Front line nurses' experiences with deteriorating ward patients: a qualitative study

Int Nurs Rev. 2013 Dec;60(4):501-9. doi: 10.1111/inr.12061. Epub 2013 Oct 16.


Background: Nurses in the general ward are faced with patients who are at high risk of clinical deterioration. Having the key role in performing routine vital signs monitoring, non-registered nurses such as enrolled nurses are the front line nurses who play a pivotal role in detecting and responding to the deteriorating ward patient.

Aims: (1) To explore the experience of enrolled nurses with deteriorating patients in pre-cardiac arrest situations and (2) to identify strategies to enhance their role in caring for deteriorating ward patients.

Method: A qualitative study using critical incident technique was conducted. Fifteen enrolled nurses who had encountered deteriorating ward patients were interviewed. Data were analysed using content analysis.

Findings: Three themes emerged describing enrolled nurse's experience with deteriorating patients: recognizing deterioration, responding to deterioration and taking responsibility. Two themes, including educational development and modifying clinical processes, were strategies identified to enhance the ability of enrolled nurses in recognizing and managing deteriorating patients.

Conclusion: The study highlighted a need to enhance the ability of front line nurses in recognizing and responding to patient deterioration through nursing education and modifications of clinical processes.

Implications for nursing and health policy: Nursing education could focus on increasing the awareness of the importance of performing complete vital signs monitoring and undertaking accurate interpretation of vital signs. Strategies to improve clinical processes could include the need for registered nurses to provide supervision of enrolled nurses in the interpretation of vital signs readings and share the responsibility of performing vital signs monitoring.

Keywords: Enrolled Nurses; Front line Nurses; Patient Deterioration; Patient Safety; Pre-Cardiac Arrest; Vital Signs; Ward Patients.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Clinical Competence*
  • Disease Progression
  • Female
  • Humans
  • Interviews as Topic
  • Male
  • Nursing Assessment*
  • Qualitative Research
  • Singapore
  • Task Performance and Analysis*
  • Vital Signs*