From Intuitive Concern to Safety Action: A Qualitative Meta-Synthesis of Nurses' Experiences of Recognising Patient Deterioration.
TL;DR
Nurses' intuition is best understood as a situated form of clinical judgement, not as a vague feeling, which can function as an early patient-safety signal when it prompts reassessment, is effectively communicated and is supported within clinical systems.
Abstract
Aim
To synthesise qualitative evidence on nurses' experiences of intuitively recognising patient deterioration.
Background
Nurses often report intuition, gut feeling or a sense that "something is not right" when patients deteriorate, yet how such concern is experienced, assessed, communicated and acted upon remains insufficiently understood.
Design
Qualitative evidence synthesis. DATA SOURCES PubMed, Embase, CINAHL, PsycINFO, Web of Science, the Cochrane Library and the JBI EBP Database were searched for English-language peer-reviewed studies published from 1987 to September 2025.
Methods
Eligible studies were qualitative or mixed-methods studies with extractable qualitative findings on nurses' intuition, concern, clinical judgement or recognition of deterioration in adult patients. Methodological quality was assessed using the Critical Appraisal Skills Programme qualitative checklist. Data were synthesised using Thomas and Harden's thematic synthesis approach.
Results
Fifteen studies were included. Seven descriptive themes and four analytical themes were developed. Nurses' intuitive concern was conceptualised as a dynamic pathway: it began with subtle deviations from baseline, moved through cyclical assessment and clinical judgement, and led to patient-safety action through communication and escalation. Team and organisational conditions shaped this pathway, while emotional consequences and experiential learning fed back into future noticing and judgement.
Conclusion
Nurses' intuition is best understood as a situated form of clinical judgement, not as a vague feeling. It can function as an early patient-safety signal when it prompts reassessment, is effectively communicated and is supported within clinical systems. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Nurses should treat intuitive concern as a prompt for reassessment, communication and escalation. Education and clinical systems should support its articulation and integration with objective evidence. IMPACT This review explains how intuitive concern contributes to early deterioration recognition and becomes actionable within clinical practice. REPORTING
Method
PRISMA and ENTREQ. NO PATIENT OR PUBLIC CONTRIBUTION No patients or members of the public were involved.