Caring for deteriorating paediatric patients in the emergency department: A mixed method study

Abstract

Background: Paediatric presentations to emergency departments are common for a range of conditions with varying severity. Children can compensate well and early signs of deterioration may not be obvious. Nurses working in emergency departments (ED) should not only have the knowledge and skill to recognise the unwell child, but also be confident and competent to provide care.

Aim: To explore the self-reported preparedness, confidence and competence of emergency nurses in caring for deteriorating paediatric patients, and to identify how their confidence and competence could be improved.

Methods: An exploratory sequential mixed methods study with two phases was used. In Phase One, qualitative data were collected via focus group and thematically analysed. The findings from Phase One informed Phase Two survey development, with quantitative data collected and analysed.

Results: Findings from both phases identified that emergency nurses' confidence and competence when caring for deteriorating paediatric patients did not correlate with their level of qualification. In contrast, increased years of experience in caring for this cohort did increase level of confidence. Availability of human resources further impacted nurses' confidence when caring for deteriorating paediatric patients and emergency nurses showed an interest and enthusiasm for further education in caring for the deteriorating paediatric patient.

Conclusions: Regular exposure to paediatrics was key to nurses having confidence and competence to care for deteriorating patients, irrespective of educational qualifications. A focus on interprofessional insitu simulation could address human resource challenges to enhance skill development.

Keywords: Paediatric nursing; clinical deterioration; emergency departments; emergency nursing; mixed methods; nursing education.