'Patients of concern' to nurses in acute care settings: A descriptive study

Background: Nurses are required to recognise early clinical deterioration in patients and call emergency support. Nurses often use the subjective non-specific criterion, 'concerned about the patient' as the indication for calling. No study has identified cues of relevance to this criterion. Purpose: The purpose of this study is to identify cues of potential early clinical deterioration used to recognise 'a patient of concern' who is not meeting the current objective physiologic emergency response team calling criteria. Method: An exploratory descriptive approach was used involving interviews with a purposive sample of 17 experienced registered nurses who recalled incidences of calling the team to adult patients based on the criterion, 'concerned about patient'. The transcribed audio tapes of interviews were coding to identify cues. Findings: Main findings are ten identified changes of concern (cues): noisy breathing, inability to talk in sentences, increasing supplemental O-2 requirements to maintain SaO(2), agitation, impaired mentation, impaired cutaneous perfusion, not expected trajectory, new or increasing pain, new symptom, and new observation that nurses used to recognise potential early clinical deterioration. Two mediating factors were also identified that influenced the decision-making process. Conclusion: The ten changes of concern (cues) can be considered precursors of potential early deterioration that may assist nurses to detect patients at possible risk. Nurses are also aware that some patient groups are at higher risk as they are not able to communicate potential deterioration as perhaps other patients can. This study has only identified two patient groups and it is possible others should be considered. The availability of identified precursors indicates their validity for recognizing possible early clinical deterioration should be investigated further. (C) 2009 Australian College of Critical Care Nurses Ltd. Published by Elsevier Australia (a division of Reed International Books Australia Pty Ltd). All rights reserved.