Exploring the nurses' experiences in recognising and managing clinical deterioration in emergency patients: A qualitative study

Introduction: Emergency department patients are at a particularly high risk of deterioration. The frontline nurses are key players in identifying and responding to deterioration events; however, few studies have sought to explore the whole process of recognition and management clinical deterioration from emergency nurses.

Aim: The aim of this study was to explore the experiences of emergency nurses and provide a whole picture of how they recognise and manage clinical deterioration.

Method: A qualitative descriptive study involving 11 senior nurses and 7 junior nurses was conducted in the emergency department of a 3000-bed tertiary general hospital using semi-structured interviews. Each interview was conducted confidentially by a trained researcher and an observer in an undisturbed room of the emergency department, which was audio-recorded and lasted approximately 40 to 55 min. The interviews were transcribed and thematically analysed. Ethics approval was granted by the Human Research Ethics Committee of the hospital before the study started.

Results: Four salient themes emerged from the content analysis of the interviews. The first, 'early recognition and response', revealed the importance of vital signs assessment in recognising and responding to clinical deterioration. The second, 'information transfer', depicted the skills and difficulties of transferring information in escalations of care. The third, 'abilities, education, and training', presented the abilities that emergency nurses should have and their perspectives on training. The fourth, 'support culture', described the major role of senior nurses in collaboration with colleagues in the emergency department.

Conclusions: This study explored the experiences of emergency nurses in recognising and managing clinical deterioration. The findings illuminate the need to support the critical role of emergency nurses, with an emphasis on their abilities and continuous interprofessional collaboration training to improve the recognition and management of clinical deterioration.