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Nursing Surveillance for Deterioration in Pediatric Patients: An Integrative Review
James R Stotts1, Audrey Lyndon2, Garrett K Chan3
1Department of Family Health Nursing, University of California, San Francisco, CA, USA; Department of Patient Safety and Regulatory Affairs, UCSF Health, San Francisco, CA, USA.
Insights
Pediatric nurses
Area of Science:
- Pediatric Nursing
- Patient Safety
- Healthcare Quality Improvement
Background:
- Adverse events affect up to 19% of hospitalized children, often due to delayed recognition or treatment.
- Early detection of patient deterioration is crucial for recovery, yet research often overlooks factors influencing surveillance effectiveness.
Purpose of the Study:
- To explore actions and factors influencing the quality of pediatric nursing surveillance for patient deterioration.
Main Methods:
- An integrative review of 24 original research studies on nursing surveillance in non-critical pediatric hospital settings.
- Studies were synthesized using a socio-technical systems theory framework and assessed for quality.
Main Results:
- Key surveillance activities include assessment, documentation, decision-making, intervention, and communication.
- Factors influencing nurses' detection of deterioration encompass patient acuity, nurse expertise, staffing, communication tools, and team collaboration.
Conclusions:
- Current research inadequately addresses clinical data interpretation, synthesis, and role integration in nursing surveillance.
- Further research is needed on contextual factors to improve nursing interventions for timely recognition and mitigation of pediatric patient deterioration.
Problem:
Adverse events occur in up to 19% of pediatric hospitalized patients, often associated with delays in recognition or treatment. While early detection is recognized as a primary determinant of recovery from deterioration, most research has focused on profiling patient risk and testing interventions, and less on factors that impact surveillance efficacy. This integrative review explored actions and factors that influence the quality of pediatric nursing surveillance.
Eligibility Criteria:
Original research on nursing surveillance, escalation of care, or cardiopulmonary deterioration in hospitalized pediatric patients in non-critical environments, published in English in peer reviewed journals.
Sample:
Twenty-four studies from a literature search within the databases of CINAHL, PubMed, and Web of Science were evaluated and synthesized using a socio-technical systems theory framework. Study quality was assessed using The Mixed Methods Appraisal Tool.
Results:
Assessment, documentation, decision-making, intervening and communicating were identified as activities associated with surveillance of deterioration. Factors that influenced nurses' detection of deterioration were patient acuity, nurse education, experience, expertise and confidence, staffing, standardized assessment and communication tools, availability of emergency services, team composition and opportunities for multidisciplinary care planning.
Conclusions:
Research provides insight into some aspects of nursing surveillance but does not adequately explore factors that affect clinical data interpretation and synthesis, and role integration between nurse and parents, and nurse and other clinicians on surveillance of clinical stability.
Implications:
Research is needed to enhance understanding of the contextual factors that impact nursing surveillance to inform intervention design to support nurses' timely recognition and mitigation of clinical deterioration.
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