Ward nurses’ experiences of caring for adult patients with early signs of clinical deterioration: a qualitative study

Authors

DOI:

https://doi.org/10.12923/pielxxiw-2025-0022

Keywords:

general ward, clinical deteriorations, rapid response team, early warning scores, intensive care

Abstract

WARD NURSES’ EXPERIENCES OF CARING FOR ADULT PATIENTS WITH EARLY SIGNS OF CLINICAL DETERIORATION: A QUALITATIVE STUDY

Aim. Despite advancements in care,ward nurses still experience challenges in early detection and response, facing unnecessary delays in patient treatments. The aim of the study was to describe ward nurses’ experiences caring for adult patients with early signs of clinical deterioration.

Material and methods. A qualitative content analysis approach was used. Data collection was completed through an online focus group discussion in November 2023. The meeting was attended by ten ward nurses with experience in caring for adult patients with early signs of clinical deterioration. This study complied with the Consolidated Criteria for Reporting Qualitative Research (COREQ).

Results. The analysis identifi ed one main category:”Dealing with the challenges of care for adult patients with early signs of clinical deterioration”, which was divided into two subcategories “Early signs of deterioration assessment”, and “Response to early signs of deterioration”.

Conclusions. Ward nurses perceived that unusual changes in patient’s psychosocial and physical functioning were observed at the early phase of patient deterioration. It has been observed that the negative behaviors of other clinicians aff ect the promptness of clinical response. Consequently, there is a need to improve the clinicians’ negative behaviors and develop an eff ective early warning screening tool that accurately capture early signs of patient deterioration in the ward.

References

1. Lavoie P, Pepin J, Alderson M. Defining patient deterioration through acute care and intensive care nurses’ perspectives. Nursing in Critical Care. 2016;21(2):68-77. https://doi.org/10.1111/nicc.12114

2. National Confidential Enquiry into Patient Outcome and Death. Inspiring change: a review of the quality of care for acute non-invasive ventilation patients. 2017. Available from: http://www.ncepod.org.uk/2017niv.html

3. Allen G. Barriers to non-critical care nurses identifying and responding to early signs of clinical deterioration in acute care facilities. Medsurg Nursing. 2020;29(1):43-52.

4. Cuzco C, Delgado‐Hito P, Marín Pérez R, et al. Patients experience while transitioning from the intensive care unit to a ward. Nursing in Critical Care. 2022;27(3):419-428. https://doi.org/10.1111/nicc.12697

5. Petersen JA. Early warning score challenges and opportunities in the care of deteriorating patients. Dan. Med. J. 2018 Feb;65(2):B5439.

6. Hosny R, Hussein RS, Hussein WM, et al. Effectiveness of Rapid Response Team implementation in a tertiary hospital in Egypt: an interventional study. BMJ Open Quality. 2024;13(3):e002540. https://doi.org/10.1136/bmjoq-2023-002540

7. Stewart J, Carman M, Spegman A, et al. Evaluation of the effect of the modified early warning system on the nurse-led activation of the rapid response system. Journal of Nursing Care Quality. 2014;29(3):223-9. https://doi.org/10.1097/NCQ.0000000000000048

8. Chua WL, Legido-Quigley H, Jones D, et al. A call for better doctor–nurse collaboration: A qualitative study of the experiences of junior doctors and nurses in escalating care for deteriorating ward patients. Australian Critical Care. 2020;33(1):54-61. https://doi.org/10.1016/j.aucc.2019.01.006

9. Subbe CP, Duller B, Bellomo R. Effect of an automated notification system for deteriorating ward patients on clinical outcomes. Critical Care. 2017;21:1-9. https://doi.org/10.1186/s13054-017-1635-z

10. Dresser S, Teel C, Peltzer J. Frontline Nurses’ clinical judgment in recognizing, understanding, and responding to patient deterioration: A qualitative study. International Journal of Nursing Studies. 2023;139:104436. https://doi.org/10.1016/j.ijnurstu.2023.104436

11. Dalton, M, Harrison, J, Malin, A, et al. Factors influencing nurses’ assessment of patient acuity and response to acute deterioration. British Journal of Nursing. 2018;27(4):212-218. https://doi.org/10.12968/bjon.2018.27.4.212

12. Massey D, Chaboyer W, Anderson V. What factors influence ward nurses’ recognition of and response to patient deterioration? An integrative review of the literature. Nursing Open. 2017;4(1):6-23. https://doi.org/10.1002/nop2.53

13. Odell M. Detection and management of the deteriorating ward patient: an evaluation of nursing practice. Journal of Clinical Nursing. 2015;24(1-2):173-182. https://doi.org/10.1111/jocn.12655

