The role of the ward nurse in recognition and response to clinical deterioration: a scoping review

BACKGROUND

Nurses play a key role in the recognition and response to clinical deterioration.

AIM

The aim of this scoping review was to explore, map and synthesise existing research related to the ward nurses' role in recognising and responding to clinical deterioration.

METHODS

A scoping review was undertaken to identify English only studies focused on the ward nurse's role in recognition and response to clinical deterioration of the hospitalised adult. Search terms included 'clinical deterioration', 'nurses', 'wards', 'general', 'hospital, units' and 'hospitals'. The Cumulative Index to Nursing and Allied Health Literature, EMBASE, Ovid MEDLINE, PubMed, ProQuest and Science Direct databases were searched for eligible studies.

RESULTS

Forty-six studies met the inclusion criteria and three major themes were synthesised: (i) recognition of deterioration; (ii) nursing assessment; and, (iii) challenges responding to patient deterioration.

CONCLUSION

The review highlighted significant variability in the ward nurses' role, activities, and skills in assessing, monitoring, managing and escalating care for clinical deterioration.

Refining and psychometric evaluation of the falling risk assessment tool in ophthalmology inpatients

AIMS

The aim of this study was to refine the Falling Risk Assessment Tool in Ophthalmology Inpatients (FRAT) and assess its psychometric properties.

DESIGN

A cross-sectional design was used.

METHODS

A convenience sample of 730 patients in the ophthalmology department was recruited in a level A tertiary hospital in Guangdong Province from July 2021 to January 2022. Data were analysed using item analysis, interrater reliability, content validation, internal consistency reliability and exploratory factor analysis.

RESULTS

Five factors were extracted, accounting for 63.039% of the variance. The interrater reliability of the tool was 0.97. Cronbach's α was 0.658. The I-CVI was 0.75-1.00, the S-CVI/UA was 0.95 and the adjusted mean values of Kappa for indicators ranged from 0.72 to 1.00, as evaluated by the expert group. The FRAT showed satisfactory reliability and validity, and can be used to measure the fall risk assessment in ophthalmology inpatients.

PATIENT OR PUBLIC CONTRIBUTION

After explaining the purpose, the patients received our fall risk assessment and answered the corresponding questionnaire questions.

Characteristics and processes of registered nurses' clinical reasoning and factors relating to the use of clinical reasoning in practice: a scoping review

OBJECTIVE

The objective of this review was to examine the characteristics and processes of clinical reasoning used by registered nurses in clinical practice, and to identify factors reported to relate to the use of clinical reasoning by registered nurses in clinical practice.

INTRODUCTION

Significant variability in the clinical reasoning of graduate registered nurses has been identified in research, with underdeveloped and unsafe clinical reasoning being linked to failure-to-rescue and sentinel events in the clinical setting. The identification of characteristics and processes of clinical reasoning, and factors relating to registered nurses' clinical reasoning when engaged in clinical practice, will increase understanding of the clinical reasoning requirements for undergraduate registered nurses and of potential factors that may affect their clinical reasoning.

INCLUSION CRITERIA

Studies including registered nurses who met the criteria for registered nurse registration in Australia and who used clinical reasoning to engage with health care consumers in all practice environments were eligible for inclusion.

METHODS

Eight databases were searched, with articles identified through CINAHL, MedNar, PubMed, Science Direct, ERIC, PsycINFO, Scopus, and ProQuest Dissertations and Theses. Database searches were conducted on December 31, 2020, and updated August 20, 2021, with primary qualitative and quantitative research studies in English from 2000 onwards considered for inclusion. Opinion papers, text, and reports were not included. Data were extracted based on the draft charting tool from the scoping review protocol, with results presented in tabular format and in a narrative summary.

