• Claus Sixtus Jensen, Pia Bonde Nielsen, OlesenHanne VebertHVDepartment of Child and Adolescent Health, Aarhus University Hospital, Aarhus N, Denmark., Hans Kirkegaard, and Hanne Aagaard.
• Research Centre for Emergency Medicine, Aarhus University Hospital, Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark; Department of Paediatrics and Adolescent Medicine, Herlev Gentofte Hospital, Denmark. Electronic address: claus.sixtus@skejby.rm.dk.
• J Pediatr Nurs. 2018 Jul 1; 41: e16-e22.

PurposePediatric early warning score (PEWS) systems are used to monitor pediatric patients' vital signs and facilitate the treatment of patients at risk of deteriorating. The aim of this study was to gain knowledge about nurses' experiences with PEWS and to highlight factors facilitating and impeding the use of PEWS tools in clinical practice.Design And MethodsAn exploratory qualitative design was chosen using focus group interviews to gain a deeper understanding of nurses' experiences with PEWS. A total of five focus group interviews were conducted at three hospitals, and a qualitative meaning condensation analysis as described by Kvale and Brinkmann was performed.ResultsSeven themes were identified, including i) lack of interdisciplinary awareness, ii) clinical judgment and PEWS-a multi-faceted approach, iii) PEWS supports a professional language, iv) monitoring the patient's - a challenge, v) PEWS helps to visualize the need for escalating care, vi) an inflexible and challenging tool, and vii) supportive tools enhance the nurses' experiences of PEWS positively.ConclusionsOur findings suggest that attention should be given to nurses' perceptions of how both clinical judgment and PEWS should be seen as essential in providing nurses with information about the patients' conditions. If not, the risk of failing to recognize patients' deteriorating conditions will remain as this can have an impeding influence on nurses' use of PEWS. From the nurses' perspective, medical doctors seemed unaware of their role in using PEWS.Copyright © 2018 Elsevier Inc. All rights reserved.

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