{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T15:35:48Z","timestamp":1762875348081,"version":"3.38.0"},"reference-count":31,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2006,1,3]],"date-time":"2006-01-03T00:00:00Z","timestamp":1136246400000},"content-version":"vor","delay-in-days":2,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nursing in Critical Care"],"published-print":{"date-parts":[[2006,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>This paper reports on an evaluation of the role and contribution of outreach in the management of the critically ill ward patient using Stake's Responsive Model (<jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"#b1\">Stake, 1975<\/jats:ext-link>) and case study methodology (<jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"#b2\">Simons, 1980<\/jats:ext-link>). Twenty cases were examined, purposefully sampling all staff involved in the case identified by an initial interview with the outreach nurse. In total, 80 interviews were carried out, 20 with the outreach nurses and 54 with other members of health care teams involved in the cases, and six further targeted in\u2010depth interviews with senior anaesthetic and nursing staff. The outreach contribution which emerged from the data analysis consisted of four core categories: action (getting things done, getting decisions made and following through), focus<jats:italic>and<\/jats:italic>vision (concentrating on one patient and having a vision of what action was needed to meet their care needs), orchestration (a communication and co\u2010ordinating role) and expertise (bringing critical care skills and experience to the bedside). These categories were validated and developed in the six in\u2010depth interviews. Three themes emerged from the data describing aspects of the acute care context in which outreach operates. The interviews revealed a battleweary workforce overwhelmed by the complex and increased demands of the critically ill ward patient. The medical and nursing teams at the bedside are inexperienced and often unsupported by senior clinical decision\u2010makers. This is dealt with by \u2018passing the buck\u2019 creating gaps and delays in care management which are the problems addressed by the outreach contribution. Outreach may solve problems for the critically ill ward patient, but the underlying causes remain poorly understood.<\/jats:p>","DOI":"10.1111\/j.1362-1017.2006.00140.x","type":"journal-article","created":{"date-parts":[[2010,9,21]],"date-time":"2010-09-21T11:04:54Z","timestamp":1285067094000},"page":"42-51","source":"Crossref","is-referenced-by-count":17,"title":["An evaluation of the contribution of critical care outreach to the clinical management of the critically ill ward patient in two acute NHS trusts"],"prefix":"10.1111","volume":"11","author":[{"given":"Annie","family":"Chellel","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Debbie","family":"Higgs","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julie","family":"Scholes","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2006,1,3]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1362-1017.2004.0075b.x"},{"key":"e_1_2_11_3_1","unstructured":"Audit Commission. (1999).Critical to sucess \u2013 the Place of Efficient and Effective Critical Care Services within the Acute Hospital. London: Audit Commission."},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.327.7422.1014"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000119428.02968.9E"},{"key":"e_1_2_11_6_1","doi-asserted-by":"crossref","first-page":"22","DOI":"10.5694\/j.1326-5377.1999.tb123492.x","article-title":"Recognising clinical instability in hospital patients before cardiac arrest or unplanned admission to intensive care. A pilot study in a tertiary \u2013 care hospital","volume":"171","author":"Buist MD","year":"1999","journal-title":"Medical Journal of Australia"},{"key":"e_1_2_11_7_1","first-page":"36","article-title":"Nursing Observations on Ward Patients at Risk of Critical Illness","volume":"98","author":"Chellel A","year":"2002","journal-title":"Nursing Times"},{"key":"e_1_2_11_8_1","first-page":"245","article-title":"Supporting staff caring for critically ill patients in acute areas","volume":"4","author":"Coad S","year":"1999","journal-title":"Nursing in Critical Care"},{"key":"e_1_2_11_9_1","first-page":"126","article-title":"Supporting ward staff in acute areas: the past, present and the future?","volume":"7","author":"Coad S","year":"2002","journal-title":"Nursing in Critical Care"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2702.2002.00625.x"},{"volume-title":"Comprehensive Critical Care \u2013 A Review of Adult Critical Care Services","year":"2000","author":"Department of Health.","key":"e_1_2_11_11_1"},{"volume-title":"Modernising Critical Care Services Health Service Circular 2000\/017","year":"2000","author":"Department of Health.","key":"e_1_2_11_12_1"},{"volume-title":"Critical Care Outreach 2003: Progress in Developing Services","year":"2003","author":"DH, NHS Modernisation Agency.","key":"e_1_2_11_13_1"},{"key":"e_1_2_11_14_1","first-page":"216","article-title":"Critical Care without walls: the outreach experience of one trust Part 1: background and planning","volume":"6","author":"Dove J","year":"2001","journal-title":"Nursing in Critical Care"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003246-199402000-00014"},{"volume-title":"The Discovery of Grounded Theory: Strategies for Qualitative Research","year":"1967","author":"Glaser B","key":"e_1_2_11_16_1"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2044.1999.00837.x"},{"key":"e_1_2_11_18_1","first-page":"279","article-title":"Critical care without walls: the outreach experience of one trust Part 2: implementation and evaluation","volume":"6","author":"Groom P","year":"2001","journal-title":"Nursing in Critical Care"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2044.2003.03077.x"},{"key":"e_1_2_11_20_1","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1016\/S0035-8819(25)01722-2","article-title":"Unexpected deaths and referrals to intensive care of patients on general wards. Are some cases potentially avoidable?","volume":"33","author":"McGloin H","year":"1999","journal-title":"Journal of the Royal College of Physicians of London"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.316.7148.1853"},{"volume-title":"Qualitative Data Analysis an Expanded Source Book","year":"1994","author":"Miles M","key":"e_1_2_11_22_1"},{"volume-title":"Principles and Practice of High Dependency Nursing","year":"2000","author":"Norman J","key":"e_1_2_11_23_1"},{"key":"e_1_2_11_24_1","unstructured":"NorrisM.(2000).Contextual Factor THAT Enable or Disable Nurses' Professional Practice. Brighton: University of Sussex.Unpublished PhD Thesis."},{"key":"e_1_2_11_25_1","first-page":"132","article-title":"The critical care outreach service and the early warning system on surgical wards","volume":"7","author":"Odell M","year":"2002","journal-title":"Nursing in Critical Care"},{"volume-title":"Qualitative Research abd Evaluation Methods","year":"2002","author":"Patton M.","key":"e_1_2_11_26_1"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2044.2003.03331.x"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-004-2268-7"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0964339702000459"},{"key":"e_1_2_11_30_1","unstructured":"ScholesJ FreemanM GrayM RobinsonD Matthews SmithG MillerC.(2004). Evaluation of Nurse Education Partnership. (Unpublished Department of Health Report available from author)."},{"key":"e_1_2_11_31_1","unstructured":"SimonsH.(1980). 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Programme evaluation particularly responsive evaluation\u2019 Western Michigan University Evaluation Centre Kalamazoo Occasional Paper Number 5."}],"container-title":["Nursing in Critical Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/j.1362-1017.2006.00140.x","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,25]],"date-time":"2025-02-25T23:38:33Z","timestamp":1740526713000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/j.1362-1017.2006.00140.x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2006,1]]},"references-count":31,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2006,1]]}},"alternative-id":["10.1111\/j.1362-1017.2006.00140.x"],"URL":"https:\/\/doi.org\/10.1111\/j.1362-1017.2006.00140.x","archive":["Portico"],"relation":{},"ISSN":["1362-1017","1478-5153"],"issn-type":[{"type":"print","value":"1362-1017"},{"type":"electronic","value":"1478-5153"}],"subject":[],"published":{"date-parts":[[2006,1]]}}}