Dr Duncan Smith
About
Overview
Duncan joined the Division of Nursing at the then City, University of London in 2014, following a career in acute and critical care nursing in the NHS. Before moving into critical care outreach, he worked across acute and critical care settings, developing extensive experience in the assessment and management of acutely unwell and critically ill adults. He moved into critical care outreach practice in 2010, where his clinical interests increasingly focused on the recognition of deterioration, escalation of care and supporting ward teams in the management of deteriorating patients. Alongside his academic role at City St George’s, University of London, Duncan is an Honorary Consultant Nurse with the Patient Emergency Response and Resuscitation Team (PERRT) at University College London Hospitals NHS Foundation Trust, where he continues to practise clinically.
Duncan is also a Generic Instructor Course Educator for the Resuscitation Council UK and Advanced Life Support Group and contributes to the Resuscitation Council UK Education Subcommittee. He has a longstanding interest in resuscitation education, clinical teaching, debriefing and the development of healthcare professionals.
In 2018, Duncan was awarded an NIHR/HEE Clinical Doctoral Research Fellowship to undertake his PhD. His doctoral research focused on developing a theoretically informed behaviour change intervention to improve the recognition of and response to clinical deterioration by registered nurses and healthcare assistants. His subsequent research has continued to focus on clinical deterioration, critical care outreach and the development and evaluation of complex interventions designed to improve healthcare professionals’ behaviour and patient care.
Duncan’s methodological interests include implementation science, behaviour change, mixed-methods research and the use of theory to inform intervention development and evaluation. His current programme of research includes work examining how ward-based healthcare professionals recognise and respond to deteriorating patients and the optimisation and evaluation of interventions designed to support more reliable escalation and response. He collaborates with researchers and clinical teams nationally and internationally and supervises MSc, MRes and doctoral research.
Duncan has a particular interest in supporting clinical-academic careers and developing research capacity amongst nurses and allied health professionals. He has supervised and mentored clinicians undertaking NIHR-funded research training awards and contributes to initiatives aimed at strengthening research engagement and capability within nursing and advanced practice.
Duncan is Deputy Programme Director for the MSc Advanced Clinical Practice and leads APM052 Advanced Clinical Assessment, a core clinical module within the programme. He has taught across the four pillars of advanced practice and supervises postgraduate research students.
Earlier in his career, Duncan spent two years living and working in Uganda with Voluntary Service Overseas (VSO). During this time, he worked alongside Ugandan colleagues in pre-registration nursing education and supported the development of nurses working in intensive care. This experience contributed to his longstanding interest in nursing education, workforce development and healthcare in resource-constrained settings.
Qualifications
- Doctor of Philosophy (PhD - nursing), City, University of London, United Kingdom, July 2018 - November 2022
- Postgraduate Certificate (academic practice/education), City, University of London, United Kingdom, 2014 - September 2015
- Master of Science (cardio-respiratory), Imperial College London, UK, 2011 - September 2013
- Diploma in Tropical Nursing, London School of Hygiene & Tropical Medicine, United Kingdom, February - September 2006
- Master of Nursing, University of Nottingham, UK, September 1999 - July 2003
Employment
- Honorary Consultant Nurse, University College London Hospitals NHS Foundation Trust, April 2015 - present
- Honorary Charge Nurse, University College London Hospitals NHS Foundation Trust, United Kingdom, January 2015 - June 2022
- Lecturer in Adult Nursing, City, University of London, United Kingdom, August 2014 - August 2020
Fellowships
- Clinical Doctoral Research Fellowship, Health Education England/National Institute for Health Research, April 2018 - July 2022
Memberships of professional organisations
- Fellow, Higher Education Academy, October 2015 - present
- Nursing & Midwifery Council
Teaching
Module leader
APM052 - Advanced Clinical Assessment, Critical Thinking and Diagnostic Reasoning Across the Lifespan
Contributor
CAM001/CA3001 - Core Concepts in Critical Care
Contributor
CAM002/CA3002 - Dimensions in Critical Care
Publications
Publications by category
Book
- DeVita, M.A., Hillman, K. and Bellomo, R. (Eds.), (2011). Textbook of Rapid Response Systems. Springer New York. ISBN 9780387928524.
Chapter
- Sprogis, S.K. and Smith, D. (2024). Tiered Rapid Response Systems. Textbook of Rapid Response Systems (pp. 161-173). Springer Nature Switzerland. ISBN 9783031679506.