RESULTS

The 29 qualitative and 5 quantitative research studies included in the scoping review utilized exploratory descriptive, descriptive rationalist, narrative, ethnography, correlational, observational, and grounded theory methodologies in their research designs. Observation, think-aloud sessions, questionnaires, surveys, interviews, and focus groups were used to collect data from the 1099 participants in 9 countries. Multiple concepts related to the characteristics (n=35) and processes (n=30) of clinical reasoning were detected in the research studies, with 5 categories identified: i) situation management, ii) data management, iii) interpreting, iv) implementing and evaluating, and v) professional practice, with an additional processes category identified (decision-making processes). The factors (n=26) reported to relate to clinical reasoning were categorized into environment of care, care requirements, professional practice, experience, knowledge, and decision-making processes. Connections between the various concepts were evident throughout the review.

CONCLUSIONS

The scoping review identified characteristics and processes of clinical reasoning, as well as factors reported to relate to clinical reasoning in all studies. The concepts that comprise the clinical reasoning of registered nurses in clinical practice must be considered in undergraduate registered nurse education. Registered nurses must complete their baccalaureate program with well-developed clinical reasoning to ensure safe clinical practice. Understanding the characteristics and processes of registered nurses' clinical reasoning in clinical practice, and the factors reported to relate to clinical reasoning, supports the creation of targeted resources for development and assessment of clinical reasoning.

Development and psychometric evaluation of the Attitudes Towards Recognising Early and Noticeable Deterioration (ATREND) scale

AIMS AND OBJECTIVES

To develop and evaluate the psychometric properties of an instrument that measures nurses' Attitudes Towards Recognising Early and Noticeable Deterioration (ATREND).

BACKGROUND

General ward nurses play an important role in recognising patient deterioration. However, their attitudes towards early recognition of clinical deterioration have not been adequately explored due to the lack of a valid and reliable scale.

DESIGN

An instrument development and validation study.

METHODS

A three-phase structure that followed the STROBE checklist was used: (1) item generation, (2) content and face validity assessment and (3) psychometric properties evaluation. The scale items were developed based on a comprehensive literature review and content validity assessment by 15 international experts from five countries. The psychometric properties of the ATREND scale were tested on 434 registered nurses, with retest evaluations (n = 100) at two hospitals. Exploratory and confirmatory factor analyses were used to examine the factor structure of the scale. The scale was also evaluated for its internal consistency, test-retest reliability and convergent validity.

RESULTS

The scale's content validity was 0.95. A 3-factor solution was identified from the final 11 items: (1) beliefs about importance of patient observation, (2) use of broader patient assessment skills and (3) confidence in recognising clinical deterioration. The internal consistency reliability of the scale was supported with an acceptable Cronbach's alpha value of 0.745. Test-retest reliability of the scale was excellent, with an intraclass correlation coefficient of 0.825. The ATREND scale shows evidence of good convergent validity.

CONCLUSION

The final 11-item ATREND scale demonstrates adequate initial evidence of reliability and validity for use in acute ward settings.

RELEVANCE TO CLINICAL PRACTICE

Nursing educators and clinicians may use this scale to assess ward nurses' attitudes and practices towards early recognition of clinical deterioration and then enhance their competencies and behaviours in the recognition of clinical deterioration.

Professional Self-Concept and Self-Confidence for Nurses Dealing with COVID-19 Patients

Purpose: To identify the impact of dealing with COVID-19 patients in clinical areas on nurses’ professional self-concept and self-confidence. Background: Professional self-concept is considered a critical factor in the recruitment/retention process in nursing, nursing shortage, career satisfaction, and academic achievements. Professional self-confidence is also a crucial determinant in staff satisfaction, reducing turnover, and increasing work engagement. Design: Descriptive, comparative study. Methods: The study was conducted between February to May 2021 by utilizing a convenience sampling technique. A total of 170 nurses from two facilities were recruited from two COVID-19- and non-COVID-19-designated facilities. The level of professional self-concept and self-confidence was assessed by utilizing the Nurses’ Self-Concept Instrument and Self-Confidence Scale. Results: The professional self-concept level among the group exposed to COVID-19 patients was lower than the comparison group, while the professional self-confidence level among the exposed group to COVID-19 patients was similar to the comparison group. On the other hand, the satisfied staff and those who received professional training in dealing with COVID-19 patients reported a higher level of professional self-concept. Conclusions: Dealing with COVID-19 patients has an impact on professional self-concept; the exposure group was lower than those who did not deal with COVID-19 patients, while the professional self-confidence level among the exposed group was similar to the comparison group. Getting professional training in dealing with COVID-19 patients and being satisfied at work were significant factors in improving professional self-concept. Policymakers should create strategies that target the improvement of professional training in dealing with COVID-19 patients.

