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. |