Visualising Deteriorating Conditions

The research aims were to investigate the difficulties ward staff experienced in detecting deterioration and how these were resolved. The emphasis within the literature tends to be on identifying premonitory signs that may be useful in predicting deterioration. Changes in respiratory rate is the most consistent of these (Fieselmann et al. 1993; Sax and Charlson 1987; Schein et al. 1990; Smith and Wood 1998) but in common with other signs, it lacks sensitivity and specificity. The sample consisted of 44 nurses, doctors (Interns) and health care support workers from a general medical and surgical ward. Data were collected by means of nonparticipant observations and interviews, using grounded theory as originated by (Glaser and Strauss 1967) and (Glaser 1978). As data were collected, the constant comparative method and theoretical sensitivity were used as outlined in grounded theory. A core category of “visualising deteriorating conditions” emerged, together with its sub-core categories of “intuitive knowing”, “baselining” and “grabbing attention”.The main concern in visualising deteriorating conditions is to ensure that patients suspected of deterioration are successfully referred to medical staff. The aim is to convince those who can treat or prevent further deterioration to intervene. Through intuitive knowing they pick up that patients have changed in a way that requires a medical assessment. To make the referral more credible, nurses attempt to contextualise any changes in patients by baselining (establishing baselines). Finally with the backup of colleagues, nurses refer patients by providing as much persuasive information as possible in a way that grabs attention. The whole process is facilitated by knowledge and experience, together with mutual trust and respect