New nurse graduates and rapidly changing clinical situations: the role of expert critical care nurse mentors

OBJECTIVES

New nurse graduates may be prone to instances of failure to rescue. Mentoring programs may be an opportunity to assist them with clinical decision making in situations of patient decline. We explored the experiences of new nurse graduates and expert nurses after participation in a mentoring program.

METHODS

In this exploratory-descriptive study, five seasoned nurses were paired with five new nurse graduates. After four months, the new nurse graduates were interviewed, and the expert nurses participated in a focus group.

RESULTS

Themes emerged for the new nurse graduates: 1) importance of the charge nurse, 2) differences in practice areas, and 3) supportive healthcare teams. The focus group revealed three themes: 1) remembering what it was like, 2) desiring to help, and 3) having confidence in their preparation as mentors.

CONCLUSIONS

New nurse graduates relied on charge nurses for assistance. Therefore, it is imperative that charge nurses receive adequate support.

Evaluation of the effectiveness of an eLearning program in the nursing observation and assessment of acute surgical patients: A naturalistic observational study

AIM/OBJECTIVE

The aim of this study was to evaluate the effectiveness of an eLearn program in changing surgical nurses' approach to clinical assessment.

BACKGROUND

Nurses need to have the knowledge and skills to recognise and respond to changes in patients' physiological condition in a timely manner. A private health service in Melbourne, Australia developed an online (eLearn) program highlighting the importance of clinical assessment and provided nurses with an overview of the Airway,Breathing, Circulation, Disability, Exposures ('ABCDE') approach.

DESIGN

A before and after study design that involved naturalistic observation of nurse-patient interactions and nurses' performing patient clinical assessments was undertaken on two surgical wards.

METHODS

The intervention ward nurses received standard education and exposure to the eLearning program. The comparison ward nurses received standard workplace education on patient assessment. The nurses were observed from May to August 2018.

RESULTS

Following completion of the eLearn, intervention ward nurses were observed to spend more time with their patients conducting clinical assessment. On both wards, not all nurses performed comprehensive ABCDE assessment and there was variability associated with the sequencing of ABCDE assessment.

CONCLUSIONS

This study provides some evidence that completion of an eLearn can change clinical practice, however the intensity of the intervention was insufficient to achieve optimal practice in the conduct of clinical assessments.

Evaluation of a Prehospital Rotation by Senior Residents: A Web-Based Survey

The added value of prehospital emergency medicine is usually assessed by measuring patient-centered outcomes. Prehospital rotations might however also help senior residents acquire specific skills and knowledge. To assess the perceived added value of the prehospital rotation in comparison with other rotations, we analyzed web-based questionnaires sent between September 2011 and August 2020 to senior residents who had just completed a prehospital rotation. The primary outcome was the perceived benefit of the prehospital rotation in comparison with other rotations regarding technical and non-technical skills. Secondary outcomes included resident satisfaction regarding the prehospital rotation and regarding supervision. A pre-specified subgroup analysis was performed to search for differences according to the participants’ service of origin (anesthesiology, emergency medicine, or internal medicine). The completion rate was of 71.5% (113/158), and 91 surveys were analyzed. Most senior residents found the prehospital rotation either more beneficial or much more beneficial than other rotations regarding the acquisition of technical and non-technical skills. Anesthesiology residents reported less benefits than other residents regarding pharmacological knowledge acquisition and confidence as to their ability to manage emergency situations. Simulation studies should now be carried out to confirm these findings.

