Signs and symptoms in hospitalized children and adolescents' triggering nurses' awareness: A qualitative study across Denmark and Norway

BACKGROUND: Assessment of signs and symptoms in hospitalized children presents unique challenges due to the children's age-related differences, such as vital signs and the broad range of medical conditions that affects children. Early detection of clinical changes in children is crucial to prevent deterioration, and while standardized tools exist, there is a growing recognition of the need to consider subjective factors based on experienced nurses' knowledge and intuition. OBJECTIVE: To explore which signs and symptoms, apart from vital signs, that trigger nurses' concern regarding deterioration of hospitalized children and adolescents. DESIGN: This study used a descriptive qualitative design. SETTINGS: The study was conducted at three pediatric departments in Denmark and a nursing department of a university in Norway, offering post graduate education programs for health care professions working with children and adolescents throughout Norway. PARTICIPANTS: A total sample of 29 registered nurses with varying levels of experience participated. METHOD: Four focus group interviews were used to collect data and analyzed with inductive content analysis approach. RESULTS: Nurses' knowledge about children's clinical conditions is influenced by the nurses experience, their use of senses like touching the child with their hands, and the use of various approaches. Information from parents about the child's normal behavior are considered valuable. These sources of information, often difficult to verbalize, might be referred to as intuition or "gut feeling" and often guides the nurses' actions when vital signs appear normal, and nurses rely on their senses to assess the child's condition. Specific indicators triggering concern include changes in respiration, circulation, level of consciousness, and facial expressions. Challenges arise from nighttime assessments, interactions with parents, the presence of electronic devices, and children's ability to compensate. Clinical experience is a significant factor in nurses' ability to recognize changes in in the child's condition. CONCLUSION: This study highlights the multifaceted nature of nurses' assessments of clinical conditions in hospitalized children. Nurses draw on their experiences, intuition, and interactions with parents to complement vital signs-based assessments. Their intuition, or "gut feeling" serves as a valuable tool when vital signs do not fully capture the child's clinical status. Specific signs and symptoms that trigger nurses' concern, along with the challenges they face, contribute to a comprehensive understanding of the complexity of assessing children's clinical conditions. These findings, emphasize the role of nurses in early recognition of clinical deterioration in hospitalized children and the need for assessments that go beyond vital signs. TWEETABLE ABSTRACT: Both objective assessments and intuitive clinical judgment play an important role in identifying potential deterioration in pediatric patients.