Clinical deterioration: A concept analysis

Padilla, Ricardo; Mayo, Ann M.

doi:10.1111/jocn.14238

Cited by 76 publications

(65 citation statements)

References 59 publications

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“…In this sense, early warning scores can help nurses and staff in the daily assessment of signs of clinical worsening in children, as well as direct to early intervention, as nurses are considered the forefront of patient care in the hospital and play a key role in recognizing and responding to clinical deterioration. 1 In addition, the systematization of the registration of vital and clinical data, through a simple and structured instrument, can assist the care team, contributing to the provision of safe care and allocation of care and human resources according to the patient's real needs. 29 The following aspects are considered as limitations of the present study: cross-sectional and unicentric study, small non-probabilistic sample and the gap in the national literature on the use of Early Warning Pediatric Scores as a criterion to identify clinical deterioration in Brazilian children, which made it difficult to discuss the data.…”

Section: Discussionmentioning

confidence: 99%

Factors Associated With the Clinical Deterioration Recognized by an Early Warning Pediatric Score

Miranda

Camargo

Sobrinho

et al. 2020

Texto contexto - enferm.

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Objective: To identify the factors associated with clinical deterioration recognized by a Pediatric Early Warning Score. Method: A cross-sectional study conducted in a tertiary pediatric public hospital with 271 children aged from zero to ten, hospitalized between May and October 2015. For the identification of the children with and without signs of clinical deterioration, the translated, adapted and validated version of the Brighton Pediatric Early Warning Score was applied to the Brazilian context. Logistic regression analysis and prevalence ratio (PR) were used to measure the association between the variables studied. A 95% Confidence Interval (CI) and p value were adopted as a measure of statistical significance to identify potential associated factors. Results: The factors associated with the clinical deterioration of the children studied were age ≤ 2 years old (p=0.000), hospitalization in the emergency unit (p=0.000), comorbidity (p=0.020) and clinical diagnosis of respiratory disease (p=0.000). Conclusion: Children ≤ 2 years old, with comorbidity, diagnosed with respiratory disease and hospitalized in the emergency unit showed an increased likelihood of clinical deterioration. The identification of factors associated with clinical deterioration may alert and direct the health team to children more susceptible to this phenomenon.

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Section: Discussionmentioning

confidence: 99%

Factors Associated With the Clinical Deterioration Recognized by an Early Warning Pediatric Score

Miranda

Camargo

Sobrinho

et al. 2020

Texto contexto - enferm.

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“…Frail patients have a higher risk of deterioration and increased mortality (Gobbens, Luijkx, Wijnen‐Sponselee, & Schols, 2010), so early recognition and response to clinical deterioration improve patient outcomes (Padilla & Mayo, 2018). Active clinical observation, early recognition, interventions to slow patients’ deterioration and the potential for deterioration are all emphasised (Gray, Currey, & Considine, 2018a; Odell, Victor, & Oliver, 2009).…”

Section: Introductionmentioning

confidence: 99%

“…Healthcare professionals in homecare comprise a mix of nurses, skilled health workers and assistants (Genet et al, 2012). These workers play an important role in noticing and responding to patients’ deterioration (Gray et al, 2018a; Padilla & Mayo, 2018). Greater expectations in homecare have resulted in a disparity between competence demands and actual worker competence (Bing‐Jonsson, Foss, & Bjørk, 2016; Genet et al, 2011; Maybin, Charles, & Honeyman, 2016).…”

Section: Introductionmentioning

confidence: 99%

Homecare professionals’ observation of deteriorating, frail older patients: A mixed‐methods study

Strømme

Aase

Tjoflåt

2020

Journal of Clinical Nursing

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Aim and objectives To develop knowledge about homecare professionals’ observational competence in early recognition of deterioration in frail older patients. Background The number of frail older patients in homecare has been rising, and these patients are at higher risk of deterioration and mortality. However, studies are scarce on homecare professionals’ recognition and response to clinical deterioration in homecare. Design This study applies an explorative, qualitative, mixed‐methods design. Methods The data were collected in two homecare districts in 2018 during 62 hr of participant observation, as well as from six focus group interviews. The data were subjected to qualitative content analyses. The Standards for Reporting Qualitative Research (SRQR) checklist was used to report the results. Results The data analyses revealed two main themes and five sub‐themes related to homecare professionals’ observational practices. The first main theme entailed patient‐situated assessment of changes in patients’ clinical condition, that is, the homecare professionals’ recognised changes in patients’ physical and mental conditions. The second theme was the organisational environment, in which planned, practical tasks and collaboration and collegial support were emphasised. Conclusions The homecare professionals in the two districts varied in their ability to recognise signs of patient deterioration. Their routines are described in detailed work plans, which seemed to affect assessment of their patients’ decline. Relevance for clinical practice The results can inform homecare services on how homecare professionals’ observational competence and an appropriate organisational system are essential in ensuring early detection of deterioration in frail older patients.

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“…Common identifiers of patient deterioration include changes in vital signs, oxygenation status and/or altered mental status (Goldhill & McNarry, 2004). In addition to objective determinants of patient deterioration, Padilla and Mayo (2018) include a subjective component due to evidence of clinicians' use of intuition or having a sense of concern for the patient when determining deterioration (p. 4). Caring for deteriorating patients is challenging; a nurse's ability to identify and manage patient deterioration effectively is associated with knowledge, confidence and level of experience (Liaw, Scherpbier, Klainin-Yobas, & Rethans, 2011;Massey, Chaboyer, & Aitken, 2014).…”

Section: Introductionmentioning

confidence: 99%

The art of balance: Preceptors’ experiences of caring for deteriorating patients

Ratta

2018

Journal of Clinical Nursing

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Clinical deterioration: A concept analysis

Cited by 76 publications

References 59 publications

Factors Associated With the Clinical Deterioration Recognized by an Early Warning Pediatric Score

Factors Associated With the Clinical Deterioration Recognized by an Early Warning Pediatric Score

Homecare professionals’ observation of deteriorating, frail older patients: A mixed‐methods study

The art of balance: Preceptors’ experiences of caring for deteriorating patients

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