Reflections from the frontline of nursing on acute patient deterioration

Abstract

Aims: To describe medical-surgical nurses' reflections on their experiences with patient deterioration.

Background: An extensive body of knowledge exists regarding optimal responses to acute patient deterioration within a hospital environment. Much less attention has focused on the profound psychological and emotional impact these experiences of unexpected deterioration can have on nurses who provided the supportive or rescue care. A triggering event, such as patient deterioration, or direct questioning about these experiences, can lead nurses to reflect further on the situation. Engaging in reflection is believed to enhance learning and improve clinical judgement when future complex situations arise. Findings related to nurses' reflective practice when recalling previous situations with deteriorating patients are limited. This gap in the literature provided the basis for the current project.

Design: A qualitative descriptive design.

Methods: Twenty medical-surgical nurses were interviewed in 2018. The nurses were recruited through purposive sampling. Semi-structured telephone interviews explored nurses' experiences of a patient deterioration. Conventional content analysis with iterative coding and categorising and theme development was used for data analysis.

Findings: Three themes emerged as participants reflected on their experiences. The themes were, Enduring frustration and regret, Feeling deeply responsible for and to the patient and Making sense of what happened.

Conclusions: Medical-surgical nurses who care for acutely deteriorating patients can experience lasting emotional, psychological and physical concerns that often go unrecognised and untreated. Furthermore, nurses with this background commonly reported their perceived increased risk for workplace distress.

Relevance to clinical practice: Findings from this study are important for nurses, healthcare administrators and leaders, and patients. Participating in a rescue attempt often has a negative impact on nurses' perception of workplace stress and on persistent concerns about nurses' mental and physical health. The findings can be useful in informing additional studies about the phenomenon. Findings also can inform the exploration of workplace design. Organisations should assess for factors influencing workplace stress, develop strategies to mitigate the presence of workplace stress and foster nurses' well-being so they can respond to future scenarios of patient deterioration, while maintaining their physical and mental health.

Patient or public contribution: This study did not include any patient or public input.

Keywords: moral distress; nursing; patient deterioration; workplace distress.