Highlights
- •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.
Abstract
Purpose
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.
Results
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.
Conclusions
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.
Implications
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.
Keywords
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Article info
Publication history
Published online: June 13, 2022
Accepted:
May 22,
2022
Received in revised form:
May 15,
2022
Received:
November 23,
2021
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
