Perception of clinical deterioration cues among medical-surgical nurses

To examine medical-surgical nurses' capacity and tendency to perceive cues indicating clinical deterioration and nursing characteristics influencing deterioration cue perception.

Cross-sectional, explorative study design.

Data were collected over 10 weeks between September-November 2017. Medical-surgical nurses completed an online survey consisting of a demographic questionnaire, the Occupational Fatigue, Exhaustion Recovery scale and 50 detection trials. Descriptive statistics and statistical tests were used to describe and interpret data.

A significant association was found between nurses' capacity and tendency to perceive deterioration cues. As nurses' capacity to perceive deterioration cues increased, nurses were more likely to classify patient cues as indicators of deterioration. Fatigue, education, and certification were not identified as characteristics associated with deterioration cue perception. However, experience was observed to significantly influence nurses' capacity to perceive deterioration cues based on levels of skills acquisition.

Study findings imply that future research should be directed at determining whether other individual factors and organizational system dynamics influence deterioration cue perception.

To better understand how nurses perceive deterioration cues, this study integrated concepts from the Situation Awareness model and Signal Detection Theory. Novice, advanced beginner and competent nurses were found to have a lower capacity to perceive deterioration cues compared with proficient and expert nurses. With simulation increasingly being used as a primary teaching modality in nursing, the development of a simulation-based signal detection training intervention may be beneficial in enhancing deterioration cue perception.