British and Finnish nurses' attitudes, practice, and knowledge on deteriorating patient in-service education: A study in two acute hospitals.

Aim: The aim was to assess both nurses' attitudes about in-service education, and the impact had by attending in-service education on nurses' management and knowledge of deteriorating patients.

Background: In-service education cannot reach its best potential outcomes without strong leadership. Nurse managers are in a position of adopting leadership styles and creating conditions for enhancing the in-service education outcomes.

Design: We conducted a comparative cross-sectional study between British and Finnish nurses (N = 180; United Kingdom: n = 86; Finland: n = 94).

Methods: A modified "Rapid Response Team Survey" was used in data collection. A sample of medical and surgical registered nurses were recruited from acute care hospitals. Self-reporting, self-reflection, and case-scenarios were used to assess nurses' attitudes, practice, and knowledge. Data were analyzed by Mann-Whitney-U and Chi-square tests.

Results: Nurses' views on education programs were positive; however, low confidence, delays caused by hospital culture, and fear of criticism remained barriers to post education management of deteriorating patients. Nurses' self-reflection on their management of deteriorating patients indicates that 20-25% of deteriorating patients are missed.

Conclusion: Nurse managers should promote a no-blame culture, mitigate unnecessary hospital culture and routines, and facilitate in-service education focusing on identification and management of deteriorating patients, simultaneously improving nurses' confidence.