Nurses' potentialities and difficulties in identifying clinical deterioration
DOI:
https://doi.org/10.21527/2176-7114.2026.51.16871Keywords:
Clinical Deterioration, Nursing Care, Hospital Care, CommunicationAbstract
Objective: to analyze the strengths and challenges faced by nurses in identifying clinical deterioration in adult patients in a general medicine unit. Methods: a qualitative and descriptive study conducted at a university hospital in southern Brazil between March and June 2024. Sixteen nurses, selected through purposive sampling, participated. The data for this article were collected through participant observation and semi-structured interviews and analyzed using discursive textual analysis with the aid of IRAMUTEQ software. Results: The strengths identified included effective communication among the nursing team, the use of handover tools, early detection of clinical changes, and teamwork. The difficulties, on the other hand, were related to the absence of care protocols, structural and logistical limitations, a diverse patient population, high staff turnover and professional inexperience, failures in interprofessional communication, and demotivation at work. Conclusion: The identification of clinical deterioration is influenced by organizational and communication factors, as well as by nurses’ professional experience, highlighting the need for institutional strategies that strengthen patient safety.
References
1. Langkjaer CS, Bove DG, Nielsen PB, Iversen KK, Bestle MH, Bunkenborg G. Nurses' Experiences and Perceptions of two Early Warning Score systems to Identify Patient Deterioration-A Focus Group Study. Nurs Open. 2021 Jul;8(4):1788-1796. DOI: 10.1002/nop2.821
2. Santos, Ribeiro M, Costa M, Lyris Camerino Bomfim, Cavalcante E, Rafael P, et al. Análise Epidemiológica e tendências de mortalidade por sepse no Brasil de 2018 a 2022. Brazilian Journal of Implantology and Health Sciences [Internet]. 2018;6(8):5148–61. Available from: https://bjihs.emnuvens.com.br/bjihs/article/view/3203
3. Calderon K, Van Landingham E, Purcell S, Kennard M. Identifying and treating sepsis in onder people: a quality improvement project in hospitals and nursing homes in Texas. Nursing Older People. 2021. Jun 1;33(3)36-41
4. Ferreira BEM, dos Santos DM, da Silevira AP, de Souza WF, Carniel F. Adesão dos profissionais de enfermagem as metas de segurança da OMS: uma revisõ de literatura. REAEnf [Internet}. 26jan.2021 [citado 30dez.2025];8:e5967. Available from: https://acervomais.com.br/index.php/enfermagem/article/view/5967
5. Oliveira ESF de, Brasil CCP, Higa E de FR. Pesquisa qualitativa no contexto da formação ao cuidado em saúde: perspectivas interdisciplinares. Ciênc saúde coletiva. 2024;29(8):e06122024. DOI: https://doi.org/10.1590/1413-81232024298.06122024
6. Moraes R, Galiazzi MC. Análise textual discursiva. 2. ed. Ijuí: Editora Unijuí, 2011.
7. Pinto JM, Pedrosa MEF, Silva KMM, Gener MES. Atribuições da enfermagem e a importância do acolhimento do enfermeiro na atenção básica: uma revisão bibliográfica integrativa. JNT- Facit Business and Technology Journal. 2021[acesso 2024 Mar 5];26(1):200-211. Disponível em: https://revistas.faculdadefacit.edu.br/index.php/JNT/article/view/997/676
8. Díaz OA, López RLS, Torres HEA. Enfermeiros novatos e os fatores que influenciam a adaptação ao trabalho após a incorporação ao mundo laboral. Esc Anna Nery. 2023;27:e20220236. DOI: https://doi.org/10.1590/2177-9465-EAN-2022-0236pt
9. Chua WL, Wee LC, Lim JYG, Yeo MLK, Jones D, Tan CK, et al. Automated rapid response system activation-Impact on nurses' attitudes and perceptions towards recognising and responding to clinical deterioration: Mixed-methods study. J Clin Nurs. 2023;32(17-18):6322-6338. DOI: 10.1111/jocn.16734
10. Valadão FS, Sanchez MCO, Porto MA de OP, Xavier ML, Braga AL de S, Chrizostimo MM. Processo de comunicação entre a equipe multidisciplinar no contexto da gestão na atenção básica: revisão integrativa. Research, Society and Development. 2022 Aug 16;11(11):e86111133465.