Evaluation of nurses' experiences of a post education program promoting recognition and response to patient deterioration: Phase 2, clinical coach support in practice

Front-line nurses providing around the clock care are pivotal to the identification, recognition, and response to patient deterioration. However, there is growing evidence that patient deterioration indicators are poorly managed and not escalated to rapid response teams (RRTs), contributing to adverse outcomes. Access to effective educational programs has been cited as vital in optimising nurses' recognition and response to deteriorating patients. Several studies evaluated educational programs, but have not explored nurses' experiences of engaging in patient deterioration events post attendance. Participants in a multimodal education program (DeTER) were invited to attend a series of focus groups three months post workshop as phase two of an overall study. A convenience sample of 22 acute care nurses was recruited. A qualitative descriptive design incorporating focus groups and thematic analysis was used to evaluate participants' experiences of engaging with the RRT during patient deterioration events and whether clinical coach support in practice influenced their recognition and response. Four themes were identified within the data, categorised as enhanced confidence, effective communication, supportive culture, and early response. The importance of an educational model using multimodal strategies, underpinned by coach support and guidance post workshop, was clearly demonstrated to optimise nurses' management of patient deterioration events.

Dental hygiene graduates' educational preparedness: Self-confidence ratings of the CDHA baccalaureate competencies

PURPOSE

In 2015, the Canadian Dental Hygienists Association (CDHA) published the first Canadian Competencies for Baccalaureate Dental Hygiene Programs (CCBDHP). To date, there is little evidence to support that baccalaureate graduates have gained these abilities. The purpose of the study was to investigate the confidence levels of baccalaureate graduates in their ability to demonstrate the CCBDHP.

METHODS

An online, anonymous study was conducted with the 2013-2016 graduates of the University of British Columbia to rate their confidence level in the 13 competency domains and associated 110 sub-competencies of the CCBDHP based on a 5-point scale ranging from not confident to confident.

RESULTS

Thirty of the 84 graduates responded to the survey for a 36% response rate. The mostly confident and confident scores were added to determine the number of sub-competencies within each domain in which 75% to 100% of respondents identified such confidence. The competency domains in which graduates expressed the highest confidence included Collaboration (100%), Communication (100%), Clinical Therapy (100%), Disease Prevention (100%), Oral Health Education (90%), Professionalism (90%), Research Use (90%) and Leadership (90%). They expressed the least confidence in the competency domains of Health Promotion (50%), Advocacy (22%) and Policy Use (0%).

CONCLUSION

These data provided the UBC faculty with important insights into the educational preparedness of baccalaureate graduates. The findings are also relevant for other Canadian programmes and contribute to a larger national dialogue about the CCBDHP and the transition of graduates into practice.

Development and initial validation of an instrument to measure novice nurses' perceived ability to provide care in acute situations - PCAS

BACKGROUND

Novice nurses need to be better prepared to provide care in acute situations. There is currently no validated scale specifically measuring nurses' perception of their ability to provide care in acute situations. The aim of this study was to develop and examine the psychometric properties of a scale that measures novice nurses self-reported perception of ability to provide care in acute situations.

METHOD

Development and test of the psychometric properties of the Perception to Care in Acute Situations (PCAS) scale. Items were generated from interviews with novice nurses (n = 17) and validated using opinions of an expert panel and cognitive interviews with the target group.Two hundred nine novice nurses tested the final scale. Exploratory factor analysis (EFA) was used to test construct validity, item reduction and underlying dimensions between the measured variables and the latent construct.

RESULT

The PCAS scale contains 17 items grouped into three factors. EFA demonstrated a clean three factor logic construct solution with no cross-loadings, high correlation for the total scale in both Cronbach's alfa 0.90 and ordinal alpha 0.92.

CONCLUSIONS

The PCAS scale has proven to have acceptable validity. The factors," confidence in provision of care", "communication" and "patient perspective" are likely to be important aspects of providing care in acute situations. Additional testing of the PCAS is needed to conclude if it is sensitive enough to evaluate interventions aimed at improving novice nurses competence and suitable as a guide for reflection for novice nurses.

