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Signal detection for pediatric patient deterioration with nursing students: An explanatory sequential design

Leslie T Zimpelman¹

¹Texas Christian University, Fort Worth, TX USA.

International Journal of Nursing Studies Advances

|January 16, 2026

Summary

Nursing students struggle to detect early pediatric patient deterioration, showing low sensitivity to vital sign changes. This highlights a critical need for improved training to prevent failure to rescue in pediatric care.

Keywords:

Nursing students Pediatric patient deterioration Signal detection

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Area of Science:

Nursing Education
Pediatric Critical Care
Patient Safety

Background:

Failure to rescue results from missed early signs of patient deterioration.
Pediatric patients present unique physiological responses, complicating deterioration detection for nursing students educated primarily on adult cases.

Purpose of the Study:

To identify vital signs nursing students recognize as indicators of pediatric deterioration.
To determine factors influencing nursing students' responses to these signals.
To assess how these influences impact their performance in signal detection trials.

Main Methods:

An explanatory sequential mixed-method design was employed with senior baccalaureate nursing students.
Participants engaged in signal detection trials, followed by interviews for a subset.
Quantitative data (sensitivity, response bias) and qualitative data (thematic analysis) were analyzed.

Main Results:

Students exhibited low sensitivity (d'=1.19) to pediatric deterioration signals and a tendency to misclassify non-critical stimuli.
Respiratory rate changes were the most reliably detected vital sign.
Four key themes emerged as influences on student responses, correlating with performance variations.

Conclusions:

The study reveals a significant gap in nursing students' ability to detect early pediatric deterioration, emphasizing the need for enhanced educational strategies.
Signal detection methodology offers a novel approach to assess and address knowledge gaps in nursing students, improving preparedness for clinical practice.
Improving early detection skills is crucial for reducing failure to rescue incidents in pediatric patients.