Several studies have demonstrated that patients in hospital exhibit premonitory signs of cardiac arrest which may be observed by nursing staff but are frequently not acted upon.  Similar findings have been observed in relation to deterioration in a patient's clinical condition prior to admission to intensive care units with suggestion that early recognition and treatment of these signs may prevent the necessity for some ICU admissions.

Aim:  The aim of this study is to determine if nursing texts on physical assessment outlined signs of clinical deterioration.  It is postulated that the inability of the nurse in an acute care setting to recognize the signs of clinical deterioration may be due to the quantity and quality of available information about the assessment process found in commonly used nursing textbooks.

Method: A literature review was conducted, and a checklist of clinical signs important in understanding, detecting and investigating the patient at risk of clinical deterioration was compiled.  The clinical signs were grouped according to the airway, breathing, circulation, disability and exposure system of assessment taught in advanced life support.  Eleven physical assessment nursing texts were reviewed to determine whether they contained comprehensive explanations of how to assess the patient at risk of clinical deterioration.

Results:  The results demonstrated that none of the texts contained sections devoted to assessing the patient at risk of clinical deterioration, and few of the texts could be regarded as giving a comprehensive, systematic description of an assessment system for use with the acutely ill.

Implications:  There is a need for physical assessment nursing texts to reflect the full scope of clinical assessment from the healthy individual to the patient at risk of clinical deterioration.  Research has demonstrated that if clinically deteriorating patients can be identified at an early stage there are significant improvements in morbidity and mortality.