Caring for deteriorating paediatric patients in the emergency department: A mixed method study

Ilangakoon, Chanika; Jones, Tamsin; Innes, Kelli; Morphet, Julia

doi:10.1016/j.auec.2020.07.006

Cited by 9 publications

(22 citation statements)

References 26 publications

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“…One factor, centred around the beliefs about capability and skills required to deliver treatment for paediatric sepsis, had comparatively lower ratings indicating that nurses need additional development to enhance confidence in skills required for managing paediatric sepsis. Similar findings have been identified in previous studies [ 51 , 55 ], highlighting the importance of education initiatives focusing on kinaesthetic skill acquisition (and so, enhanced belief in capability) in training, especially where exposure to critically unwell children may otherwise be infrequent. In our study, only 35% of nurses reported caring for a child with sepsis as a weekly or fortnightly occurrence, highlighting the relatively low exposure to paediatric sepsis.…”

Section: Discussionsupporting

confidence: 89%

“…We identified, years of paediatric experience as a significant predictor of increased knowledge. Previous study findings have also identified years of paediatric experience contributes to increased capability and confidence caring for paediatric patients [ 55 ]. While years of clinical experience cannot be replaced, we argue, based on our findings, there is a need for dedicated and ongoing resources targeting specialised paediatric sepsis education to enhance exposure; to supplement years of experience.…”

Section: Discussionmentioning

confidence: 94%

“…In our study, only 35% of nurses reported caring for a child with sepsis as a weekly or fortnightly occurrence, highlighting the relatively low exposure to paediatric sepsis. The identified positive link between beliefs in capability and skills to sepsis knowledge should inform future QI and education initiatives to focus on increasing confidence in capability [ 51 , 55 – 57 ] as a mechanism for enhancing knowledge translation and subsequent care for children.…”

Section: Discussionmentioning

confidence: 99%

“…3 c). A lack of provision of dedicated human resources has been identified as the greatest challenge in caring for critically ill paediatric patients, impacting nurse’s confidence in their capability [ 55 ]. Our identified link between confidence and knowledge informs future models, aiming to justify resources dedicated to paediatric sepsis QI initiatives.…”

Section: Discussionmentioning

confidence: 99%

“…Importantly, surveys of students, and of the healthcare workforce have revealed relatively low levels of agreement and knowledge about sepsis, which contrasts with the fact that sepsis represents one of the leading diseases associated with preventable deaths across all age groups [ 49 , 64 ]. In Australia, despite the fact that national sepsis standards are being developed, currently there are no standards or mandates for under-graduate, post-graduate, or facility specific training for ED nurses on sepsis [ 28 , 55 ]. In Australia, a generalist model in undergraduate nursing curriculum [ 34 ] contrasts with that in the United Kingdom, which offers specialised paediatric nursing degrees.…”

Section: Discussionmentioning

confidence: 99%

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Knowledge translation following the implementation of a state-wide Paediatric Sepsis Pathway in the emergency department- a multi-centre survey study

Harley

Schlapbach

Lister

et al. 2021

BMC Health Serv Res

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Background Several health care systems internationally have implemented protocolised sepsis recognition and treatment bundles for children to improve outcomes, as recommended by the Surviving Sepsis Campaign. Successful implementation of clinical pathways is challenging and dependent on nurse engagement. There is limited data on knowledge translation during implementation of sepsis quality improvement programs. Methods This cross-sectional, multicentre observational survey study evaluated knowledge and perceptions of Emergency Department nurses in relation to the recognition, escalation and management of paediatric sepsis following implementation of a sepsis pathway. The study was conducted between September 2019 and March 2020 across 14 Emergency Departments in Queensland, Australia. The primary outcome was a sepsis knowledge score. An exploratory factor analysis was conducted to identify factors impacting nurses’ perceptions of recognition, escalation and management of paediatric sepsis and their association with knowledge. Using a logistic mixed effects model we explored associations between knowledge, identified factors and other clinical, demographic and hospital site variables. Results In total, 676 nurses responded to the survey and 534 were included in the analysis. The median knowledge score was 57.1% (IQR = 46.7–66.7), with considerable variation observed between sites. The exploratory factor analysis identified five factors contributing to paediatric sepsis recognition, escalation and management, categorised as 1) knowledge and beliefs, 2) social influences, 3) beliefs about capability and skills delivering treatment, 4) beliefs about capability and behaviour and 5) environmental context. Nurses reported strong agreement with statements measuring four of the five factors, responding lowest to the factor pertaining to capability and skills delivering treatment for paediatric sepsis. The factors knowledge and beliefs, capability and skills, and environmental context were positively associated with a higher knowledge score. Years of paediatric experience and dedicated nurse funding for the sepsis quality improvement initiative were also associated with a higher knowledge score. Conclusion Translation of evidence to practice such as successful implementation of a sepsis care bundle, relies on effective education of staff and sustained uptake of protocols in daily practice. Our survey findings identify key elements associated with enhanced knowledge including dedicated funding for hospitals to target paediatric sepsis quality improvement projects.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Knowledge translation following the implementation of a state-wide Paediatric Sepsis Pathway in the emergency department- a multi-centre survey study

Harley

Schlapbach

Lister

et al. 2021

BMC Health Serv Res

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Using clinical simulation to assess a new paediatric ESCALATION system education package: Empirical research mixed methods

Cooper,

Iten,

Leslie

et al. 2024

Nursing Open

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AimThe aim of the study was to assess the suitability of an online education package to prepare health professionals to use a new paediatric early warning system.DesignQuasi‐experimental mixed methods using co‐production.MethodsParticipants completed the Package and participated in up to four clinical scenarios. Data were collected using self‐report surveys, and during clinical scenarios; escalation of care, documentation, family involvement, communication handovers were assessed, and recorded debriefings were thematically analysed. Data were integrated using tabulated joint displays.ResultsEleven nurses and three doctors were recruited from three mixed adult and paediatric hospitals. Following completion of the Package and clinical scenarios 13/14 (93%) participants agreed preparedness and confidence to use the ESCALATION System had increased. For 53% handovers, the communication framework was followed, for 79% charts, documentation was complete. Participants engaged with the parent (actor) for 97% scenario interactions. The Package was effective and participation in clinical scenarios appeared to enhance learning.Patient or public contributionConsumers participated in the steering group overseeing the study and in the expert panel who reviewed the education package and clinical scenarios.

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Artificial Intelligence for Pediatric Emergency Medicine

Alsabri,

Aderinto,

Mourid

et al. 2024

Journal of Medicine, Surgery, and Public Health

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Caring for deteriorating paediatric patients in the emergency department: A mixed method study

Cited by 9 publications

References 26 publications

Knowledge translation following the implementation of a state-wide Paediatric Sepsis Pathway in the emergency department- a multi-centre survey study

Knowledge translation following the implementation of a state-wide Paediatric Sepsis Pathway in the emergency department- a multi-centre survey study

Using clinical simulation to assess a new paediatric ESCALATION system education package: Empirical research mixed methods

Artificial Intelligence for Pediatric Emergency Medicine

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