When Nurses Worry: A Concept Analysis of Intuition in Clinical Deterioration

Abstract

Background: Nurse worry is a criterion often included in early warning systems tools and used to escalate care when other clinical markers do not indicate deterioration. What it means to worry, however, is not always clear.

Aims: To generate a concept analysis of nurse worry in relation to clinical deterioration.

Design: Rodgers's evolutionary method was used.

Method: A review was first conducted in April 2024, searching the Cumulative Index for Nursing and Allied Health Literature, Pubmed, EmCare, and Embase databases. A total of 22 articles were subjected to analysis of the antecedents, attributes, and consequences of nurse worry in the context of clinical deterioration. The processes of nurse worry were subsequently mapped and conceptualised, leading to a descriptive statement of nurse worry.

Results: Worry captures a nurse's sense of knowing the patient and is embodied via assessing, sensing, recognising, and processing information, cues, and patterns.

Conclusion: Nurse worry is a complex process, impacted by external and internal factors. Implications for the profession or patient care: Assured practice, driven by validation of a nurse's worry, leads to proactive care of the deteriorating patient, whereas apprehensive practice, driven by fear and trepidation, leads to reactive care of the deteriorating patient.

Impact: Nurse worry is a criterion often included in early warning systems tools and used to escalate care when other clinical markers do not indicate clinical deterioration. What it means to worry, however, is not always clear. From the concept analysis, a descriptive statement of nurse worry emerged. Worry captures a nurse's sense of knowing the patient and is embodied via assessing, sensing, recognising, and processing information, cues, and patterns.

Implications for the profession or patient care: This research has implications for nurses, policymakers, and organisations, as nurse worry is an important element in detecting clinical deterioration. Nurse worry must be organisationally supported.

Reporting methods: PRISMA Extension for Scoping Reviews (PRISMA-SCR).

Patient or public contribution: No Patient or Public Contribution.

Keywords: clinical deterioration; concept analysis; escalation; nurse worry.

FIGURE 1

PRISMA flowchart (Covidence).

FIGURE 2

Conceptual model of nurse worry.

FIGURE 3

Worry surrogate terms. Generated via Worditout (https://worditout.com/).