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Caring for deteriorating paediatric patients in the emergency department: A mixed method study
Chanika Ilangakoon1, Tamsin Jones1, Kelli Innes1
1Nursing and Midwifery, Monash University, 47-49 Moorooduc Highway, Frankston, Victoria, Australia.
Insights
Emergency nurses gain confidence and competence in caring for deteriorating pediatric patients through experience, not just qualifications. Further education and simulation can enhance these skills.
Area of Science:
- Pediatric Emergency Nursing
- Clinical Competence
- Healthcare Simulation
Background:
- Pediatric emergency department (ED) presentations are frequent, with children's ability to compensate masking early signs of deterioration.
- Nurses in EDs require specialized knowledge, skills, confidence, and competence to effectively manage deteriorating pediatric patients.
Purpose of the Study:
- To assess emergency nurses' self-reported preparedness, confidence, and competence in managing deteriorating pediatric patients.
- To identify strategies for improving nurses' confidence and competence in this critical area.
Main Methods:
- An exploratory sequential mixed-methods study was conducted in two phases.
- Phase One involved qualitative data collection through focus groups, followed by thematic analysis.
- Phase Two utilized findings from Phase One to develop and administer a quantitative survey.
Main Results:
- Nurses' confidence and competence did not correlate with educational qualifications but increased with years of experience.
- Human resource availability significantly impacted nurses' confidence in managing deteriorating pediatric patients.
- Nurses expressed strong interest in further education for pediatric patient care.
Conclusions:
- Consistent exposure to pediatric care is crucial for building nurse confidence and competence, regardless of formal qualifications.
- Interprofessional in-situ simulation presents a viable strategy to address human resource limitations and advance skill development.
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.
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