Karen Davey, Duncan Smith
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.