11. Ferreira, ALA. Reflections on Time Management in the Nursing Field. Revista urug. enferm. 2023; 18(1): e504. DOI: https://doi.org/10.33517/rue2023v18n1a5
12. Echer IC, Boni FG, Juchem BC, Mantovani VM, Pasin SS, Caballero LG, et al.. Passagem de plantão da enfermagem: desenvolvimento e validação de instrumentos para qualificar a continuidade do cuidado. Cogitare Enferm. 2021;26:e74062. DOI: https://doi.org/10.5380/ce.v26i0.74062
13. Guzinski C, Lopes ANM, Flor J, Migliavaca J, Tortato C, Pai DD. Boas práticas para comunicação efetiva: a experiência do round interdisciplinar em cirurgia ortopédica. Rev Gaúcha Enferm. 2019;40(spe):e20180353. DOI: https://doi.org/10.1590/1983-1447.2019.20180353
14. Pinheiro CMH, Pitombeira MGV, Pereira A de S, Pereira MD, Cavalcante L de FD, Gois RHPC, et al. A padronização da passagem de plantão do enfermeiro e sua implicação na segurança do paciente: revisão integrativa. REAS.2022 [acesso 2024 Mar 4];15(8):e10805. Disponível em: https://acervomais.com.br/index.php/saude/article/view/10805
15. Prestes A. Manual do gestor hospitalar. / Organizadores: Andréa Prestes, José Antônio Ferreira Cirino, Rosana Oliveira e Viviã de Sousa. – Brasília: Federação Brasileira de Hospitais, 2019. [acesso 2024 Mar 4]. Disponível em:https://fbh.com.br/wp-content/uploads/2020/11/MANUAL-FBH_web.pdf
16. Braz LC, Paz DD, de Souza LM, Brinati LM, Correia MDL, Toledo LV. Análise dos óbitos entre pacientes críticos: comparação da mortalidade estimada pelo saps-3 e mortalidade observada. R. Enferm. Cent. O. Min. 2022 [acesso 16 Mar 2024];12. Disponível em: http://www.seer.ufsj.edu.br/recom/article/view/4719
17. Oliveira EM de, Secco LMD, Figueiredo WB de, Padilha KG, Secoli SR. Nursing Activities Score and the cost of nursing care required and available. Rev Bras Enferm. 2019;72:137–42. DOI: https://doi.org/10.1590/0034-7167-2017-0655
18. Vicente LG. Intervenções preventivas de enfermagem para adultos e idosos com risco de lesão por pressão: estudo misto [Trabalho de Conclusão de Curso]. Rio Grande, RS: Universidade Federal do Rio Grande, Escola de Enfermagem; 2024.
19. Parente A do N, Ferreira GRON, Cunha CLF, Ramos AMPC, Sá AMM, Haddad M do CFL, et al. Educação permanente para qualidade e segurança do paciente em hospital acreditado. Acta paul enferm. 2024;37:eAPE00041. DOI: https://doi.org/10.37689/acta-ape/2024AO0000041
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Marhesca Carolyne de Miranda Barros Gomes, Rosemary Silva da Silveira, Simoní Saraiva Bordignon, Emanuelli Mancio Ferreira da Luz, Kelly Neuma Lopes de Almeida Gentil Schneider, Clara Santana Sousa
This work is licensed under a Creative Commons Attribution 4.0 International License.
By publishing in Revista Contexto & Saúde, authors agree to the following terms:
The works are licensed under the Creative Commons Atribuição 4.0 Internacional (CC BY 4.0) license, which allows:
Share — to copy and redistribute the material in any medium or format;
Adapt — to remix, transform, and build upon the material for any purpose, including commercial.
These permissions are irrevocable, provided that the following terms are respected:
Attribution — authors must be properly credited, with a link to the license and indication of any changes made.
No additional restrictions — no legal or technological measures may be applied that restrict the use permitted by the license.
Notes:
The license does not apply to elements in the public domain or covered by legal exceptions.
The license does not grant all rights necessary for specific uses (e.g., image rights, privacy, or moral rights).
The journal is not responsible for opinions expressed in the articles, which are the sole responsibility of the authors. The Editor, with the support of the Editorial Board, reserves the right to suggest or request modifications when necessary.
Only original scientific articles presenting research results of interest that have not been published or simultaneously submitted to another journal with the same objective will be accepted.
Mentions of trademarks or specific products are intended solely for identification purposes, without any promotional association by the authors or the journal.
License Agreement (for articles published from September 2025): Authors retain copyright over their article and grant Revista Contexto & Saúde the right of first publication.
