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