Nursing surveillance for clinical deterioration among intensive care unit patients: A scoping review

Abstract

Objectives: To comprehensively examine and summarize the existing knowledge on nursing surveillance for clinical deterioration among intensive care unit patients by presenting study and subject, clinical deterioration, and nursing surveillance characteristics in quantitative and qualitative studies.

Methods: A systematic literature search was conducted in five electronic databases. Literature addressing nursing surveillance for detecting clinical deterioration among adult intensive care unit patients was included. Surveillance identified in quantitative studies was categorized into four nursing data types (scales, assessment records, activity records, and notes). Themes and subthemes were identified from qualitative studies. This review adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guideline.

Results: Twenty-four sources of evidence were included. Most studies were published since 2012 and conducted in developed countries. Forty-seven clinical deterioration events were identified, and prolonged length of stay was the most frequently identified events. Forty-two surveillance variables were categorized into nursing data types. Assessment records were the most frequently used nursing surveillance variables, yet notes were insufficiently employed. Qualitatively identified surveillance was categorized into six themes: vigilance and monitoring, detection and decision making, integrated documentation practice, collaborative communication, intervention and risk management, and interaction with information technology systems.

Conclusions: The integration of quantitative surveillance data with qualitative elements has the potential to enhance patient safety in intensive care environments. This scoping review offers valuable insights for nursing researchers, educators, practitioners, and stakeholders by presenting a comprehensive understanding of nursing surveillance. By synthesizing evidence that connects surveillance variables with specific nursing data types, this review highlights more effective use of surveillance data in the early detection of clinical deterioration among intensive care patients.

Implications for clinical practice: This paper provides a comprehensive understanding of nursing surveillance, including the utilization of nursing surveillance data and the implementation of nursing surveillance research into clinical practice.