Research Article| Volume 66, e67-e73, September 2022

Beyond objective measurements: Danish nurses' identification of hospitalized pediatric patients at risk of clinical deterioration – A qualitative study


      • Children often present subtle signs and symptoms of clinical deterioration.
      • Identifying pediatric patients at risk of deterioration requires more than relying on a score.
      • Non-measurable signs and symptoms are important to nurses when observing inpatient pediatric patients at the bedside.



      While the use of Pediatric Track and Trigger Tools as a standard to discriminate high level of urgency in pediatric care has received considerable attention, less focus has been given to other important factors such as nurses' clinical observations and judgement. The purpose of this study was to explore nurses' observational practice and focus on which non-measurable signs and symptoms nurses find important when identifying inpatient pediatric patients at risk of clinical deterioration.

      Design and methods

      This was an inductive qualitative study based on an interpretive description methodology. Data were obtained through participant observation of experienced nurses working in a Danish pediatric unit and focus group interviews with pediatric nurses. Field notes were taken, and focus group interviews were audio taped and transcribed. A thematic text condensation method was used to analyse data.


      Findings revealed the following four main themes of non-measurable signs and symptoms that nurses find important when identifying children at risk of clinical deterioration: Colour and skin tone; sounds; movement patterns; behavioural signs.


      This study suggest that pediatric patients show signs and symptoms that go beyond the objective measurements integrated in Pediatric Track and Trigger Tools and they should not be ignored as they are highly valuable to nurses who are responsible for observing inpatient pediatric patients at risk of clinical deterioration.


      More empirical research on nurses' observational practice is recommended, especially research to identify the signs and symptoms - both measurable and non-measurable – that are significant to nurses at the bedside.


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