Exploring Ward Registered Nurses' Emotional Responses When Caring for Clinically Deteriorating Patients: An Interview Study Informed by Affective Events Theory.

AIM: To explore ward-based registered nurses' emotions, emotion-driven behaviours, and the perceived impact of these emotions on caring for clinically deteriorating patients.

BACKGROUND

Clinical deterioration in ward patients is frequently missed or poorly managed despite widespread implementation of Early Warning Score systems. Behavioural and systemic factors may contribute to these failures; however, emotional influences remain underexplored.

DESIGN

Descriptive interview study underpinned by Affective Events Theory.

METHODS

Registered nurses from a United Kingdom teaching hospital with experience caring for clinically deteriorating patients were purposively sampled. Semi-structured interviews were conducted using a topic guide informed by the seven Affective Events Theory constructs. Interviews were audio-recorded, transcribed verbatim, and analysed using a combined inductive thematic approach and deductive mapping to theoretical constructs.

RESULTS

Five themes were identified and mapped to six of the seven Affective Events Theory constructs: work environment, work events, affective reactions, work attitudes, affect-driven behaviours and judgement-driven behaviours. The dispositions construct did not emerge as a distinct theme. Participants predominantly described negative emotional responses. Short-term coping strategies, including emotional distancing, supported care delivery but were perceived to increase longer-term burnout risk. Affect-driven behaviours included heightened vigilance and increased bedside presence; however, reluctance to leave deteriorating patients conflicted with established escalation protocols. Judgement-driven behaviours shaped longer-term attitudes, including reduced motivation and intentions to leave nursing.

CONCLUSIONS

Emotional responses to clinical deterioration shaped immediate nursing behaviours that were both beneficial and potentially detrimental to patient care, while also influencing longer-term professional attitudes.

PATIENT CONTRIBUTION: Two patient and public involvement advisors reviewed the interview topic guide before data collection and contributed to the development of questions exploring the therapeutic relationship between nurses and patients.