title: A review of educational strategies to improve nurses' roles in recognizing and responding to deteriorating patients.
abstract: BACKGROUND
  Physiological instability leading to clinical deterioration often precedes cardiopulmonary arrest. Nurses, who have the most frequent patient contact and responsibility for ongoing monitoring of patients, play a crucial role in recognizing and responding to clinical deterioration. The importance of education in supporting such a role has been addressed in numerous studies.
  
  
  OBJECTIVE
  This study aimed to identify nurses' educational needs and explore educational strategies to enhance their ability in recognizing and managing wards with deteriorating patients.
  
  
  METHODS
  A literature search from databases (2000-2010) was undertaken to include papers that identified the educational needs of ward nurses and existing educational programmes related to the care of deteriorating patients.
  
  
  RESULTS
  Twenty-six papers were included in this review. Findings identified the educational need to empower nurses with the appropriate knowledge and skills in recognizing, reporting and responding to patient deterioration. The review of existing educational programmes and their outcomes identified valuable teaching information and strategies, and areas that could be improved in meeting nurses' educational needs.
  
  
  CONCLUSIONS
  The review has highlighted important aspects of patient safety in clinical deterioration that could be further addressed by educational strategies targeting the role of ward nurses. These strategies include: utilizing clinical decision-making models to develop nurses' decision making skills; developing a standardized tool for systematic nursing assessment and management of clinical deterioration; incorporating training in clinical deterioration as a core competence of pre-registered nursing education; providing vital signs training to nursing assistants; and conducting more rigorous studies to evaluate the effectiveness of the educational programmes.
authors.affiliation: Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore. nurliaw@nus.edu.sg
authors.forename: S Y
authors.initials: SY
authors.lastname: Liaw
authors.forename: A
authors.initials: A
authors.lastname: Scherpbier
authors.forename: P
authors.initials: P
authors.lastname: Klainin-Yobas
authors.forename: J-J
authors.initials: JJ
authors.lastname: Rethans
mesh_terms: D004506:Education, Nursing / Q000379:methods*; D006801:Humans; D007318:Inservice Training / Q000379:methods*; D008991:Monitoring, Physiologic / Q000451:nursing; D009730:Nursing Assessment; D009741:Nursing Staff, Hospital / Q000193:education; D019370:Observation; D018794:Problem-Based Learning / Q000379:methods*