Journal articles (22)
- Smith, D., Chua, W.L., Azimirad, M., Turunen, H., Phone Ko, J., Tasala, N.... Aitken, L.M. (2026). Automaticity and habit in recognition and responses to clinical deterioration among ward nursing staff: An international cross-sectional study. International Journal of Nursing Studies, 184, pp. 105676-105676. doi:10.1016/j.ijnurstu.2026.105676
- Davey, K. and Smith, D. (2026). Exploring Ward Registered Nurses' Emotional Responses When Caring for Clinically Deteriorating Patients: An Interview Study Informed by Affective Events Theory. Journal of Clinical Nursing. doi:10.1111/jocn.70482
- Virtudazo, M.D., Ede, J., Smith, D. and Pattison, N. (2026). The determinants of nursing staff escalating clinical deterioration out-of-hours: A mixed methods systematic review. International Journal of Nursing Studies, 178, pp. 105406-105406. doi:10.1016/j.ijnurstu.2026.105406
- Smith, D., McIntyre, S. and Sekhon, M. (2026). Acceptability of a behaviour change intervention to improve care of clinically deteriorating patients on acute hospital wards: A theory-based mixed-methods study. Australian Critical Care, 39(1), pp. 101512-101512. doi:10.1016/j.aucc.2025.101512
- Kavanagh-Brown, W., Smith, D. and Bowden, T. (2025). The assessment and management of acute dyspnoea: a case study. British Journal of Nursing, 34(7), pp. 386-391. doi:10.12968/bjon.2024.0455
- Woolfe Loftus, N., Smith, D. and Aitken, L.M. (2025). The Scope of Nurses' Assessment of Deteriorating Patients in Coronary Care Units: A Mixed Methods Study. Journal of Clinical Nursing, 34(4), pp. 1250-1263. doi:10.1111/jocn.17500
- Smith, D., Cartwright, M., Dyson, J. and Aitken, L.M. (2024). Use of nominal group technique methods in the virtual setting: A reflective account and recommendations for practice. Australian Critical Care, 37(1), pp. 158-165. doi:10.1016/j.aucc.2023.09.004
- Smith, D. and Aitken, L.M. (2023). Rethinking the problem of clinically deteriorating patients: Time for theory-informed solutions. Australian Critical Care, 36(6), pp. 925-927. doi:10.1016/j.aucc.2023.09.001
- Hong, J.Q.Y., Chua, W.L., Smith, D., Huang, C.M., Goh, Q.L.P. and Liaw, S.Y. (2023). Collaborative practice among general ward staff on escalating care in clinical deterioration: A systematic review. Journal of Clinical Nursing, 32(17-18), pp. 6165-6178. doi:10.1111/jocn.16743
- Chua, W.L., Smith, D., Wee, L.C., Ting, K.C., Yeo, M.L.K., Mordiffi, S.Z.... Liaw, S.Y. (2023). Development and psychometric evaluation of the Attitudes Towards Recognising Early and Noticeable Deterioration (ATREND) scale. Journal of Clinical Nursing, 32(11-12), pp. 2684-2699. doi:10.1111/jocn.16350
- Williams, G., Pirret, A., Credland, N., Odell, M., Raftery, C., Smith, D.... Massey, D. (2023). A practical approach to establishing a critical care outreach service: An expert panel research design. Australian Critical Care, 36(1), pp. 151-158. doi:10.1016/j.aucc.2022.01.008
- Smith, D., Cartwright, M., Dyson, J., Hartin, J. and Aitken, L.M. (2022). Selecting intervention content to target barriers and enablers of recognition and response to deteriorating patients: an online nominal group study. BMC Health Services Research, 22(1). doi:10.1186/s12913-022-08128-6
- Smith, D., Cartwright, M., Dyson, J., Hartin, J. and Aitken, L.M. (2021). Barriers and enablers of recognition and response to deteriorating patients in the acute hospital setting: A theory‐driven interview study using the Theoretical Domains Framework. Journal of Advanced Nursing, 77(6), pp. 2831-2844. doi:10.1111/jan.14830
- Smith, D., Cartwright, M., Dyson, J., Hartin, J. and Aitken, L.M. (2020). Patterns of behaviour in nursing staff actioning the afferent limb of the rapid response system (RRS): A focused ethnography. Journal of Advanced Nursing, 76(12), pp. 3548-3562. doi:10.1111/jan.14551
- Smith, D., Sekhon, M., Francis, J.J. and Aitken, L.M. (2019). How actionable are staff behaviours specified in policy documents? A document analysis of protocols for managing deteriorating patients. Journal of Clinical Nursing, 28(21-22), pp. 4139-4149. doi:10.1111/jocn.15005
- Smith, D., Francis, J.J. and Aitken, L.M. (2019). DEveloping a Complex Intervention for DEteriorating patients using theoretical modelling (DECIDE study): Study protocol. Journal of Advanced Nursing, 75(9), pp. 2024-2035. doi:10.1111/jan.14076
- Loftus, N.W. and Smith, D. (2019). Investigating ward nurses’ responses to deteriorating patients. Nursing Standard, 34(3), pp. 76-82. doi:10.7748/ns.2019.e11020
- Loftus, N.W. and Smith, D. (2018). Investigating ward nurses’ responses to deteriorating patients. Nursing Standard. doi:10.7748/ns.2018.e11020
- Smith, D. and Bowden, T. (2017). Using the ABCDE approach to assess the deteriorating patient. Nursing Standard, 32(14), pp. 51-63. doi:10.7748/ns.2017.e11030
- Bowden, T. and Smith, D. (2017). An overview of adult cardiopulmonary resuscitation equipment. Nursing Standard, 31(23), pp. 54-63. doi:10.7748/ns.2017.e10461
- Smith, D.J. and Aitken, L.M. (2016). Use of a single parameter track and trigger chart and the perceived barriers and facilitators to escalation of a deteriorating ward patient: a mixed methods study. Journal of Clinical Nursing, 25(1-2), pp. 175-185. doi:10.1111/jocn.13104
- Smith, D. (2012). Counterpulsation in cardiogenic shock: the belief is there but where is the evidence? British Journal of Cardiac Nursing, 7(8), pp. 387-394. doi:10.12968/bjca.2012.7.8.387
Practitioner article
- (2012). Counterpulsation in cardiogenic shock: the belief is there but where is the evidence? British Journal of Cardiac Nursing, pp. 387-395
Professional activities
Clinical activity
- Consultant Nurse - Patient Emergency Response and Resuscitation Team (Critical Care Outreach), University College London Hospitals NHS Foundation Trust, June 2022 - present