title: Nurses' worry or concern and early recognition of deteriorating patients on general wards in acute care hospitals: a systematic review.
abstract: BACKGROUND
  Nurses often recognize deterioration in patients through intuition rather than through routine measurement of vital signs. Adding the 'worry or concern' sign to the Rapid Response System provides opportunities for nurses to act upon their intuitive feelings. Identifying what triggers nurses to be worried or concerned might help to put intuition into words, and potentially empower nurses to act upon their intuitive feelings and obtain medical assistance in an early stage of deterioration. The aim of this systematic review is to identify the signs and symptoms that trigger nurses' worry or concern about a patient's condition.
  
  
  METHODS
  We searched the databases PubMed, CINAHL, Psychinfo and Cochrane Library (Clinical Trials) using synonyms related to the three concepts: 'nurses', 'worry/concern' and 'deterioration'. We included studies concerning adult patients on general wards in acute care hospitals. The search was performed from the start of the databases until 14 February 2014.
  
  
  RESULTS
  The search resulted in 4,006 records, and 18 studies (five quantitative, nine qualitative and four mixed-methods designs) were included in the review. A total of 37 signs and symptoms reflecting the nature of the criterion worry or concern emerged from the data and were summarized in 10 general indicators. The results showed that worry or concern can be present with or without change in vital signs.
  
  
  CONCLUSIONS
  The signs and symptoms we found in the literature reflect the nature of nurses' worry or concern, and nurses may incorporate these signs in their assessment of the patient and their decision to call for assistance. The fact that it is present before changes in vital signs suggests potential for improving care in an early stage of deterioration.
authors.affiliation: Gelderse Vallei Hospital, Willy Brandtlaan 10, Ede, 6716, RP, The Netherlands. douwg@zgv.nl.|Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ Healthcare, Postbus 9101, Nijmegen, 6500, HB, The Netherlands. douwg@zgv.nl.
authors.forename: Gooske
authors.initials: G
authors.lastname: Douw
authors.affiliation: University of Southampton, Level A, (MP11) South Academic Block, General Hospital, Tremona Road, Southampton, SO16 6YD, UK. L.Schoonhoven@soton.ac.uk.|Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ Healthcare, Postbus 9101, Nijmegen, 6500, HB, The Netherlands. L.Schoonhoven@soton.ac.uk.
authors.forename: Lisette
authors.initials: L
authors.lastname: Schoonhoven
authors.affiliation: Gelderse Vallei Hospital, Willy Brandtlaan 10, Ede, 6716, RP, The Netherlands. HolwerdaT@zgv.nl.
authors.forename: Tineke
authors.initials: T
authors.lastname: Holwerda
authors.affiliation: Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ Healthcare, Postbus 9101, Nijmegen, 6500, HB, The Netherlands. Getty.Huisman-deWaal@radboudumc.nl.
authors.forename: Getty
authors.initials: G
authors.lastname: Huisman-de Waal
authors.affiliation: Gelderse Vallei Hospital, Willy Brandtlaan 10, Ede, 6716, RP, The Netherlands. ZantenA@zgv.nl.
authors.forename: Arthur R H
authors.initials: AR
authors.lastname: van Zanten
authors.affiliation: Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ Healthcare, Postbus 9101, Nijmegen, 6500, HB, The Netherlands. theo.vanachterberg@med.kuleuven.be.|Centre for Health Services and Nursing Research, KU Leuven, Kapucijnenvoer 35 blok d - box 7001, 3000, Leuven, Belgium. theo.vanachterberg@med.kuleuven.be.
authors.forename: Theo
authors.initials: T
authors.lastname: van Achterberg
authors.affiliation: Department of Intensive Care, Radboud university medical centre, Postbus 9101, Nijmegen, 6500 HB, The Netherlands. Hans.vanderHoeven@radboudumc.nl.
authors.forename: Johannes G
authors.initials: JG
authors.lastname: van der Hoeven
mesh_terms: D001775:Blood Circulation; D001831:Body Temperature; D003221:Confusion / Q000175:diagnosis; D003244:Consciousness Disorders / Q000175:diagnosis; D042241:Early Diagnosis; D006801:Humans; D009730:Nursing Assessment / Q000379:methods*; D009741:Nursing Staff, Hospital; D010146:Pain / Q000175:diagnosis; D011595:Psychomotor Agitation; D012119:Respiration