title: Caring for Acutely Ill Patients in General Wards: A Qualitative Study.
abstract: BACKGROUND
  The number of acutely ill patients has risen in general wards due to the aging population, more advanced and complicated therapeutic methods, economic changes in the health system, therapeutic choices and shortage of intensive care unit beds. This may lead to adverse events and outcomes with catastrophic results. The purpose of this study was to describe the conditions of acutely ill patients, from the perspective of caregivers.
  
  
  METHODS
  The study was conducted in Tehran University of Medical Sciences and its two affiliated general teaching hospitals. Ten nurses and physicians participated in interviews, which were analyzed using qualitative content analysis methods.
  
  
  RESULTS
  Four main categories of difficulties in caring for acutely ill patients in general wards were described: problems in identifying acutely ill patients, problems in clinical management of acutely ill patients, inappropriate use of Intensive Care Unit (ICU) beds, and poor structure for mortality control. The staff do not appropriately diagnose the signs of deterioration. There are problems with the appropriate management of acutely ill patients, even if they are considered to be acutely ill and in need of special attention in general wards.
  
  
  CONCLUSIONS
  Many shortcomings exist caring for acutely ill patients, ranging from identification to clinical management; there are also structural and contextual problems. An immediate plan is necessary to circumvent the challenges and to improve the care for acutely ill patients. These challenges highlight the need for changes in current levels of care for acutely ill patients, as well as the need for appropriate support systems.
authors.affiliation: Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran, Ministry of Health and Medical Education, Tehran, Iran.
authors.forename: Ali Reza
authors.initials: AR
authors.lastname: Jeddian
authors.affiliation: Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK.
authors.forename: Antje
authors.initials: A
authors.lastname: Lindenmeyer
authors.affiliation: Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK.
authors.forename: Tom
authors.initials: T
authors.lastname: Marshall
authors.affiliation: School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Arash
authors.initials: A
authors.lastname: Rashidian
authors.affiliation: School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Leila
authors.initials: L
authors.lastname: Sayadi
authors.affiliation: Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran, Ministry of Health and Medical Education, Tehran, Iran.
authors.forename: Nazila
authors.initials: N
authors.lastname: Jafari
mesh_terms: D000208:Acute Disease / Q000451:nursing* / Q000628:therapy*; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D007492:Iran; D008297:Male; D009726:Nurses; D005791:Patient Care / Q000592:standards*; D010362:Patients' Rooms / Q000458:organization & administration*; D019555:Physician-Nurse Relations; D010820:Physicians; D036301:Qualitative Research