Investigating ward nurses’ responses to deteriorating patients
Intended for healthcare professionals
Evidence and practice    

Investigating ward nurses’ responses to deteriorating patients

Nicholas Woolfe Loftus Staff nurse, Coronary Care Unit, St Bartholomew’s Hospital, Barts Health NHS Trust, London
Duncan Smith Lecturer, City, University of London, London; honorary charge nurse in the Patient Emergency Response and Resuscitation Team (PERRT), University College London Hospitals NHS Foundation Trust, London, and clinical doctoral research fellow

Why you should read this article:
  • To enhance your understanding of the factors that can influence nurses’ responses to deteriorating patients

  • To optimise recognition of, and responses to, deteriorating patients to reduce the risk of serious complications and possibly death

  • To ensure that your knowledge and skills are evidence-based and underpinned by the latest research

Deteriorating patients often present with suboptimal vital signs. If these are not recognised by healthcare staff, the patient’s condition can deteriorate further, potentially leading to serious complications and even death. Despite efforts to improve ward nurses’ recognition of, and responses to, deteriorating patients, this aspect of care has been found to be suboptimal.

Aim To identify factors that influence ward nurses’ responses to deteriorating patients.

Method A literature review was undertaken, based on the research question ‘What factors influence the trigger component of ward-based registered nurses’ afferent response to deteriorating patients?’ Several electronic databases were searched electronically to identify relevant articles, alongside hand-searching. Inclusion and exclusion criteria were set to determine which articles should be included in the literature review.

Findings Nine studies were identified for inclusion in the literature review. Four main themes that influenced ward nurses’ responses to deteriorating patients emerged: communication, diurnal and weekend variation, knowledge and attitudes, and nurse staffing levels.

Conclusion Effective communication was identified as an important factor in improving ward nurses’ responses to deteriorating patients, as was improved knowledge of ‘do not attempt cardiopulmonary resuscitation’ (DNACPR) orders. It was also identified that increased ward nurse numbers improved responses to deteriorating patients, as did increased availability of senior healthcare staff, which enabled junior staff to escalate care.

Nursing Standard. doi: 10.7748/ns.2018.e11020


Woolfe Loftus N, Smith D (2018) Investigating ward nurses’ responses to deteriorating patients. Nursing Standard. doi: 10.7748/ns.2018.e11020

Peer review

This article has been subject to external double-blind peer review and checked for plagiarism using automated software



Conflict of interest

None declared

Published online: 18 September 2018

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