Attitudes and practices towards vital signs monitoring on paediatric wards: Cross-validation of the Ped-V scale

Published:April 09, 2022DOI:


      • Paediatric patients admitted to hospital wards are at risk of deterioration.
      • Nurses' attitudes and practices towards paediatric vital signs monitoring can vary.
      • The Ped-V scale was developed by adapting the V-scale to the paediatric context.
      • The Ped-V scale is valid and reliable for use in the paediatric hospital context.



      To develop and psychometrically test an instrument measuring the attitudes and practices towards vital signs (VS) monitoring in nurses caring for children on paediatric wards (Ped-V scale).

      Design and methods

      This is a multicentre cross-validation study with a cross-sectional design. The Ped-V scale was developed by adapting the V-scale to the paediatric context and administered to a convenience sample of clinical nurses working in paediatric wards from January to May 2020. The content validity of the Ped-V scale was evaluated by a group of 10 experts. The psychometric properties of the scale were tested through Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA).


      Overall, 10 Italian hospitals participated in the study, and 640 questionnaires were completed (87% female). At EFA a 30-item version of the scale and four factors emerged. This solution was confirmed at CFA: F1) ‘Inaccuracy of VS monitoring and workload’; F2) ‘Clinical competence and communication’; F3) ‘Standardization and protocol adherence’; F4) ‘Misconceptions about key indicators’. Cronbach's alpha ranged between 0.63 and 0.85.


      The Ped-V scale is valid and reliable for use in the paediatric context to identify barriers concerning nurses' self-efficacy, competences, and knowledge of clinical indicators of paediatric critical deterioration, attitudes towards accuracy, standardization, communication to senior team members and the appropriate use of technology in paediatric VS monitoring.

      Practice implications

      The Ped-V scale may assist in identifying gaps in nurses' attitudes and devising strategies to change nurses' beliefs, knowledge, skills and decreasing individual, local cultural or organizational barriers towards VS monitoring.


