title: What factors influence ward nurses' recognition of and response to patient deterioration? An integrative review of the literature.
abstract: In this integrative review, we aimed to: first, identify and summarize published studies relating to ward nurses' recognition of and response to patient deterioration; second, to critically evaluate studies that described or appraised the practice of ward nurses in recognizing and responding to patient deterioration; and third, identify gaps in the literature for further research.
  
  
  
  An integrative review.
  
  
  
  The Cumulative Index to Nursing and Allied Health Literature (CINAHL) Ovid Medline, Informit and Google Scholar databases were accessed for the years 1990-2014. Data were extracted and summarized in tables and then appraised using the Mixed Method Appraisal Tool. Data were grouped into two domains; recognizing and responding to deterioration and then thematic analysis was used to identify the emerging themes.
  
  
  
  Seventeen studies were reviewed and appraised. Recognizing patient deterioration was encapsulated in four themes: (1) assessing the patient; (2) knowing the patient; (3) education and (4) environmental factors. Responding to patient deterioration was encapsulated in three themes; (1) non-technical skills; (2) access to support and (3) negative emotional responses.
  
  
  
  Issues involved in timely recognition of and response to clinical deterioration remain complex, yet patient safety relies on nurses' timely assessments and actions.
authors.affiliation: Anaesthetics Department, Nambour General Hospital, Sunshine Coast Hospital and Health Service Hospital Rd Nambour QLD 4560 Australia; Griffith University.
authors.forename: Debbie
authors.initials: D
authors.lastname: Massey
authors.affiliation: NHMRC Centre of Research Excellence in Nursing (NCREN) Menzies Health Institute Queensland School of Nursing and Midwifery Griffith University QLD 4222 Australia; Institute of Health and Care Sciences Gothenburg University Australia.
authors.forename: Wendy
authors.initials: W
authors.lastname: Chaboyer
authors.affiliation: NHMRC Centre for Research Excellence in Nursing Interventions for Hospitalised Patients (NCREN) Centre for Health Practice Innovation Menzies Health Institute Qld Gold Coast Campus Qld 4222 Australia.
authors.forename: Vinah
authors.initials: V
authors.lastname: Anderson
keywords: Integrative review; nurses; patient deterioration; recognizing; responding