Factors Associated With Junior Nurses Ability to Recognise and Respond to Clinical Deterioration: A Cross-Sectional Study in Tertiary Hospitals in Malawi

Abstract

Rationale

Recognising and responding swiftly to patient deterioration is critical for preventing adverse events. Junior nurses play a vital role in identifying the signs of clinical deterioration and initiating interventions. No prior studies have assessed junior nurses’ abilities to manage clinical deterioration in Malawi.

Objectives

This study aimed to assess junior nurses’ ability to recognise and respond to clinical deterioration in Malawian tertiary hospitals and identify associated factors.

Methods

The institutional based cross-section study design was used which included 322 junior nurses across all departments of four tertiary hospitals in Malawi (November–December 2023). Data collection utilised a questionnaire for clinical deterioration recognition and response ability in junior nurses. Chi-square, Fisher's exact, and logistic regression tests were used for data analysis.

Findings

Junior nurses achieved a median score of 71 with an interquartile range of 68–75 on the clinical deterioration questionnaire. According to the study, nurses with more work experience, those who worked in intensive care units, and those who participated in discussions about clinical deterioration had better scores. In contrast, nurses with less than 1 year of experience were 5.5 times more likely to struggle with recognising and responding to clinical deterioration than those with 5 years of experience (OR: 5.506, p = 007). Additionally, working in the paediatric department decreased junior nurses’ ability to recognise and respond to clinical deterioration six times compared to working in the intensive care unit (OR: 6.068, p = 0.018). Furthermore, junior nurses who had never engaged in discussions related to clinical deterioration had a seven times higher likelihood of poor ability to recognise and respond to clinical deterioration (OR = 6.954, p = 0.005).

Conclusion

This study highlights the need for specialised training programmes related to clinical deterioration that incorporate active learning, such as clinical scenarios and practical applications, along with mentorship initiatives to enhance junior nurses’ skills and confidence in recognising and responding to clinical deterioration.