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        • Armitage M.
        • Eddleston J.
        • Stokes T.
        Recognising and responding to acute illness in adults in hospital: Summary of NICE guidance.
        British Medical Journal. 2007; 335: 258-259
        • Aylott M.
        Developing rigour in observation of the sick child: Part 1.
        Paediatric Nursing. 2006; 18: 38-44
        • Bagnasco A.
        • Dasso N.
        • Rossi S.
        • Timmins F.
        • Aleo G.
        • Catania G.
        • Sasso L.
        A qualitative descriptive inquiry of the influences on nurses’ missed care decision-making processes in acute hospital paediatric care.
        Journal of Nursing Management. 2020; 28: 1929-1939
        • Bagnasco A.
        • Zanini M.
        • Aleo G.
        • Catania G.
        • Kalisch B.J.
        • Sasso L.
        Development and validation of the MISSCARE survey—Pediatric version.
        Journal of Advanced Nursing. 2018; 74: 2922-2934
        • Bagozzi R.P.
        • Yi Y.
        Specification, evaluation, and interpretation of structural equation models.
        Journal of the Academy of Marketing Science. 2012; 40: 8-34
        • Bartholomew L.K.
        • Parcel G.S.
        • Kok G.
        • Gottlieb N.H.
        • Fernandez M.E.
        Planning health promotion programs: An intervention mapping approach Jossey-Bass.
        3rd ed. Jossey-Bass, 2011
        • Bollen K.A.
        • Long J.S.
        Testing structural equation models.
        vol. 154. Sage Publications, 1993
        • Bonafide C.P.
        • Brady P.W.
        • Keren R.
        • Conway P.H.
        • Marsolo K.
        • Daymont C.
        Development of heart and respiratory rate percentile curves for hospitalized children.
        Pediatrics. 2013; 131: e1150-e1157
        • Brekke I.J.
        • Puntervoll L.H.
        • Pedersen P.B.
        • Kellett J.
        • Brabrand M.
        The value of vital sign trends in predicting and monitoring clinical deterioration: A systematic review.
        PLoS One. 2019; 14: e0210875
        • Burchill C.
        • Anderson B.
        • O’Connor P.C.
        Exploration of nurse practices and attitudes related to postoperative vital signs.
        Medsurg Nursing. 2015; 24: 249-255
        • Burchill C.N.
        • Polomano R.
        Certification in emergency nursing associated with vital signs attitudes and practices.
        International Emergency Nursing. 2016; 27: 17-23
        • Chapman S.M.
        • Oulton K.
        • Peters M.J.
        • Wray J.
        Missed opportunities: Incomplete and inaccurate recording of paediatric early warning scores.
        Archives of Disease in Childhood. 2019; 104: 1208-1213
        • Chua W.L.
        • Liaw S.Y.
        Assessing beyond vital signs to detect early patient deterioration.
        Evidence-Based Nursing. 2016; 19: 53
        • Chua W.L.
        • Mackey S.
        • Ng E.K.C.
        • Liaw S.Y.
        Front line nurses’ experiences with deteriorating ward patients: A qualitative study.
        International Nursing Review. 2013; 60: 501-509
        • Cohen J.
        Statistical power analysis for the behavioral sciences (revised edition).
        Academic Press, 2013
        • Comrey A.L.
        • Lee H.B.
        A first course in factor analysis.
        2nd ed. Psychology Press, 2013
        • Convertino V.A.
        • Wirt M.D.
        • Glenn J.F.
        • Lein B.C.
        The compensatory reserve for early and accurate prediction of hemodynamic compromise: A review of the underlying physiology.
        Shock. 2016; 45: 580-590
        • Dall’Ora C.
        • Griffiths P.
        • Hope J.
        • Barker H.
        • Smith G.B.
        What is the nursing time and workload involved in taking and recording patients’ vital signs? A systematic review.
        Journal of Clinical Nursing. 2020; 29: 2053-2068
        • Dall’Ora C.
        • Griffiths P.
        • Hope J.
        • Briggs J.
        • Jeremy J.
        • Gerry S.
        • Redfern O.C.
        How long do nursing staff take to measure and record patients’ vital signs observations in hospital? A time-and-motion study.
        International Journal of Nursing Studies. 2021; 118: 103921
        • Dall’Ora C.
        • Griffiths P.
        • Redfern O.
        • Recio-Saucedo A.
        • Meredith P.
        • Ball J.
        Nurses’ 12-hour shifts and missed or delayed vital signs observations on hospital wards: Retrospective observational study.
        BMJ Open. 2019; 9
        • Downey C.L.
        • Chapman S.
        • Randell R.
        • Brown J.M.
        • Jayne D.G.
        The impact of continuous versus intermittent vital signs monitoring in hospitals: A systematic review and narrative synthesis.
        International Journal of Nursing Studies. 2018; 84: 19-27
        • Ertuğ N.
        Evaluating the validity and reliability of the V-scale instrument (Turkish version) used to determine nurses’ attitudes towards vital sign monitoring.
        International Journal of Nursing Practice. 2018; 24: e12637
        • Ferrando P.J.
        • Lorenzo-Seva U.
        Assessing the quality and appropriateness of factor solutions and factor score estimates in exploratory item factor analysis.
        Educational and Psychological Measurement. 2018; 78: 762-780
        • Fishbein M.
        • Ajzen I.
        Prediction and change of behavior: The reasoned action approach.
        Psychology Press, 2010
        • Fleming S.
        • Thompson M.
        • Stevens R.
        • Heneghan C.
        • Plüddemann A.
        • Maconochie I.
        • Tarassenko L.
        • Mant D.
        Normal ranges of heart rate and respiratory rate in children from birth to 18 years of age: A systematic review of observational studies.
        Lancet. 2011; 377: 1011-1018
        • Fornell C.
        • Larcker D.F.
        Evaluating structural equation models with unobservable variables and measurement error.
        Journal of Marketing Research. 1981; 18: 39-50
        • Franklin C.
        • Mathew J.
        Developing strategies to prevent inhospital cardiac arrest: Analyzing responses of physicians and nurses in the hours before the event.
        Critical Care Medicine. 1994; 22: 244-247
        • Furr M.
        Scale construction and psychometrics for social and personality psychology.
