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AimIn this integrative review, we aimed to: first, identify and summarize published studies relating to ward nurses' recognition of and response to patient deterioration; second, to critically evaluate studies that described or appraised the practice of ward nurses in recognizing and responding to patient deterioration; and third, identify gaps in the literature for further research.DesignAn integrative review.MethodsThe Cumulative Index to Nursing and Allied Health Literature (CINAHL) Ovid Medline, Informit and Google Scholar databases were accessed for the years 1990–2014. Data were extracted and summarized in tables and then appraised using the Mixed Method Appraisal Tool. Data were grouped into two domains; recognizing and responding to deterioration and then thematic analysis was used to identify the emerging themes.ResultsSeventeen studies were reviewed and appraised. Recognizing patient deterioration was encapsulated in four themes: (1) assessing the patient; (2) knowing the patient; (3) education and (4) environmental factors. Responding to patient deterioration was encapsulated in three themes; (1) non‐technical skills; (2) access to support and (3) negative emotional responses.ConclusionIssues involved in timely recognition of and response to clinical deterioration remain complex, yet patient safety relies on nurses’ timely assessments and actions.

COVID-19 has created an unprecedented public health emergency. Nurses are classified as frontline workers and face significant risk for high viral loads, infection, and death (Sim, 2020). Currently, nurses and nursing are highly visible in the media, conducting fever clinics, responding to workforce surges, and caring for critically ill patients, and world leaders acknowledge their contribution in daily reports. This has culminated in a new zeitgeist when the anonymous street artist and political activist, Banksy, portrayed nurses as superheroes (Morris, 2020). Although this acknowledgement and support for nurses is welcome, there is increasing concern about the current constructs of angel and hero used to describe nurses (Stokes-Parish, 2020). This concern was echoed by the British Association of Critical Care Nurses' president, Nicki Credland: We're not angels, we're not heroes, we are human beings that have chosen a career, that are highly educated, that work in a patient safety-critical profession, who simply want to go and do the job that we trained to do and be protected to do it. (British Association of Critical Care Nurses, 2020) In this contemporary discussion article, we propose that the hero and angel constructs undermine the professionalism of the nursing workforce, and reinforces the perception that nursing is an innately feminine, nurturing role. We argue that this discourse continues to undermine the continuing endeavors to consolidate nursing's standing as a profession. Heroes in the COVID-19 Era-The Evolution Nurses' contribution to healthcare outcomes is well documented (Aiken et al., 2011; Guetterman et al., 2019). There are almost 28 million nurses globally, accounting for nearly 60% of the healthcare workforce and delivering approximately 90% of primary healthcare services internationally (World Health Organization, 2020). Nurses are increasingly working in clinical situations where access to essential equipment is limited or denied; they have been exposed to heavy COVID-19 viral loads and have worked long hours, in some instances, and with suboptimal nurse-patient ratios to manage the surge in healthcare demand. Additionally, many have had to simultaneously upskill and develop new ways of working. According to the International Council of Nurses (2020), at least 600 nurses have died as a result of the pandemic. Nurses and nursing have responded to these challenges with maturity, responsiveness, and agility, and perhaps for this reason the constructs angel and hero have been adopted by the media (Frost, 2020; Johnson, 2020; Mosley, 2020; Pownall, 2020). This depiction of nurses as heroes and angels is not new. In their study of the image of the nurse in mass media, Kalish and Kalish (1983) identified that nurses have been portrayed as angels of mercy since the mid-nineteenth century. Although the acknowledgement and support for nursing is welcome, there is increasing concern from political, clinical, and research perspectives about this portrayal. Before examining the consequences of the ange...

As technological developments continue to offer patients more health care choices patient acuity increases. Patients that traditionally would have been cared for in a critical care environment are increasingly located on general wards. This change impacts on the acute care sector in a number of ways. Patients who are inpatients have more complex problems and a greater number of co-morbidities and are therefore more likely to suffer physiological deterioration. Procedures requiring inpatient stays are often more complex and associated with higher rates of mortality and morbidity. As patient acuity has increased research has highlighted that the care of the acutely ill ward patient is suboptimal. Suboptimal care implies a lack of knowledge regarding the significance of clinical findings relating to dysfunction of airway, breathing and circulation. This paper analyses the literature on the factors that contribute to suboptimal ward care of the acutely ill patient. It uses the categories proposed by McQuillan et al. [McQuillan P, Pilkington S, Allan A, Taylor B, Short A, Morgan G, et al. Confidential inquiry into quality of care before admission to intensive care. BMJ 1998;316(7148):1853-8] in relation to suboptimal ward care in an attempt to develop a conceptual analysis of the factors that influence suboptimal ward care and acutely ill ward patients. Thus, it aims to develop and enhance practitioners' knowledge and understanding of this topic and therefore improve patient care outcomes.

A dedicated surgical team and patient acuity potentially influence the performance of scrub nurses' non-technical skills. Familiarity with team members foster advanced planning, thus minimizing distractions and interruptions that impact on scrub nurses' performance. Development of interventions aimed at improving non-technical skills has the potential to make a substantial difference and enhance patient care.

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Video exemplars aid student preparation for OSCEs, providing a flexible, innovative and clear example of the assessment process. Video exemplars improved self-rated student confidence and understanding of performance expectations, leading to increased engagement and reduced anxiety when preparing for the OSCE, but not overall OSCE performance. Such OSCE exemplars could be used to increase staff capacity and improve the quality of the student learning experience.

There is considerable controversy around psychiatric diagnosis generally and personality disorders specifically. Since its conception, borderline personality disorder has been controversial because of the stigma associated with the diagnosis and the therapeutic nihilism held by practitioners who encounter people with this high prevalence problem in acute settings. This paper reviews the history of the diagnosis of BPD and summarizes some of the controversy surrounding the categorical nature of diagnosis. Both the DSM 5 and ICD-11 will be discussed; however, for the purposes of this paper, the DSM 5 will take the primary focus due to greater cultural significance. Recent developments in the treatment of borderline personality disorder suggest that it is a highly treatable condition and that full clinical recovery is possible. This paper formulates an argument that despite problems with psychiatric diagnosis that are unlikely to be resolved soon, a diagnosis should be made with an accompanying formulation to enable people to receive timely and effective treatment to enable personal and clinical recovery.