The Ability of Newly Qualified Saudi Nurses Working on Paediatric Wards to Recognise a Deteriorating Child: Can a Focused Educational Intervention Impact On This?

Abstract

Background:
It is crucial that nurses are able to recognise and respond early to child deterioration in hospital wards, to avoid cardiac arrests and improve patients’ outcomes. However, taking and interpreting vital signs accurately in the paediatric clinical setting is both complex and challenging. Many researchers have found that nurses working in children’s wards do not always identify deterioration at an early enough point in a child’s illness trajectory to respond and alert medical staff in order to avoid critical care unit admission.
Aim:
The aim of this study was to explore the ability of Saudi-educated newly qualified nurses, working in paediatric wards, to recognise children’s deterioration and to determine the impact of a focused educational intervention on this ability.
Method:
A two-phased quantitative and qualitative method study was used to assess nurses’ responses to three clinical vignettes (a deteriorating child, an improving child and an ambiguous scenario). The nurses’ ability to correctly identify this was captured using a Think Aloud approach, and quantified using a visual analogue scale pre- and post- an educational intervention. The quantitative component of the research was supported by qualitative data from the responses to the vignettes and from semi-structured interviews.
Findings:
Twenty-seven nurses in two geographical regions in the Kingdom of Saudi Arabia (KSA) participated in the pre-intervention phase of the study, and twenty of the original twenty-seven participated in the post- intervention phase. In the pre-intervention phase, over half of newly qualified nurses working in two regions of the KSA could not identify the deteriorating child, and none of the nurses correctly identified all three vignettes. From the qualitative data three main themes were identified; experience and training, the absence of focused training and assessment, and recognition and response.
Post-intervention (12 months from phase one), there was a good proportional improvement change in correct responses of the intervention group compared to the control group. The recognition of deterioration was improved in the intervention group and the nurses showed greater confidence in making decisions, whereas the control group persisted in rationalising their lack of ability by claiming to be still “new”.
Conclusion:
Even in non-stressful simulated scenarios using vignettes, many newly qualified nurses working with children failed to recognise signs of child deterioration and their responsibilities during this. The culturally-adapted focused educational intervention course (called RADAR) delivered to a group of newly qualified KSA nurses was adapted from the UK RESPOND course and demonstrated a positive impact on their ability to communicate their clinical assessment and understanding of their role in the early recognition of child deterioration.