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HLTH6083 Recognising and Prioritising the Care of the Deteriorating Child

Module Overview

This module will equip practitioners that work with infants, children and young people and their families/carers with the knowledge and skills undertake a systematic assessment, to recognise deviations from appropriate norms, to prioritise and escalate referral. It will provide an overview and critique of the evidence base that informs current practice.

Aims and Objectives

Module Aims

To enable you to apply a range of assessment strategies to recognise and monitor deterioration indicators in the infant, child and young person. You will develop an in depth and systematic understanding of their physiological compensatory mechanisms and use your initiative to respond to ensure the safety of the infant, child and young person, by selecting from a range of evidence based interventions. 1. Use a wide range of evidence based sources to critically analyse assessment tools and practices used to assess and communicate indicators of deterioration in infants, children and young people. 2. Demonstrate an in depth understanding of the physiology and compensatory mechanisms that affect deterioration/potential deterioration in cardio, respiratory and/or neurological function of the infant, child or young person, 3. Critically analyse the evidence base for therapeutic interventions, prioritise and evaluate the effectiveness for the infant, child or young person. 4. Analyse the effectiveness of the practitioners role as a communicator within the interprofessional team, when caring for a deteriorating infant child or young person and their family/carers. 5. Understand the implications of legal or ethical or professional issues in practice which influence the care of the deteriorating infant, child or young person and their family/carers.

Learning Outcomes

Learning Outcomes

Having successfully completed this module you will be able to:

  • Undertakes in depth, systematic assessments to recognise a child at risk of/presenting with respiratory deterioration and recognises the degree of compensatory mechanisms. Applies knowledge of the complex physiology of the deteriorating child from the module to make holistic practice assessments
  • Undertakes in depth, systematic assessments to recognise a child at risk of/presenting with cardiovascular deterioration and recognises the degree of compensatory mechanisms. Applies knowledge of the complex physiology of the deteriorating child from the module to make holistic practice assessments.
  • Undertakes in depth, systematic assessments to recognise a child at risk of/presenting with neurological deterioration and recognises the degree of compensatory mechanisms. Applies knowledge of the complex physiology of the deteriorating child from the module to make holistic practice assessments.
  • Recognises the early/late warning signs of deterioration in respiratory, cardiovascular and neurological function for the infant, child and young person. Able to recognise when the deteriorating child needs referral/escalation of treatment
  • Selects appropriate monitoring tools and utilize monitoring equipment for the deteriorating child. Recognises the appropriate frequencies for data collection, patterns of deterioration, analyses influences upon data trends and communicates/documents findings
  • Communicates appropriately with the deteriorating child or young person, assesses their understanding, provides them with relevant information, supports and acts as their advocate.
  • Communicates appropriately with the family of the deteriorating child or young person, recognizes suitable locations for discussions, deals with conflict, provides support and recognises when to ask for help.
  • Prioritises relevant assessment information for and makes appropriate verbal referrals to the inter-professional team (in order to generate the desired response). Communicates and works effectively, in partnership with members of the inter-professional team, in caring for the deteriorating child


The syllabus will enable you to recognise and escalate concerns about a deteriorating infant, child or young person, in order to make reliable decisions concerning an immediate plan of evidence-based care. You will learn about: • Respiratory assessment (including non-invasive ventilation and blood gases) • Cardiovascular assessment (including CHD and shock) • Influences upon paediatric fluid and electrolyte balance • Neurological assessment and managing head/spinal injuries • Assessment of child with sepsis and the child with DKA. • Communication skills for escalating concerns and when communicating with children, young people and their families/carers • Legal, ethical and professional issues • Current clinical research, skills for critical analysis of evidence for application in practice and critical appraisal of the research quality. Current Perspectives In 2008, the Centre for Maternal and Child Enquiries (CEMACH) conducted the confidential enquiry which identified of the 126 UK child deaths, 89 occurred in hospital and of these 63 were deemed avoidable or potentially avoidable. The most significant, recurrent, avoidable factor was the failure to recognise the severity of illness in children (CEMACH 2008). The report recommended implementing Early Warning tools/alert criteria to identify hospitalised children at risk of deterioration and improve outcomes. A range of tools are being implemented in clinical practice but the evidence to support the validity and reliability of these is weak (Chapman et al 2010). Internationally, USA based research demonstrated 95% of in-hospital paediatric cardiac arrests were witnessed or monitored, suggesting clinicians knew the child warranted close supervision (Berg et al 2008).

Special Features

The practitioner must be assessed by an appropriate mentor who must be negotiated with their manager. This should ideally be undertaken by a senior member of the paediatric nursing team (with the mentorship qualification) or in the instance that the practitioner either works independently or as an adult practitioner caring for children, they require co-mentorship from either their manager who seconded them to the module or the senior nurse/practitioner responsible for children in the practice area. International students on this module are required to produce a separate portfolio of evidence to demonstrate how they would achieve the practice competencies in their area of practice. This portfolio will be developed and discussed prior to submission, with the module leader. This will contribute, in part, to the achievement of the Learning Outcomes (LO). Practice competencies 1-4 contribute towards meeting LO 1 and 2. Practice Competencies 5 contribute towards meeting LO3 and Practice Competencies 6-8 contribute towards meeting LO4. This portfolio will demonstrate how learning on the module has enhanced understanding of these cases, and the assessment and care given. The portfolio will also clearly indicate how future professional practice will be enhanced by the learning undertaken on this module.

