Predicting patients' deterioration and recovery

The purpose of this study was to identify patient cues that expert nurses identify as a patient moves to/from deterioration and/or recovery. The sample of 33 nurses was drawn from a medical intensive care unit (MICU). Data were collected through interviews regarding nurses' knowledge about caring for patients with acute gastrointestinal bleeding, heart failure/post-myocardial infarction, and pulmonary edema. Using the constant comparative technique, cues were identified and grouped into early, imminent, and late patterns for deterioration and into categories of early, midway, and complete for recovery. Rationales for the nurses' decisions included memories of patients with similar cues, using multiple not single cues, and clustering both physiological and psychological cues together. This study is a beginning effort toward validating nurses' intuitiveness and provides knowledge about expert practice that can be taught to novice practitioners and incorporated into protocols for care.