Recognising the Sick Patient: An Emergency Nurses View

Abstract

This paper reports a literature review that examines how health professionals (mainly nurses) recognise the signs of physical deterioration in their patients. Investigation of literature in this area provides information of how nurses' clinical decision making skills influence how physical deterioration is identified and determines what changes in the delivery of care could have an impact on emergency department patients at risk of life threatening deterioration. Physical deterioration does not occur in isolation and in most instances is preceded by a period of abnormal physiological signs. Therefore the ability to recognise subtle physiological changes plays a significance part in reducing the incidence of adverse events. An emphasis on surveillance and an infrastructure that supports how nurses report and respond to subtle signs of deterioration is found to be a significant factor in preventing physical deterioration going unnoticed. Systems that provide health professionals with a guide for triggering appropriate responses have been shown to improve patient outcomes regardless of the level of experience of the health professionals activating the call for assistance. Early recognition of physical deterioration allows health professionals to intervene in such a way that outcomes for patients are improved. This is either by rapid acute care interventions or by timely activation of a care of the dying pathway in those patients who do not wish to be resuscitated. Emergency nurses have a vital role to play in preventing the physiological deterioration of those patients who wait in emergency corridors to be seen by admitting registrars or to go to the ward. A change in focus that encourages a rapid response to deterioration will assist emergency nurses take responsibility for initiating and evaluating interventions aimed at restoring normal functioning.