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Collaborative practice among general ward staff on escalating care in clinical deterioration: A systematic review

Hong, J. Q. Y., Chua, W. L., Smith, D. ORCID: 0000-0003-4290-8423 , Huang, C. M., Goh, Q. L. P. & Liaw, S. Y. (2023). Collaborative practice among general ward staff on escalating care in clinical deterioration: A systematic review. Journal of Clinical Nursing, 32(17-18), pp. 6165-6178. doi: 10.1111/jocn.16743


To understand the issues surrounding collaborative practice and collaboration experiences among general ward staff in the escalation of care for clinically deteriorating patients.

A systematic synthesis without meta-analysis.

Review Methods
Seven electronic databases (CINAHL, Cochrane, Embase, PsycINFO, PubMed, Scopus and ProQuest Theses and Dissertations) were searched from their inception to 30 April 2022. Two reviewers independently screened titles, abstracts and full text for eligibility. The critical appraisal skill programme, Joanna Briggs Institute checklist for analytical cross-sectional studies and mixed methods appraisal tool were used to appraise the quality of the included studies. Both quantitative and qualitative research data were extracted, analysed and then synthesised using the data-based convergent qualitative synthesis approach. This review adhered to the Synthesis without meta-analysis (SWiM) reporting guidelines.

A total of 17 studies were included. Two themes and six sub-themes were generated: (1) intraprofessional factors—inadequate handover, workload and mutual support, raising and acting on concerns, and seeking help from seniors and (2) interprofessional factors—differences in communication styles, and hierarchical approach versus interpersonal relationships.

This systematic review highlights the need to address the intra- and interprofessional issues surrounding collaborative practice in escalation of care among general ward staff.

Implications for the Profession
Findings from this review will inform healthcare leaders and educators on the development of relevant strategies and multi-disciplinary training to foster effective teamwork among nurses and doctors, with the goal of improving the escalation of care for patients with clinical deterioration.

No Patient or Public Contribution
This systematic review did not directly involve patient or public contribution to the manuscript.

Publication Type: Article
Additional Information: © 2023 The Authors. Journal of Clinical Nursing published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
Publisher Keywords: clinical deterioration, collaboration, escalation of care, nurse, nursing, patient care team, systematic review
Subjects: R Medicine > RT Nursing
Departments: School of Health & Psychological Sciences > Nursing
SWORD Depositor:
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Available under License Creative Commons Attribution Non-commercial No Derivatives.

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