Chung Jeehae, Jung Hyesil
College of Nursing, Gachon University, 191 Hambakmoero, Yeonsu-gu, Incheon, South Korea.
School of Nursing, Inha University, 100 Inha-ro, Michuhol-gu, Incheon, 22212, South Korea.
BMC Nurs. 2024 Nov 26;23(1):861. doi: 10.1186/s12912-024-02531-6.
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.
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.
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.
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.
This study was registered with PROSPERO under the registration number CRD42024552344.
普通病房护士对病情恶化患者的早期识别和应对是核心能力。临床病情恶化是一种病情加重的情况，会增加发病和死亡风险。虽然客观指标常用，但近期研究表明主观数据和护士的直觉可作为早期发现患者病情恶化的重要指标。本研究旨在从护士角度全面识别和分类用于检测普通病房住院患者临床病情恶化的指标。
这是一项采用乔安娜·布里格斯研究所方法收敛性综合方法的混合方法系统评价。检索了四个电子数据库（PubMed、CINAHL、Embase和Scopus）。根据感兴趣的人群（护士）、感兴趣的现象（患者病情恶化）、背景（急性医院环境中的成人护理）、研究类型（原始研究）以及2014年1月至2023年12月在英文同行评审期刊上发表的文章进行筛选。两位作者独立进行所有筛选步骤并评估纳入研究的方法学质量。任何分歧通过讨论解决。本评价按照系统评价和Meta分析的首选报告项目进行报告。
21项研究符合纳入标准。关键指标包括生命体征、出入量、实验室数据和观察数据。护士还依靠患者主诉的主观数据及其自身直觉来预测患者病情恶化。特定护理干预的频率和模式也起着重要作用。
本评价从护士角度确定了重要指标，强调了主观观察、直觉和特定护理干预在预测患者病情恶化方面的价值。将主观因素与客观数据相结合可改善对临床病情恶化的早期识别和应对，从而提高患者安全性和治疗效果。本评价为未来旨在量化主观因素（如患者主诉和护士直觉）的研究奠定了基础，以便将这些因素作为预测患者病情恶化的关键指标纳入护理记录。
本研究在PROSPERO注册中心注册，注册号为CRD42024552344。
