{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T06:13:25Z","timestamp":1778825605115,"version":"3.51.4"},"reference-count":39,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T00:00:00Z","timestamp":1766534400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T00:00:00Z","timestamp":1766534400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001778","name":"Deakin University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001778","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Advanced Nursing"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To explore and describe registered nurses' perceptions of the patient and clinician characteristics, healthcare systems, and processes that contribute to deterioration resulting in a Medical Emergency Team (MET) review.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>An exploratory descriptive qualitative study using semi\u2010structured interviews.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A purposive sample of experienced registered nurses from acute medical and surgical wards in a large teaching hospital in Melbourne, Australia was recruited from July to August 2018. Semi\u2010structured interviews were conducted, guided by a semi\u2010structured interview schedule. Interviews were analysed using the 7 steps of Framework Method analysis: transcription, familiarisation, coding, developing a working analytical framework, applying the analytical framework, charting data into the framework, and interpreting the data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty\u2010one interviews were conducted with participants who had a median of 5.5\u2009years' total nursing experience and 2\u2009years' experience in their current ward. The major finding was The Downward Spiral of Clinical Deterioration theme characterised by a worsening spiral of clinical deterioration risk culminating in MET review. The Downward Spiral comprised four sub\u2010themes: Physiological Age, not Chronological Age Matters; Delirium Demands Attention; Unclear Therapeutic Goals; 24\/7 Risk in a 9\u2010to\u20105 Service.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This integrates existing knowledge to explain how patient characteristics and healthcare systems and processes interact to contribute to clinical deterioration risk in the time between admission and MET review.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Implications for the Profession and\/or Patient Care<\/jats:title>\n                    <jats:p>Identifying patients at increased risk of deterioration may assist with earlier, proactive intervention and improve patient outcomes associated with clinical deterioration in acute healthcare.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Impact<\/jats:title>\n                    <jats:p>Recognising and responding to clinical deterioration remains a challenge in acute healthcare, associated with poor patient outcomes and consuming substantial resources. To date, registered nurses' perceptions of the factors leading to Medical Emergency Team review have not been described. The Downward Spiral of Clinical Deterioration describes how patient and clinician characteristics and healthcare systems and processes interact to increase clinical deterioration risk, culminating in Medical Emergency Team review. These findings may help researchers integrate disparate clinical deterioration models and concepts. Insights into how the safety of healthcare systems can be improved may assist administrators and clinicians in reducing the incidence of clinical deterioration in the future.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Reporting Method<\/jats:title>\n                    <jats:p>The study is reported according to the Consolidated Criteria for Reporting Qualitative Studies (COREQ).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patient or Public Contribution<\/jats:title>\n                    <jats:p>This study did not include patient or public involvement in its design, conduct, or reporting.<\/jats:p>\n                  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