Skip to main content

Table 3 Signs and symptoms underlying worry or concern as indicator of deterioration, reported by nurses or analyzing RRS calls

From: Nurses’ worry or concern and early recognition of deteriorating patients on general wards in acute care hospitals: a systematic review

10 indicators Analysis qualitative studies (exploring cues nurses use) Analysis qualitative studies (process of recognition) Analysis RRS worry calls
Change in Breathing Inability to talk in sentences, noisy breathing, gasping, wheezing, using accessory muscles, change in breathing [26], short of breath [26], breathless [27], increasing supplemental O2 to maintain SaO2, increase in respiratory rate (just more than the day before) [26] and low SpO2 [27] Respiratory distress [36], breathing more labored, trouble breathing [38] and continued use of oxygen [11] Dyspnea [20, 21], respiratory distress [23, 24], low SpO2 [24] and fall in SaO2 [23]
Change in Circulation Impaired cutaneous perfusion [26], cold feet [26], coldness [27], tachycardia [27], (new) sweating [26, 27, 39], clammy [27, 39], (quite) pale [27], new observation, just a bit paler [26], color drainage changes, dusky [27], more pale than usual, porcelain pale, just a sort of gray, loss of pink color to their skin and color draining [27] Cold feet [38], (new) sweating [11, 20], clammy [11], any change in color from patient’s usual one [11, 37], (quite) pale [11], pale gray, blue [11], ashen gray, sallow, change in skin color [38] and gray [31] Arrhythmia [20], rhythm disturbance and hypertension [23]
Temperature    Fever [20], rigors, febrile [23] and hypo/hyperthermia [24]
Change in Mentation Confused [26], impaired mentation [26], change in mentation [26], lethargic [26, 34], vaguer, slower [26], sleepy, not making sense, less verbal [34] and sensory change in the level of consciousness [34] Withdrawn [11], confused [11, 38], drowsy [11, 37], lethargic [31] and sensory change in the level of consciousness [38] Confused [23], drowsy [23], (mental) deterioration [24] and sensory change in the level of consciousness (without a decrease in Glasgow Coma Scale of ≥2 points) [20]
Agitation Agitation [26], not getting out of bed [26], uneasy, want to sit in chair instead of bed, cannot get right position, restless [26], not comfortable [26], not comfortable in or out of bed, sitting on the edge of the seat, unsettled, distressed, anxious, climbing about, wanting tablets [27], pulling catheters and tubes out, calling out, pressing the buzzer more often [27], activity level [33] and increase activating the bed alarm [34] Slumped in chair [11], not getting out of bed [11], not comfortable [38] and panicky [35] Agitation [23, 24] restless [24] and aggression [21]
Pain New or increasing pain, and jaw, neck, shoulder [26] chest [26] pain combined with bleeding [27] (Unusual) pain [38] Chest pain [2023] and headache [20, 24]
Unexpected Trajectory Not progressing [26], not expected trajectory, not following recovery pattern, not responding to treatment [26], abdominal distension, not eating [26] and bleeding [27] Not progressing [11], abdominal distension, not eating [11] and vomiting [11] Nausea [21, 24], vomiting [24], bleeding [22, 23], hypoglycaemia, dizzy [2224], unstable blood sugars [21], syncope, collapse, fall [24] and seizures [22]
Patient indicates feeling unwell Feeling of impending doom [27], feeling not right, feeling unwell [26, 27], new symptom, feeling different, feeling terrible, knowing something is happening, cannot explain what is wrong, generally unwell [26], scared and patient is not like this normally [27]   
Subjective nurse observation Patient looks unwell [27], cannot settle the patient down, new symptom [26], does not look or seem right [27, 34], a look in the eyes, like a gaze [27], something is not right [39], patient looks terrible [33] and not patient’s normal face [34] Reduced motivation, neglect, not getting out of bed, not acting in their normal way [38], patient looks unwell [11], changes in mood [38], does not look or seem right [35, 37, 38], something is not right [30 ,35], patient somehow looks so ill, difference in behavior, patient is quieter, patient did not open eyes [38] and patient looks really bad [31]  
Knowing without a rationale Gut feeling [27], knowing something is happening, unconscious something [26], knowing something is wrong [26, 27, 39], intuition, sixth sense [37], cannot put a finger on it [27], just a feeling [27] and something does not look right [34] Instinct [11], just knowing [11, 30], gut feeling [11, 38, 40], knowing something is wrong [37, 40], intuition, sixth sense [39], just a feeling [38], something does not look right [40], not as expected, cannot put a label on it [40], something is a tiny bit worse [40] and sensing [36]