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Table 5 Processes of care and knowledge or skills incorrectly assumed to be sufficiently present among the KNH staff

From: Factors influencing performance of health workers in the management of seriously sick children at a Kenyan tertiary hospital - participatory action research

Process

Knowledge or skill observed to be deficient among ETAT+ participants

Assessment of the key signs

Effects of illness on the physiology of the sick child that brings about the key signs.

Perception of the health workers of the signs ‘inability to drink’ and intermediate levels of consciousness between a state of alertness and unarousable coma.

Assessing nutritional status

Measuring patients’ length/height

‘(…can we see your height measuring board?). What is that? ….We don’t have one. (..and what’s that?- pointing a height measuring board). I don’t know, I have always seen it there’. (Nurse giving responses in a rapid hospital assessment exercise).

Treatment

Importance of administering drugs as prescribed and documentation of the same

Fluid therapy for dehydrated children

Incorrect but commonly used IV fluid for Plan C; Hartman’s Solution in 5% dextrose

‘… yes we use Hartman’s in 5% dextrose for severe dehydration. We were told the blood sugar becomes diluted even if its e.g. 13 mmol/l after giving plain Hartman’s it drops quite low’. (Junior clinician justifying use of 5% dextrose Hartman’s for Plan C during a CME).

Monitoring rate of administration and charting fluid chart.

‘Gosh we did not know…….you mean we have been doing rubbish work. God forbid’. (Nurse- during a CME on how monitor and chart intravenous fluid administration).

Monitoring of the sick child

Using serial respiratory and pulse rates to monitor patient progress and making clinical decision.

‘If a nurse does not monitor patients’ vital signs what is she actually doing? (Nurse A) …Before I went for paediatric nursing, I could not interpret vital signs. I believe they are not monitored because people don’t see their value. (Nurse B)’.

Feeds for the malnourished and also NG feeds

Storage of feeds, approximation of daily feed requirement.