Nontechnical Competency Framework for Health Professionals in All-Hazard Emergency Environment: A Systematic Review

OBJECTIVES

To summarize characteristics and commonalities of non-technical competency frameworks for health professionals in emergency and disaster.

METHODS

An electronic literature search was conducted in PubMed, MEDLINE, ERIC, Scopus, Cochrane database, and Google Scholar to identify original English-language articles related to development, evaluation or application of the nontechnical competency frameworks. Reviewers assessed identified articles for exclusion/inclusion criteria and abstracted data on study design, framework characteristics, and reliability/validity evidence.

RESULTS

Of the 9627 abstracts screened, 65 frameworks were identified from 94 studies that were eligible for result extraction. Sixty (63.8%) studies concentrated on clinical settings. Common scenarios of the studies were acute critical events in hospitals (44;46.8%) and nonspecified disasters (39;41.5%). Most of the participants (76; 80.9%) were clinical practitioners, and participants in 36 (38.3%) studies were multispecialty. Thirty-three (50.8%) and 42 (64.6%) frameworks had not reported evidence on reliability and validity, respectively. Fourteen of the most commonly involved domains were identified from the frameworks.

CONCLUSIONS

Nontechnical competency frameworks applied to multidisciplinary emergency health professionals are heterogeneous in construct and application. A fundamental framework with standardized terminology for the articulation of competency should be developed and validated so as to be accepted and adapted universally by health professionals in all-hazard emergency environment.

The Effect of Nurses' Leadership Behavior on the Quality of Nursing Care and Patient Outcomes

Objective

The effect of nursing management styles on patient outcomes and the quality of nursing care (QNC) has recently become a topic of discussion. This review was conducted to examine the effects of leadership styles or behaviors on QNC and on patient outcomes.

Methods

13 research studies published between 1 January 2010 and 31 May 2016 which conformed to the inclusion criteria were reviewed.

Results

The effects of nursing leaders' leadership styles or behaviors were examined in studies on patient mortality, QNC from the perspective of nurses, patient satisfaction, unwanted/adverse events, health-care-associated infections, pressure ulcers, falls, unwanted weight loss, hospital readmissions, mismanagement of feeding tubes, and inadequacies in daily nursing care.

Conclusions

Relationship-focused leadership behaviors directly or indirectly improved patient outcomes and raised the QNC compared with task-focused leadership behaviors.

The Shillam-Clipper Leadership Minimum Demographic Data Set: A Tool for Advancing Healthcare Research

OBJECTIVE

The purpose of this research study was to develop an innovative, standardized taxonomy for leader demographic data to gather consistent and comparable data across healthcare leadership studies.

BACKGROUND

Minimum data sets help ensure consistent data collection strategies for standardized comparison among similar variables across settings. A standardized approach to collecting demographic data of healthcare workforce leadership will provide the structure necessary for researchers to more adequately compare the role of demographic characteristics in research outcomes.

METHODS

This study was conducted using systematic literature review methodology with comparative analysis across demographic data sets. Two separate literature reviews were conducted: the 1st for studies of approaches to establishing minimum data sets and another for studies of healthcare leadership.

RESULTS

The outcome of this study is the Shillam-Clipper Leadership Minimum Demographic Data Set tool that includes a comprehensive list of minimum demographic variables applicable to healthcare leadership research, a glossary of operational definitions for the identified demographic variables, and a clearly articulated set of instructions for consistent and accurate data collection.

CONCLUSION

This standardized taxonomy will result in a consistent data set that will improve the effectiveness of comparative research.

The impact of combining concept-based learning and concept-mapping pedagogies on nursing students' clinical reasoning abilities

BACKGROUND

Integrating contemporary teaching strategies into the nursing curriculum is an effective approach to enhance undergraduate clinical-judgment and reasoning abilities.

OBJECTIVE

This study aims to document the impact of blending the teaching strategies of concept-based learning and concept-mapping to enhance nursing students' clinical-reasoning abilities.

