Nursing Surveillance for Deterioration in Pediatric Patients: An Integrative Review

James R Stotts; Audrey Lyndon; Garrett K Chan; Arpi Bekmezian; Roberta S Rehm

doi:10.1016/j.pedn.2019.10.008

Nursing Surveillance for Deterioration in Pediatric Patients: An Integrative Review

J Pediatr Nurs. 2020 Jan-Feb:50:59-74. doi: 10.1016/j.pedn.2019.10.008. Epub 2019 Nov 23.

Authors

James R Stotts¹, Audrey Lyndon², Garrett K Chan³, Arpi Bekmezian⁴, Roberta S Rehm⁵

Affiliations

¹ Department of Family Health Nursing, University of California, San Francisco, CA, USA; Department of Patient Safety and Regulatory Affairs, UCSF Health, San Francisco, CA, USA. Electronic address: james.stotts@ucsf.edu.
² Department of Family Health Nursing, University of California, San Francisco, CA, USA. Electronic address: audrey.lyndon@nyu.edu.
³ Department of Physiologic Nursing, University of California, San Francisco, CA, USA; Division of Primary Care and Population Health, Stanford School of Medicine, Stanford, CA, USA. Electronic address: garrett.chan@nursing.ucsf.edu.
⁴ Department of Pediatrics, University of California, San Francisco, CA, USA; San Francisco, CA, USA. Electronic address: Arpi.Bekmezian@ucsf.edu.
⁵ Department of Family Health Nursing, University of California, San Francisco, CA, USA. Electronic address: roberta.rehm@ucsf.edu.

PMID: 31770679
DOI: 10.1016/j.pedn.2019.10.008

Abstract

Problem: Adverse events occur in up to 19% of pediatric hospitalized patients, often associated with delays in recognition or treatment. While early detection is recognized as a primary determinant of recovery from deterioration, most research has focused on profiling patient risk and testing interventions, and less on factors that impact surveillance efficacy. This integrative review explored actions and factors that influence the quality of pediatric nursing surveillance.

Eligibility criteria: Original research on nursing surveillance, escalation of care, or cardiopulmonary deterioration in hospitalized pediatric patients in non-critical environments, published in English in peer reviewed journals.

Sample: Twenty-four studies from a literature search within the databases of CINAHL, PubMed, and Web of Science were evaluated and synthesized using a socio-technical systems theory framework. Study quality was assessed using The Mixed Methods Appraisal Tool.

Results: Assessment, documentation, decision-making, intervening and communicating were identified as activities associated with surveillance of deterioration. Factors that influenced nurses' detection of deterioration were patient acuity, nurse education, experience, expertise and confidence, staffing, standardized assessment and communication tools, availability of emergency services, team composition and opportunities for multidisciplinary care planning.

Conclusions: Research provides insight into some aspects of nursing surveillance but does not adequately explore factors that affect clinical data interpretation and synthesis, and role integration between nurse and parents, and nurse and other clinicians on surveillance of clinical stability.

Implications: Research is needed to enhance understanding of the contextual factors that impact nursing surveillance to inform intervention design to support nurses' timely recognition and mitigation of clinical deterioration.

Keywords: Detection; Deterioration; Nursing surveillance; Pediatric; Recognition.

Publication types

Review

MeSH terms

Child
Clinical Deterioration*
Humans
Nursing Assessment / methods*
Pediatric Nursing / methods*