Nurses' worry or concern and early recognition of deteriorating patients on general wards in acute care hospitals

Nurses' worry or concern and early recognition of deteriorating patients on general wards in acute care hospitals: a systematic review. Critical Care, 2015, 19: 230

Douw, G., et al.

http://ccforum.com/content/pdf/s13054-015-0950-5.pdf

 Nurses often recognize deterioration in patients through intuition rather than through routine vital signs measurement. Adding the ‘worry/concern’ sign to the Rapid Response System provides opportunities for nurses to act upon their intuitive feelings. Identifying what triggers nurses to be ‘worried/concerned’ might help to put intuition into words and potentially empower nurses to act upon their intuitive feelings and obtain medical assistance in an early stage of deterioration. The aim of this systematic review is to identify the signs and symptoms that trigger nurses’ ‘worry/concern’ about a patients’ condition. Method We searched the databases Pubmed, CINAHL, Psychinfo and Cochrane Library (Clinical Trials) using synonyms related to the three concepts:“nurses”, “worry/concern” and “deterioration”. We included studies concerning adult patients on general wards in acute care hospitals. The search was performed from start of the databases until February 14, 2014. Results: The search resulted in 4006 references, 18 studies (5 quantitative, 9 qualitative and 4 mixed-methods designs) were included in the review. Thirty-seven signs and symptoms reflecting the nature of ‘worry/concern’, emerged from the data and were summarized in 10 general indicators. ‘Worry/concern’ can be present both with or without change in vital signs. Conclusions: The signs and symptoms we found in the literature reflect the nature of nurses’ ‘worry/concern’ and nurses may incorporate these signs in their assessment of the patient and the decision to call for assistance. Its presence before vital signs have changed, suggests potential for improving care in an early stage of deterioration.