Ward-Based Staff Perspectives on Their Preparedness to Recognize Patient Deterioration: An Interpretive Description Study.

Abstract

Background: Despite an overall decline in serious adverse events in hospitalized patients, approximately one third of inpatient mortality continues to relate to adverse events impacting patients on general wards. The preparedness of nurses, midwives, and nursing assistants (collectively referred to as ward-based staff) to recognize patient deterioration is therefore seen as critical.

Purpose: The aim of this study was to explore ward-based staff perspectives regarding their preparedness to recognize patient deterioration.

Methods: An interpretive description approach was utilized to interview 16 participants from a single-center regional hospital. The participants included nurses, midwives, and nursing assistants who worked exclusively on wards. The participants were purposely selected to complete semistructured interviews. Data were analyzed using a six-step thematic analysis, and the study followed the Standards for Reporting Qualitative Research checklist.

Results: Three main themes (with subthemes) were identified: (a) feeling prepared (experience, intuitive awareness, early warning systems), (b) promoting preparedness (multimodal education, debriefing, collegial support), and (c) being unprepared (undergraduate education, knowledge deficit, staffing related concerns, psychological response to incident, unforeseen barriers).

Conclusions/implications for practice: The findings suggest strategies for increasing knowledge and confidence in all ward-based staff, allowing them to feel better prepared to recognize clinical deterioration. Moreover, based on the results, ward-based staff strongly perceive experience, clinical shortfalls in undergraduate education, collegial support networks, mentorship, psychological response to incidents, and multimodal education to be key contributors to preparedness.