title: Managing patients at risk of deterioration in rural hospitals: a qualitative study.
abstract: OBJECTIVE
  This paper examines strategies used by nurses to manage patients at risk of deterioration in smaller rural hospitals in Victoria, Australia.
  
  
  METHODS
  A two-stage design comprising a postal questionnaire (n = 20) and case studies (n = 7). Case study participants were interviewed and their practice was observed for one shift.
  
  
  METHODS
  Smaller rural hospitals in Victoria.
  
  
  METHODS
  Registered Nurses (Division 1).
  
  
  METHODS
  Observed and reported strategies used to manage deteriorating patients.
  
  
  RESULTS
  Nurses in this study used clinical strategies and communication strategies when managing patients who might deteriorate. These strategies were adapted to suit the individual rural context. The ability to anticipate patient requirements and confidence to act on clinical presentation were central. Nurses also had to learn the art of referral and they tailored communication according to their perception of the knowledge and skills of medical colleagues. Strategies were also influenced by staffing patterns and expectations of the community and health service.
  
  
  CONCLUSIONS
  We conclude that rural nurses play an essential role in assessing and managing risk of deterioration across a range of patient presentations and often in challenging situations. Strategies used by nurses required an understanding of the rural context of care delivery.
authors.affiliation: School of Health and Environment, La Trobe University, Bendigo, Victoria, Australia. r.endacott@latrobe.edu.au
authors.forename: Ruth
authors.initials: R
authors.lastname: Endacott
authors.forename: Michelle
authors.initials: M
authors.lastname: Westley
mesh_terms: D000223:Adaptation, Psychological; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D002985:Clinical Protocols; D003142:Communication; D007722:Health Knowledge, Attitudes, Practice; D006301:Health Services Needs and Demand; D006780:Hospitals, Rural; D006801:Humans; D007400:Interprofessional Relations; D020380:Needs Assessment; D024802:Nurse's Role / Q000523:psychology; D009730:Nursing Assessment / Q000458:organization & administration*; D015404:Nursing Methodology Research; D009741:Nursing Staff, Hospital / Q000193:education / Q000458:organization & administration / Q000523:psychology*; D017410:Practice Guidelines as Topic; D036301:Qualitative Research; D012017:Referral and Consultation / Q000458:organization & administration*; D018570:Risk Assessment; D020377:Self Efficacy; D011795:Surveys and Questionnaires; D014218:Triage; D014739:Victoria