated performance, not patient outcomes.