Abstract：
OBJECTIVE: To explore and describe acute care nurses\' decisions to recognise and respond to improvement in patients\' clinical states as they occurred in the real-world clinical environment.
METHODS: A descriptive study.
METHODS: Nine medical and eleven surgical nurses in a large Australian metropolitan hospital were individually observed during nurse-patient interactions and followed up in interview to describe their reasoning and clinical judgements behind observed decisions. Verbal description of observations and interviews were recorded and transcribed. Reflexive thematic analysis was used to analyse the data.
RESULTS: The three themes constructed from the data were as follows: nurses checking in; nurses reaching judgements about improvements; and nurses deciding on the best person to respond. Acute care nurses made targeted assessment decisions based on predicted safety risks related to improvement in clinical states. Subjective and objective cues were used to assess for and make judgements about patient improvement. Acute care nurses\' judgment of patient safety and a desire to promote patient centred care guided their decisions to select the appropriate person to manage improvement.
CONCLUSIONS: The outcomes of this research have demonstrated that the proven safety benefits of acute care nurses\' decision making in response to deterioration extend to improvement in patients\' clinical states. In response to improvement, acute care nurses\' decisions protect patients from harm and promote recovery.
CONCLUSIONS: Early recognition and response to improvement enable acute care nurses to protect patients from risks of unnecessary treatment and promote recovery.
CONCLUSIONS: This study makes explicit nurses\' essential safety role in recognising and responding to improvement in patients\' clinical states. Healthcare policy and education must reflect the equal importance of assessment for and management of deterioration and improvement to ensure patients are protected and provided with safe care.
METHODS: A descriptive study.
METHODS: Nine medical and eleven surgical nurses in a large Australian metropolitan hospital were individually observed during nurse-patient interactions and followed up in interview to describe their reasoning and clinical judgements behind observed decisions. Verbal description of observations and interviews were recorded and transcribed. Reflexive thematic analysis was used to analyse the data.
RESULTS: The three themes constructed from the data were as follows: nurses checking in; nurses reaching judgements about improvements; and nurses deciding on the best person to respond. Acute care nurses made targeted assessment decisions based on predicted safety risks related to improvement in clinical states. Subjective and objective cues were used to assess for and make judgements about patient improvement. Acute care nurses\' judgment of patient safety and a desire to promote patient centred care guided their decisions to select the appropriate person to manage improvement.
CONCLUSIONS: The outcomes of this research have demonstrated that the proven safety benefits of acute care nurses\' decision making in response to deterioration extend to improvement in patients\' clinical states. In response to improvement, acute care nurses\' decisions protect patients from harm and promote recovery.
CONCLUSIONS: Early recognition and response to improvement enable acute care nurses to protect patients from risks of unnecessary treatment and promote recovery.
CONCLUSIONS: This study makes explicit nurses\' essential safety role in recognising and responding to improvement in patients\' clinical states. Healthcare policy and education must reflect the equal importance of assessment for and management of deterioration and improvement to ensure patients are protected and provided with safe care.
摘要：
目的：探讨和描述急性护理护士在现实世界临床环境中识别和应对患者临床状态改善的决定。
方法：描述性研究。
方法：在护患互动过程中，分别观察了澳大利亚一家大型大都市医院的9名内科护士和11名外科护士，并在访谈中进行了随访，以描述他们在观察到的决策背后的推理和临床判断。对观察和访谈的口头描述进行记录和转录。使用自反性主题分析来分析数据。
结果：根据数据构建的三个主题如下：护士登记；护士对改善做出判断；护士决定最好的人做出回应。急性护理护士根据与临床状态改善相关的预测安全风险做出有针对性的评估决策。使用主观和客观线索来评估和判断患者的改善。急性护理护士对患者安全的判断和促进以患者为中心的护理的愿望指导他们选择合适的人来管理改进。
结论：这项研究的结果表明，经证实的急性护理护士应对病情恶化的决策的安全性益处延伸到患者临床状态的改善。为了改进，急性护理护士的决定保护患者免受伤害，促进康复。
结论：对改善的早期认识和反应使急性护理护士能够保护患者免受不必要治疗的风险并促进康复。
结论：这项研究使明确的护士在识别和应对患者临床状态的改善方面发挥了重要的安全作用。医疗保健政策和教育必须反映对恶化和改善的评估和管理的同等重要性，以确保患者得到保护并获得安全护理。
方法：描述性研究。
方法：在护患互动过程中，分别观察了澳大利亚一家大型大都市医院的9名内科护士和11名外科护士，并在访谈中进行了随访，以描述他们在观察到的决策背后的推理和临床判断。对观察和访谈的口头描述进行记录和转录。使用自反性主题分析来分析数据。
结果：根据数据构建的三个主题如下：护士登记；护士对改善做出判断；护士决定最好的人做出回应。急性护理护士根据与临床状态改善相关的预测安全风险做出有针对性的评估决策。使用主观和客观线索来评估和判断患者的改善。急性护理护士对患者安全的判断和促进以患者为中心的护理的愿望指导他们选择合适的人来管理改进。
结论：这项研究的结果表明，经证实的急性护理护士应对病情恶化的决策的安全性益处延伸到患者临床状态的改善。为了改进，急性护理护士的决定保护患者免受伤害，促进康复。
结论：对改善的早期认识和反应使急性护理护士能够保护患者免受不必要治疗的风险并促进康复。
结论：这项研究使明确的护士在识别和应对患者临床状态的改善方面发挥了重要的安全作用。医疗保健政策和教育必须反映对恶化和改善的评估和管理的同等重要性，以确保患者得到保护并获得安全护理。
