Intensive care unit nurses' experiences of nursing concerns, activities, and documentation on patient deterioration: A focus-group study

Abstract

Background: Although prognosis prediction models using nursing documentation have good predictive performance, the experiences of intensive care unit nurses related to nursing activities and documentation when a patient's condition deteriorates are yet to be explored.

Objective: The aim of this study was to explore nurses' experiences of nursing activities and documentation in intensive care units when a patient's condition deteriorates.

Methods: This was a descriptive qualitative study using focus-group interviews with intensive care unit nurses in tertiary or university-affiliated hospitals. In total, 19 registered nurses with at least 1 year of clinical experience in the adult intensive care unit were recruited using a purposive sampling method. Five focus-group interviews were conducted, and the data were analysed through a qualitative content analysis.

Results: Intensive care unit nurses' experiences with patient deterioration were classified into four main categories-perceived patient deterioration; endeavours to verify nurses' concerns; nursing activities to improve a patient's condition; and optimising documentation practices-which comprised 12 subcategories. Intensive care unit nurses recognise patient deterioration through nursing activities and documentation, and the two processes influence each other. However, nursing activities related to nurses' concerns were mainly handed over verbally rather than documented due to the inflexibility of the available standardised forms and the potential uncertainty of those concerns.

Conclusions: The findings reveal how intensive care unit nurses perceive, intervene, and document the condition of a deteriorating patient. Nurses' concerns may be the first sign of a patient's deteriorating condition and are therefore crucial for minimising patient risk. Therefore, efforts to systematically document nurses' concerns may contribute to improving patient outcomes.

Keywords: Clinical deterioration; Electronic health records; Intensive care units; Nurses; Nurses' concerns; Nursing process; Nursing records; Qualitative research.