14. Mohammmed Iddrisu S, Hutchinson A, Sungkar Y, et al. Nurses’ role in recognizing and responding to clinical deterioration in surgical patients. Journal of Clinical Nursing. 2018;27(9-10):1920-1930. https://doi.org/10.1111/jocn.14331

15. Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures, and measures to achieve trustworthiness. Nurse Education Today. 2004;24(2):105-12. https://doi.org/10.1016/j.nedt.2003.10.001

16. Lathen L, Laestadius L. Reflections on online focus group research with low socio-economic status African American adults during COVID-19. International Journal of Qualitative Methods. 2021;20:16094069211021713. https://doi.org/10.1177/16094069211021713

17. Tong A, Sainsbury P, Craig J. Consolidated Criteria for Reporting Qualitative Research(COREQ): A 32-Item Checklist for Interviews and Focus Groups. Int. J. Qual. Health Care. 2007;19(6):349-357. https://doi.org/10.1093/intqhc/mzm042

18. Blackwell JN, Keim-Malpass J, Clark MT, et al. Early detection of inpatient deterioration: one prediction model does not fit all. Critical Care Explorations. 2020;2(5):e0116. https://doi.org/10.1097/CCE.0000000000000116

19. Posthuma LM, Downey C, Visscher MJ, et al. Remote wireless vital signs monitoring on the ward for early detection of deteriorating patients: a case series. International Journal of Nursing Studies. 2020;104:103515. https://doi.org/10.1016/j.ijnurstu.2019.103515

20. Mann KD, Good NM, Fatehi F, et al. Predicting patient deterioration: a review of tools in the digital hospital setting. Journal of Medical Internet Research. 2021;23(9):e28209. https://doi.org/10.2196/28209

21. Mok WQ, Wang W, Liaw SY. Vital signs monitoring to detect patient deterioration: An integrative literature review. International Journal of Nursing Practice. 2015;21(2):91-98. https://doi.org/10.1111/ijn.12329

22. Chung C, McKenna L, Cooper SJ. Patients’ experiences of acute deterioration: a scoping review. International Journal of Nursing Studies. 2020;101:103404. https://doi.org/10.1016/j.ijnurstu.2019.103404

23. Muralitharan S, Nelson W, Di S, et al. Machine learning–based early warning systems for clinical deterioration: a systematic scoping review. Journal of Medical Internet Research. 2021;23(2):e25187. https://doi.org/10.2196/25187

24. da Silva DB, Schmidt D, da Costa CA, et al. DeepSigns: A predictive model based on Deep Learning for the early detection of patient health deterioration. Expert Systems with Applications. 2021;165:113905. https://doi.org/10.1016/j.eswa.2020.113905

25. Gerry S, Bonnici T, Birks J, et al. Early warning scores for detecting deterioration in adult hospital patients: systematic review and critical appraisal of methodology. BMJ. 2020;369:m1501. https://doi.org/10.1136/bmj.m1501

26. Kia A, Timsina P, Joshi HN, et al. MEWS++: enhancing the prediction of clinical deterioration in admitted patients through a machine learning model. Journal of Clinical Medicine. 2020;9(2):343. https://doi.org/10.3390/jcm9020343

27. O’Neill SM, Clyne B, Bell M, et al. Why do healthcare professionals fail to escalate as per the early warning system (EWS) protocol? A qualitative evidence synthesis of the barriers and facilitators of escalation. BMC Emergency Medicine. 2021;21:1-9. https://doi.org/10.1186/s12873-021-00403-9

28. Walker RM, Boorman RJ, Vaux A, et al. Using a behavior change approach to identifying barriers and facilitators to recognition and response to patient clinical deterioration by clinicians: A qualitative study. Journal of Clinical Nursing. 2021;30(5-6):803-818. https://doi.org/10.1111/jocn.15620

29. Manojlovich M, Harrod M, Hofer T, et al. Factors influencing physician responsiveness to nurse-initiated communication: a qualitative study. BMJ Qual. Saf. 2021;30(9):747-754. https://doi.org/10.1136/bmjqs-2020-011441

30. Hotta S, Ashida K, Tanaka M. Night‐time detection and response in relation to deteriorating inpatients: A scoping review. Nursing in Critical Care. 2024;29(1):178-190. https://doi.org/10.1111/nicc.12917.

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Published

2025-08-08

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Original papers

How to Cite

Bacalso, L. A. (2025). Ward nurses’ experiences of caring for adult patients with early signs of clinical deterioration: a qualitative study. Nursing in the 21st Century, AOP. https://doi.org/10.12923/pielxxiw-2025-0022