Learning and Teaching

Teaching and learning methods

The teaching is centred upon andragogical teaching theory (Knowles 1990). You will take responsibility for your learning, identifying your own learning needs in relation to the learning outcomes/teaching content of the module and taking responsibility for addressing these, both in the classroom and through self-directed learning. This requires self-motivation and self-directed study. You will be expected to participate in guided classroom/small group discussions (in relation to scenarios, research papers and reflections upon practice) to learn with and from other practitioners, to enable you to develop critical thinking and problem solving skills. Teaching methods will include • Scenario based lectures • Lectures to critically debate evidence based knowledge for practice, using both PowerPoint and turning point (participative) technologies, • Workshops to critically examine relevant research papers and evidence based guidelines • Small group discussions/presentations • Practitioner led seminars • Sessions taught by practitioners engaged in research activities An interactive blackboard site provides electronic access to lecture notes, current research, interactive learning tools and relevant websites. You will be expected to engage with the electronic material in preparation for discussion during timetabled sessions

Independent Study220
Total study time250

Resources & Reading list

Roland D, Oliver A, Edwards E D, Mason B W & Powell C V E (2014). Use of paediatric early warning systems in Great Britain; has there been a change of practice in the last 7 years.. Archives of Disease in Childhood. ,99 , pp. 26-29.

Berg MD, Nadkarni V M, Zuercher M & Berg RA (2008). In hospital paediatric cardiac arrest. Pediatric Clinics of North America. ,55 , pp. 589-604.

National Institute for Health and Clinical Excellence (NICE) (2007). Acutely ill patients in hospital: Recognition of and response to acute illness in adults in hospital. 

Haines C (2005). Acutely ill children within ward areas – care provision and possible development strategies. Nursing in Critical Care. ,10 , pp. 98-104.

Romanuik D, O’Mara & Akthar N (2014). Are parents doing what they want to do? Congruency between parents’ actual and desired participation in the care of their hospitalised child. Issues in Comprehensive Pediatric Nursing. ,37 , pp. 103-121.

Royal College of Nursing (RCN) (2011). Standards for assessing, measuring and monitoring vital signs in infants, children and young people. 

Advanced Life Support Group (2011). Advanced Paediatric Life Support: The practical approach. 

Dixon M, Crawford D, Teasdale & Murphy J (2009). Nursing the Highly Dependent Child or Infant. 

Crawford D, Corkin D, Coad J & Hollis R (2013). Educating children’s nurses for communicating bad news. Nursing Children and Young People. ,25 , pp. 28-33.

Edwards E D , Powell CVE, Mason BW & Oliver A (2009). Prospective cohort study to test the predictability of the Cardiff and Vale PEW system. Archives of Disease in Childhood. ,94 , pp. 602-606.

Knowles M (1990). The Adult Learner; A Neglected Species. 

Chapman S M, Grocott M P W & Franck L S (2010). Systematic Review of Paediatric Alert Criteria for identifying hospitalized children at risk of critical deterioration. Intensive Care Medicine. ,36 , pp. 600-611.

National Institute for Clinical Excellence NICE (2013). Feverish Illness in children CG160. 

Confidential Enquiry into Maternal and Child Health (CEMACH) (2008). Why Children Die?. 

Cockett A & Day H (2010). Children’s High Dependency Nursing. 


Assessment Strategy

Summative Assessment Part 1: Either a) a written assignment comprising 3, 500 words or b) an educative poster with supportive paper of 1500 words These will be marked out of 100%. a) Written Assignment: comprising 3,500 words A discussion between you, your manager/mentor and the module leader will enable you to identify and plan the focus of your written assignment in relation to the achievement of the learning outcomes. Based upon a critical review of a case study or contextual issue, the practitioner will be required to demonstrate achievement of the learning outcomes. b) Educative Poster with supportive paper of 1,500 words A discussion between you, your manager/mentor and the module leader will enable you to identify and plan the focus of your poster in relation to the achievement of the learning outcomes. The knowledge presented in the poster will be appropriately accredited and presented comprehensively. The poster will be carefully structured and laid out, in order to address the message of the poster. The theme of the poster will be substantiated by the information presented and underpinned by application of theory and research. Evidence of criticality would be provided through methodological discussion (how the inquiry was undertaken and knowledge generated), discussion about the significance of the issues and limitations. The structure of the poster will generate debate between sections of text and/or images. The poster will take an academic form. The supporting paper would provide the opportunity for in depth critical analysis of supportive/contrasting theory and current research. See table below for weightings of marks in this option. Part 2 Practice Competencies The practitioner must demonstrate evidence for the achievement of the practice competencies. This will be verified by the mentor in practice as (pass/refer) and must be submitted with the assignment* Parts 1 and 2 must be completed. The weighting of marks will be 50% for each component of poster and supportive paper option. Each component is required to be passed at a level of at least 50% and failure of one element will result in a module referral.


Practice competencies


MethodPercentage contribution
Assignment  (3500 words) 100%
Educative poster and supportive paper  (1500 words) %


MethodPercentage contribution
Practice competencies %
Written assignment  (3500 words) 100%

Repeat Information

Repeat type: Internal & External

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