Ricardo M Padilla1, Ann M Mayo1. 1. Hahn School of Nursing & Health Science, Beyster Institute for Nursing Research, University of San Diego, San Diego, CA, USA.
Abstract
AIMS AND OBJECTIVES: To present a concept analysis of clinical deterioration and introduce an operational definition. BACKGROUND: Hospitalised patients who endure cardiopulmonary arrest and unplanned intensive care unit admissions often exhibit physiological signs preceding these events. Clinical deterioration not promptly recognised can result in increased patient morbidity and mortality. A barrier to recognising and responding to clinical deterioration stems from practice variations among healthcare clinicians. DESIGN: Concept analysis. METHODS: Eight-step method of concept analysis proposed by Walker and Avant. RESULTS: Defining attributes include dynamic state, decompensation and objective and subjective determination. Antecedents identified include clinical state, susceptibility, pathogenesis and adverse event. Increased mortality, resuscitation, implementation of higher level of care and prolonged hospital admission were the consequences identified. Defining attributes, antecedents and consequences identified led to an operational definition of clinical deterioration as a dynamic state experienced by a patient compromising hemodynamic stability, marked by physiological decompensation accompanied by subjective or objective findings. CONCLUSIONS: Clinical deterioration is a key contributor to inpatient mortality, and its recognition is often underpinned by contextual factors and practice variances. Variation in the uniformity of the concept of clinical deterioration causes a gap in knowledge and necessitated clarification of this phenomenon for nursing research and practice. RELEVANCE TO CLINICAL PRACTICE: Identifying and intervening on clinical deterioration plays a vital role in the inpatient setting demonstrated by the dynamic nature of a patients' condition during hospitalisation. It is anticipated that this concept analysis on clinical deterioration will contribute to further identification of clinically modifiable risk factors and accompanying interventions to prevent clinical deterioration in the inpatient setting.
AIMS AND OBJECTIVES: To present a concept analysis of clinical deterioration and introduce an operational definition. BACKGROUND: Hospitalised patients who endure cardiopulmonary arrest and unplanned intensive care unit admissions often exhibit physiological signs preceding these events. Clinical deterioration not promptly recognised can result in increased patient morbidity and mortality. A barrier to recognising and responding to clinical deterioration stems from practice variations among healthcare clinicians. DESIGN: Concept analysis. METHODS: Eight-step method of concept analysis proposed by Walker and Avant. RESULTS: Defining attributes include dynamic state, decompensation and objective and subjective determination. Antecedents identified include clinical state, susceptibility, pathogenesis and adverse event. Increased mortality, resuscitation, implementation of higher level of care and prolonged hospital admission were the consequences identified. Defining attributes, antecedents and consequences identified led to an operational definition of clinical deterioration as a dynamic state experienced by a patient compromising hemodynamic stability, marked by physiological decompensation accompanied by subjective or objective findings. CONCLUSIONS: Clinical deterioration is a key contributor to inpatient mortality, and its recognition is often underpinned by contextual factors and practice variances. Variation in the uniformity of the concept of clinical deterioration causes a gap in knowledge and necessitated clarification of this phenomenon for nursing research and practice. RELEVANCE TO CLINICAL PRACTICE: Identifying and intervening on clinical deterioration plays a vital role in the inpatient setting demonstrated by the dynamic nature of a patients' condition during hospitalisation. It is anticipated that this concept analysis on clinical deterioration will contribute to further identification of clinically modifiable risk factors and accompanying interventions to prevent clinical deterioration in the inpatient setting.
Authors: Ata Mahmoodpoor; Sarvin Sanaie; Seied Hadi Saghaleini; Zohreh Ostadi; Mohammad-Salar Hosseini; Naeeme Sheshgelani; Amir Vahedian-Azimi; Abbas Samim; Farshid Rahimi-Bashar Journal: Front Med (Lausanne) Date: 2022-08-04
Authors: J'Belle Foster; Diana Mendez; Ben J Marais; Justin T Denholm; Dunstan Peniyamina; Emma S McBryde Journal: Trop Med Infect Dis Date: 2022-09-19
Authors: Jobbe P L Leenen; Crista Leerentveld; Joris D van Dijk; Henderik L van Westreenen; Lisette Schoonhoven; Gijsbert A Patijn Journal: J Med Internet Res Date: 2020-06-17 Impact factor: 5.428