Nurses' Perceptions of Their Non-Technical Skills in Recognising and Responding to Clinical Deterioration in Hospital Settings: A Systematic Review.
TL;DR
Patients, health care professionals and health care delivery may benefit from integration of non-technical skills into deterioration response frameworks, implemented within psychologically safe organisational cultures.
Abstract
Aim
To understand nurses' perceptions of non-technical skills in recognising and responding to clinical deterioration in hospital settings.
Design
A mixed methods systematic review was undertaken, guided by the Joanna Briggs Institute Manual for Evidence Synthesis.
Methods
A systematic search of the primary research literature published between 2012 and October 2025 was undertaken. A convergent integrated approach to synthesis, without meta-analysis, was undertaken. DATA SOURCES The MEDLINE, CINAHL, Scopus, PsychInfo and Embase electronic databases were searched. Reference lists of full-text articles retrieved were reviewed for additional data sources.
Results
Twenty-four primary studies were included. Narrative synthesis resulted in six main themes: (1) situational awareness, (2) effective teamwork and communication, (3) leadership and culture, (4) intuition, (5) level of experience and (6) fear of retribution. Across studies, supportive team culture and strong communication facilitated recognition and escalation, whereas inexperience and fear of criticism delayed action.
Conclusions
Early recognition and response to a clinical deterioration is beyond simply detecting physiological parameters. The process of recognition and response to a deterioration is enabled due to non-technical skills. In situations where the team has effective and positive team culture, where there is psychological safety, where all levels of expertise are given a voice without fear of retribution, everyone is safe to raise the alarm. Strengthening these skills and supporting junior nurses may improve escalation practice. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE The implementation of early warning scores or rapid response systems is a well-developed mechanism to improve outcomes for deteriorating patients. Unfortunately, there has been less emphasis and value placed on development of non-technical skills in the recognition and response to clinical deterioration. Organisations and professions need to mitigate barriers to the implementation of nurses' non-technical skills to improve patient outcomes. IMPACT What problem did the study address? ○ A lack of current synthesised evidence of nurses' non-technical skills in the recognition of, and response to, clinical deterioration. What were the main findings? ○ Organisational cultures that devalue less experienced nurses and non-technical skills, risk delays in recognition and response to clinical deterioration. Where and on whom will the research have an impact? ○ Patients, health care professionals and health care delivery may benefit from integration of non-technical skills into deterioration response frameworks, implemented within psychologically safe organisational cultures. Reporting Method Preferred Reporting Items for Systematic Reviews and Meta-Analyses (2020). Patient or Public Contribution No patient or public contribution. This review received no financial support. Trial Registration The protocol for this review was registered with PROSPERO (CRD42022327788) (crd.york.ac.uk/PROSPERO/display_record.php?RecordID=327788).