        SAGE Publications Ltd., 2011
        • Gawronski O.
        • Ferro F.
        • Cecchetti C.
        • Ciofi Degli Atti M.
        • Dall’Oglio I.
        • Tiozzo E.
        • Raponi M.
        Adherence to the bedside paediatric early warning system (BedsidePEWS) in a pediatric tertiary care hospital.
        BMC Health Services Research. 2021; 21: 852
        • Hoyle R.H.
        Structural equation modeling: Concepts, issues, and applications.
        Sage Publications, 1995
        • Hu L.
        • Bentler P.M.
        Fit indices in covariance structure modeling: Sensitivity to underparameterized model misspecification.
        Psychological Methods. 1998; 3: 424-453
        • Jensen C.S.
        • Kirkegaard H.
        • Aagaard H.
        • Olesen H.V.
        Clinical profile of children experiencing in-hospital clinical deterioration requiring transfer to a higher level of care.
        Journal of Child Health Care. 2019; 23: 522-533
        • Kause J.
        • Smith G.
        • Prytherch D.
        • Parr M.
        • Flabouris A.
        • Hillman K.
        • Intensive Care Society (UK), & Australian and New Zealand Intensive Care Society Clinical Trials Group
        A comparison of antecedents to cardiac arrests, deaths and emergency intensive care admissions in Australia and New Zealand, and the United Kingdom—The ACADEMIA study.
        Resuscitation. 2004; 62: 275-282
        • Liaw S.Y.
        • Scherpbier A.
        • Klainin-Yobas P.
        • Rethans J.-J.
        A review of educational strategies to improve nurses’ roles in recognizing and responding to deteriorating patients: Recognition and response to deteriorating patients.
        International Nursing Review. 2011; 58: 296-303
        • McGaughey J.
        • O’Halloran P.
        • Porter S.
        • Blackwood B.
        Early warning systems and rapid response to the deteriorating patient in hospital: A systematic realist review.
        Journal of Advanced Nursing. 2017; 73: 2877-2891
        • Mok W.
        • Wang W.
        • Cooper S.
        • Ang E.N.K.
        • Liaw S.Y.
        Attitudes towards vital signs monitoring in the detection of clinical deterioration: Scale development and survey of ward nurses.
        International Journal for Quality in Health Care. 2015; 27: 207-213
        • Mokkink L.B.
        • Prinsen C.A.
        • Patrick D.L.
        • Alonso J.
        • Bouter L.M.
        • de Vet H.C.
        • Terwee C.B.
        COSMIN study design checklist for patient-reported outcome measurement instruments.
        COSMIN. 2019;
        • Muthén L.K.
        • Muthén B.O.
        Mplus user’s guide: Statistical analysis with latent variables.
        7th ed. Muthén & Muthén, 1998
        • Odell M.
        • Victor C.
        • Oliver D.
        Nurses’ role in detecting deterioration in ward patients: Systematic literature review.
        Journal of Advanced Nursing. 2009; 65: 1992-2006
        • Ogero M.
        • Ayieko P.
        • Makone B.
        • Julius T.
        • Malla L.
        • Oliwa J.
        • Irimu G.
        • English M.
        • Clinical Information Network author group
        An observational study of monitoring of vital signs in children admitted to Kenyan hospitals: An insight into the quality of nursing care?.
        Journal of Global Health. 2018; 8: 010409
        • O’Leary F.
        • Hayen A.
        • Lockie F.
        • Peat J.
        Defining normal ranges and centiles for heart and respiratory rates in infants and children: A cross-sectional study of patients attending an Australian tertiary hospital paediatric emergency department.
        Archives of Disease in Childhood. 2015; 100: 733-737
        • Oliver A.
        • Powell C.
        • Edwards D.
        • Mason B.
        Observations and monitoring: Routine practices on the ward.
        Paediatric Nursing. 2010; 22: 28-32
        • Polit D.F.
        • Beck C.T.
        The content validity index: Are you sure you know what’s being reported? Critique and recommendations.
        Research in Nursing & Health. 2006; 29: 489-497
        • Redfern O.
        • Griffiths P.
        • Maruotti A.
        • Recio-Saucedo A.
        • Smith G.
        The association between nurse staffing levels and the timeliness of vital signs monitoring: A retrospective observational study in the UK.
        BMJ Open. 2019; 9
        • Royal College of Nursing
        Standards for assessing, measuring and monitoring vital signs in infants, children and young people.
        The Royal College of Nursing. 2017;
        • Sefton G.
        • Lane S.
        • Killen R.
        • Black S.
        • Lyon M.
        • Ampah P.
        • Carrol E.D.
        Accuracy and efficiency of recording pediatric early warning scores using an electronic physiological surveillance system compared with traditional paper-based documentation.
        Computers, Informatics, Nursing. 2017; 35: 228-236
        • Shearer B.
        • Marshall S.
        • Buist M.D.
        • Finnigan M.
        • Kitto S.
        • Hore T.
        • Ramsay W.
        What stops hospital clinical staff from following protocols? An analysis of the incidence and factors behind the failure of bedside clinical staff to activate the rapid response system in a multi-campus Australian metropolitan healthcare service.
        BMJ Quality & Safety. 2012; 21: 569-575
        • Tume L.
        The deterioration of children in ward areas in a specialist children’s hospital.
        Nursing in Critical Care. 2007; 12: 12-19
        • Tysinger E.L.
        How vital are vital signs? A systematic review of vital sign compliance and accuracy in nursing.
        J Sci Med. 2015; 1: 68-75
        • Wild D.
        • Grove A.
        • Martin M.
        • Eremenco S.
        • McElroy S.
        • Verjee-Lorenz A.
        • Erikson P.
        Principles of good practice for the translation and cultural adaptation process for patient-reported outcomes (PRO) measures: Report of the ISPOR task force for translation and cultural adaptation.
        Value in Health. 2005; 8: 94-104
        • Yeung M.S.
        • Lapinsky S.E.
        • Granton J.T.
        • Doran D.M.
        • Cafazzo J.A.
        Examining nursing vital signs documentation workflow: Barriers and opportunities in general internal medicine units.
        Journal of Clinical Nursing. 2012; 21: 975-982