Indicators of clinical deterioration in adult general ward patients from nurses' perspectives: a mixed-methods systematic review

Abstract

Background: Early recognition and response to deteriorating patients in general wards are core competencies for nurses. Clinical deterioration is a worsening condition that increases the risk of morbidity and mortality. Although objective measures are commonly used, recent research suggests that subjective data and nurses' intuitions can serve as valuable indicators for early detection of deterioration in patients. This study aims to comprehensively identify and classify the indicators used to detect clinical deterioration in patients hospitalized in general wards from nurses' perspectives.

Methods: This is a mixed-methods systematic review followed a Joanna Briggs Institute Methodology convergent integrated approach. Four electronic databases (PubMed, CINAHL, Embase, and Scopus) were searched. Studies were screened based on the population of interest (nurses), the phenomenon of interest (patient deterioration), the context (adult care in acute hospital settings), the study type (original studies), and publication in English peer-reviewed journals from January 2014 to December 2023. Two authors independently conducted all screening steps and assessed the methodological quality of the included studies. Any disagreements were resolved through discussion. This review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis.

Results: Twenty-one studies met the eligibility criteria. Key indicators included vital signs, intake and output, laboratory data, and observational data. Nurses also relied on subjective data from patients' complaints and their own intuition to predict patient deterioration. The frequency and pattern of specific nursing interventions also play an important role.

Conclusions: This review identified vital indicators from nurses' perspectives, underscoring the value of subjective observations, intuition, and specific nursing interventions in predicting patient deterioration. Integrating subjective factors with objective data can improve early recognition of and response to clinical deterioration, thereby enhancing patient safety and outcomes. This review provides a foundation for future research aimed at quantifying subjective elements, such as patient complaints and nurses' intuitions, to be included in nursing records as key indicators for predicting patient deterioration.

Trials registration: This study was registered with PROSPERO under the registration number CRD42024552344.

Keywords: Clinical deterioration; Early recognition; Mixed-methods systematic review; Nurse intuition; Nursing interventions; Observational data; Subjective indicators.

Fig. 1

PRISMA flow diagram for this systematic review