title: Defining patient deterioration through acute care and intensive care nurses' perspectives.
abstract: OBJECTIVE
  To explore the variations between acute care and intensive care nurses' understanding of patient deterioration according to their use of this term in published literature.
  
  
  BACKGROUND
  Evidence suggests that nurses on wards do not always recognize and act upon patient deterioration appropriately. Even if resources exist to call for intensive care nurses' help, acute care nurses use them infrequently and the problem of unattended patient deterioration remains.
  
  
  METHODS
  Dimensional analysis was used as a framework to analyze papers retrieved in a nursing-focused database.
  
  
  METHODS
  A thematic analysis of 34 papers (2002-2012) depicting acute care and intensive care unit nurses' perspectives on patient deterioration was conducted.
  
  
  RESULTS
  No explicit definition of patient deterioration was retrieved in the papers. There are variations between acute care and intensive care unit nurses' accounts of this concept, particularly regarding the validity of patient deterioration indicators. Contextual factors, processes and consequences are also explored.
  
  
  CONCLUSIONS
  From the perspectives of acute care and intensive care nurses, patient deterioration can be defined as an evolving, predictable and symptomatic process of worsening physiology towards critical illness. Contextual factors relating to acute care units (ACU) appear as barriers to optimal care of the deteriorating patient. This work can be considered as a first effort in modelling the concept of patient deterioration, which could be specific to ACU.
  
  
  CONCLUSIONS
  The findings suggest that it might be relevant to include subjective indicators of patient deterioration in track and trigger systems and educational efforts. Contextual factors impacting care for the deteriorating patient could be addressed in further attempts to deal with this issue.
authors.affiliation: Faculty of Nursing, Université de Montréal, Montreal, Canada.
authors.forename: Patrick
authors.initials: P
authors.lastname: Lavoie
authors.affiliation: Center for Innovation in Nursing Education (CIFI), Faculty of Nursing, Université de Montréal, Montreal, Canada.
authors.forename: Jacinthe
authors.initials: J
authors.lastname: Pepin
authors.affiliation: Faculty of Nursing, Université de Montréal, Montreal, Canada.
authors.forename: Marie
authors.initials: M
authors.lastname: Alderson
mesh_terms: D000075902:Clinical Deterioration; D064648:Critical Care Nursing / Q000379:methods*; D016638:Critical Illness / Q000451:nursing; D006801:Humans; D007362:Intensive Care Units; D009741:Nursing Staff, Hospital / Q000523:psychology*
keywords: Acute care nurses' perspective; Dimensional analysis; Intensive care nurses' perspective; Patient deterioration