To identify the factors that influence the recognizing and responding to adult patient deterioration in acute hospitals. (30th July 2019)

• Record Type: Journal Article
• Authors: Treacy, Michelle; Caroline Stayt, Louise
• Is Part Of: Journal of advanced nursing. Volume 75:Number 12(2019)
• Page Start: 3272
• Page End: 3285
• Publication Date: 2019-07-30
• Subjects: acute care -- acutely ill patient -- clinical deterioration -- critical care -- early warning score -- nurses -- patient deterioration -- rapid response teams -- recognizing and responding to patient deterioration -- vital signs; Nursing -- Periodicals; 610.7305
• DOI: 10.1111/jan.14138
• Languages: English
• ISSNs: 0309-2402

Abstract

Abstract: Aims: To identify factors that influence recognition and response to adult patient deterioration in acute hospitals. Design: A mixed‐studies systematic review. Data Sources: CINAHL, Medline, and Web of Science were searched for relevant literature published between 2007 – 2018. Review Methods: Studies were critically appraised, data extracted and thematically analysed. Results: Thirteen papers met the inclusion criteria. Three main themes were identified: (a) Knowledge and understanding of clinical deterioration; (b) Organizational factors; managing deterioration and staffing levels; and (c) Communication; inter‐professional relationships and professional‐patient communication. Conclusion: Despite national guidelines, the review findings suggest that the recognition and response to adult patient deterioration in acute hospital settings is sub‐optimal. A multitude of factors influencing the recognition and response to adult patient deterioration emerged from the findings. Impact: Patients are receiving sub‐optimal care due to failure in recognizing and responding to patient deterioration in an appropriate and timely manner. Nurses lack knowledge and understanding of deterioration. Organizational factors contribute to inadequate care and communication among professionals was highlighted as challenging. The factors that influence the recognizing and responding to patient deterioration in acute hospitals are multi‐faceted, however this review highlights immediate recommendations for professionals in the acute care setting. Abstract : 目的: 确定影响急症医院对成年患者病情恶化的认识和反应的因素。 设计: 混合研究系统性评价。 资料来源: 对CINAHL、Medline以及科学网上2007年至2018年发表的相关文献进行了检索。 综述方法: 对研究进行批判性评估、数据提取和专题分析。 结果: 13篇论文符合纳入标准。确定了三个专题:(a)关于临床病情恶化的知识和理解;(b)组织因素;处理病情恶化情况与人员配置水平;(c)沟通;专业人员之间的关系和专业人员与患者之间的沟通。 结论: 尽管有国家指导方针, 本次评价的调查结果表明, 在急症医院环境中, 对成年患者病情恶化的认识和反应并不理想。调查结果表明, 影响对成年患者病情恶化的认识和反应的因素很多。 影响: 由于未能以适当且及时的方式识别和应对患者病情恶化, 患者接受的护理并不理想。护士对病情恶化缺乏认识和了解。有人强调, 组织因素会造成专业人员的护理和沟通不足, 这是颇具挑战性的情况。影响急症医院对患者病情恶化的认识和反应的因素是多方面的, 然而, 本次评价强调, 在急症护理环境中, 应即时对专业人员提出建议。