Clinical deterioration: A concept analysis

Area of Science:

• Nursing Science
• Clinical Practice
• Patient Safety

Background:

• Hospitalized patients often show preceding physiological signs before cardiopulmonary arrest or unplanned ICU admission.
• Failure to promptly recognize clinical deterioration increases patient morbidity and mortality.
• Variations in clinical practice hinder effective recognition and response to patient deterioration.

Purpose of the Study:

• To conduct a concept analysis of clinical deterioration.
• To develop an operational definition for clinical deterioration.

Main Methods:

• Employed an eight-step concept analysis method (Walker and Avant).
• Identified defining attributes, antecedents, and consequences of clinical deterioration.

Main Results:

• Defining attributes: dynamic state, decompensation, objective/subjective determination.
• Antecedents: clinical state, susceptibility, pathogenesis, adverse event.
• Consequences: increased mortality, resuscitation, higher level of care, prolonged admission.
• Operational definition: A dynamic state compromising hemodynamic stability, marked by physiological decompensation with subjective or objective findings.

Conclusions:

• Clinical deterioration significantly contributes to inpatient mortality.
• Variations in understanding clinical deterioration create knowledge gaps, necessitating clarification for nursing.
• This concept analysis aims to improve identification and intervention for modifiable risk factors to prevent clinical deterioration.