DESIGN

A quasi experimental design is used to guide data collection from second year students.

SETTING AND PARTICIPANTS

A consecutive sample of all students undertaking adult health nursing courses at a private university in Jordan and meeting the eligibility criteria resulted in (N = 40).

METHOD

Data was collected via a questionnaire and observation to reveal students' independence in both clinical-reasoning and clinical-judgment. General Clinical-Reasoning Behavior Scale, Independence in Clinical-Reasoning and Clinical-Judgment scales were completed by the students at the beginning and end of the courses.

RESULTS

Despite requesting extensive preparation time, concept-based learning and concept-mapping as student-centered approaches enabled the move away from a content laden approach towards constructing criteria against which various patients' encounters were reflected. This study documented enhancement in students' independence in clinical-reasoning and clinical-judgment as they learned to take command of the elements of their clinical-reasoning. Significant improvement in students' general clinical-reasoning behavior was also documented.

CONCLUSION

The data collection tools utilized in this study can be used as clinical teaching aides, hence maximizing the impact of blended teaching strategies by providing the faculty with specific feedback regarding students' clinical reasoning and judgment abilities. Institutionalizing these processes by initiating relevant policies and guidelines is essential to help students take command of their clinical-reasoning, maturity, and responsibility in a practice area that is constantly changing and evolving.

How do nurses use the early warning score in their practice? A case study from an acute medical unit

AIMS AND OBJECTIVES

This study aimed to describe how nurses use the early warning score (EWS) in an acute medical ward and their compliance with the EWS and explore their views and experiences of the EWS.

BACKGROUND

early warning score systems have been implemented in response to upward trends in mortality rates. Nurses play a central role in the use of EWS systems. However, barriers to their use have been identified and include behavioural, cultural and organisational approaches to adherence. Improvement strategies including education and training and electronic devices have assisted in compliance with the system.

DESIGN

A holistic single descriptive case study design was used.

METHODS

Data triangulation was used including non-participant observation, semi-structured interviews with nurses and document analysis. Nurses were observed using EWS and were subsequently interviewed. Data analysis was guided by systematic text condensation (STC), an approach underpinned by Giorgi's phenomenological method, where meaning units and themes are identified. The study adhered to the consolidated criteria for reporting qualitative research (COREQ) guidelines.

RESULTS

Three themes with associated meaning units were found. Protocol Adherence vs. Clinical Judgement addresses nurses' knowledge, skill and experience and patient assessment. Parameter Adjustment and Escalation included parameters not being adjusted or reviewed, junior doctors not being authorised to set parameters and escalation. The final theme Culture highlighted a task-driven approach and deficient communication processes.

CONCLUSION

This study highlights the need for ongoing training, behavioural change and a cultural shift by healthcare professionals and organisations to ensure adherence with EWS escalation protocols.

RELEVANCE TO CLINICAL PRACTICE

Improvements in education and training into recognition, management and communication of a deteriorating patient are required. Also, a cultural shift is needed to improve compliance and adherence with EWS practice. The potential use of electronic data should be explored.

Nurses' experiences of managing patient deterioration following a post-registration education programme: A critical incident analysis study

The aim of this study was to explore nurses' experiences assessing and managing deteriorating patients in practice following completion of a relevant post-registration education programme. Recognising the increasing acuity of ward patients, nurses are faced with patients who are at an increased risk of deterioration. Patients who are acutely ill or deteriorating often exhibit periods of physiological deterioration; however there is evidence illustrating that these clinical changes are frequently missed, misinterpreted or mismanaged in practice. In order to prepare nurses to competently assess and manage the deteriorating patient, education as a care initiative is offered to develop the knowledge and skills required. A qualitative study using critical incident analysis was conducted to acquire narrative data from nurses, describing their clinical practice experiences of patient deterioration. Thematic analysis was used to analyse the data. Findings revealed improvements in nurses' abilities to recognise patient deterioration, greater application of the evidence base and an increase in confidence and assertiveness. There was some evidence of applying the knowledge and skills learned, however equally some nurses indicated that they remained ill-prepared to apply the skills in practice.

