title: Packaging: a grounded theory of how to report physiological deterioration effectively.
abstract: OBJECTIVE
  The aim of this paper is to present a study of how ward-based staff use vital signs and the Early Warning Score to package physiological deterioration effectively to ensure successful referral to doctors.
  
  
  BACKGROUND
  The literature tends to emphasize the identification of premonitory signs in predicting physiological deterioration. However, these signs lack sensitivity and specificity, and there is evidence that nurses rely on subjective and subtle indicators. The Early Warning Score was developed for the early detection of deterioration and has been widely implemented, with various modifications.
  
  
  METHODS
  The data reported here form part of a larger study investigating the practical problems faced by general ward staff in detecting physiological deterioration. During 2002, interviews and observations were carried out using a grounded theory approach, and a total of 44 participants were interviewed (30 nurses, 7 doctors and 7 health care support workers).
  
  
  RESULTS
  Participants reported that quantifiable evidence is the most effective means of referring patients to doctors, and the Early Warning Score achieves this by improving communication between professionals. Rather than reporting changes in individual vital signs, the Early Warning Score effectively packages them together, resulting in a much more convincing referral. It gives nurses a precise, concise and unambiguous means of communicating deterioration, and confidence in using medical language. Thus, nurses are empowered and doctors can focus quickly on identified problems.
  
  
  CONCLUSIONS
  The Early Warning Score leads to successful referral of patients by providing an agreed framework for assessment, increasing confidence in the use of medical language and empowering nurses. It is essential that nurses and nursing students are supported in its use and in developing confidence in using medical language by continued emphasis on physiology and pathophysiology in the nursing curriculum.
authors.affiliation: Lecturer, School of Nursing and Midwifery, University College Cork, Cork, Ireland. t.andrews@ucc.ie
authors.forename: Tom
authors.initials: T
authors.lastname: Andrews
authors.forename: Heather
authors.initials: H
authors.lastname: Waterman
mesh_terms: D002983:Clinical Competence; D003142:Communication; D003422:Critical Care / Q000379:methods / Q000458:organization & administration*; D016638:Critical Illness; D006323:Heart Arrest / Q000503:physiopathology; D006801:Humans; D009730:Nursing Assessment / Q000379:methods*; D009741:Nursing Staff, Hospital / Q000193:education; D011787:Quality of Health Care; D012119:Respiration