Acute Care Nurses' Partnership With Patients to Recognise and Respond to Changes in Patients' Clinical States: A Qualitative Study

Aim

To explore and describe acute care nurses' partnership with patients to recognise and respond to changes in patients' clinical states. Acute care nurses' decisions to partner with patients to recognise deterioration in clinical states and to respond by activating a rapid response system improves patient outcomes. Acutely unwell patients can also experience clinical changes that include improvement and deterioration that does not trigger rapid response system activation over the course of hospitalisation from illness and treatment. How acute care nurses partner with patients in response to improvement and deterioration not triggering a rapid response system is not well-understood.

Design

An exploratory, descriptive study underpinned by Tanner's Clinical Judgement Model.

Methods

Using purposive and quota sampling, 20 nurses with direct patient care responsibilities on one medical and one surgical ward in a large Australian hospital were recruited. Nonparticipant observations followed by semistructured interviews were conducted between January and May of 2021. Nurse–patient interactions were observed for 4 h, and verbally described and recorded. Semistructured interviews were recorded and explored nurses' reasoning behind decisions observed. Reflexive thematic analysis was used to analyse the data.

Results

Three themes were identified from the data: nurses checking in for changes; nurses forming judgements; and nurses partnering with patients to respond. Acute care nurses promoted subjective assessment based on patients' safety risks. Patients' participation in response to changes was prioritised based on acute care nurses' judgement of safety.

Conclusion

Patients receive significant safety benefits when acute care nurses partner with patients in response to their experience of improvement and deterioration during acute illness. Further research should evaluate the sensitivity of subjective cues in patient assessment.

Implications for the Profession and Patient Care

• Partnership with patients in assessment and management of improvement and deterioration improves the quality and safety of patient care.
• Assessment frameworks should equally prioritise the use of objective and subjective cues.
• Nursing education should promote the safety benefits of patient partnerships in responding to patient changes.

Reporting Method

Equator checklist COREQ.

Patient or Public Contribution

Data collected included description of patients' interactions with study participants.