Medical-surgical nurses' experiences as first responders during deterioration events: a qualitative study

AIM AND OBJECTIVE

To explore and understand the experiences of medical-surgical nurses as first responders during clinical deterioration events.

BACKGROUND

Nurses are key players in identifying and responding to deterioration events to escalate the level of care essential to address specific needs of patients. Delays in recognising signs and symptoms of patient deterioration and activation of Rapid Response Teams have been linked to a lack of nontechnical skills (leadership, teamwork, situational awareness) resulting in increased patient morbidity and mortality.

DESIGN

A descriptive, qualitative approach was used.

METHODS

A purposive sample of 28 medical-surgical nurses was recruited and interviewed from an integrated healthcare system located in the USA. Interviews were conducted from October 2014-February 2015. Interviews were audio recorded and transcribed verbatim. Transcripts were entered into MaxQDA. The constant comparative method was used for data analysis.

RESULTS

Three patterns emerged from the data analysis: Recognising and Responding to the Event, Managing the Event and Challenges Encountered during the Event. From the patterns, seven themes emerged. Themes for pattern one, Recognising and Responding, were early warning signs, continuity in patient care assignments and intuition. Themes for pattern two, Managing the Event, were cognitive, technical and behavioural skills. The theme for pattern three, Challenges Encountered during the Event, was work environment complexity.

CONCLUSION

Listening to the stories of medical-surgical nurses provided insight into how they recognised and managed patients experiencing clinical deterioration events. Furthermore, insight into the challenges that medical-surgical nurses encountered in caring for deteriorating patients were identified.

RELEVANCE TO CLINICAL PRACTICE

Implication for practice in the areas of continuity of patient assignments, formal clinical deterioration education, work environment and team collaboration and communication was presented.

What factors influence ward nurses' recognition of and response to patient deterioration? An integrative review of the literature

Aim

In this integrative review, we aimed to: first, identify and summarize published studies relating to ward nurses' recognition of and response to patient deterioration; second, to critically evaluate studies that described or appraised the practice of ward nurses in recognizing and responding to patient deterioration; and third, identify gaps in the literature for further research.

Design

An integrative review.

Methods

The Cumulative Index to Nursing and Allied Health Literature (CINAHL) Ovid Medline, Informit and Google Scholar databases were accessed for the years 1990–2014. Data were extracted and summarized in tables and then appraised using the Mixed Method Appraisal Tool. Data were grouped into two domains; recognizing and responding to deterioration and then thematic analysis was used to identify the emerging themes.

Results

Seventeen studies were reviewed and appraised. Recognizing patient deterioration was encapsulated in four themes: (1) assessing the patient; (2) knowing the patient; (3) education and (4) environmental factors. Responding to patient deterioration was encapsulated in three themes; (1) non‐technical skills; (2) access to support and (3) negative emotional responses.

Conclusion

Issues involved in timely recognition of and response to clinical deterioration remain complex, yet patient safety relies on nurses’ timely assessments and actions.

Clinical Deterioration Leadership Ability Scale: A Psychometric Study

Background and Purpose: Assessing nurses’ perceived leadership abilities during clinical deterioration provides a starting point for designing educational interventions to support leadership improvement. The study purpose was to provide psychometric testing of the Clinical Deterioration Leadership Ability Scale (CDLAS). Methods: The psychometric properties and factor structure of the CDLAS was examined. Results: Factor analysis determined a 1-factor structure (eigenvalues 5.783). Construct validity was supported by a significant difference between experienced (M = 3.48, SD = .57) and less experienced nurses (M = 3.27, SD = .68; t(146) = −2.00, p = .047). Acceptable levels of internal consistency reliability were found (.93, .95, and .94). Conclusion: The CDLAS has demonstrated acceptable validity and reliability. Further testing is needed in diverse populations and establishment of test–retest reliability.