Publication:

An observational study of monitoring vital signs in children admitted to Ward 2 at Ola During Children’s Hospital, Freetown: an insight into the quality of nursing care

Background Reliable paediatric vital-signs monitoring enables early detection of deterioration, yet adherence varies in low-resource settings. To quantify ODCH nurses’ monitoring practices, protocol adherence and equipment/workflow barriers; and to examine factors associated with compliance.

Methods Descriptive cross-sectional survey of nurses at Ola During Children’s Hospital, Freetown (25–30 August 2025). Consecutive sampling enrolled N=50 eligible nurses. A structured questionnaire captured practice, awareness/training, equipment and perceptions. Outcomes were protocol compliance (Always/Often) and a Vital-Signs (VS) Monitoring Index (0–1). Analyses used χ² with Cramér’s V, t-tests and Spearman’s ρ (α=0.05).

Results Consistent monitoring was highest for temperature 98%, pulse 88%, respiratory rate 86%, SpO₂ 78%, but lower for blood pressure 42% and pain score 10%. Protocol compliance=58% (Always 48%, Often 10%), documentation “Always” =72%. VS Index: mean 0.67, SD 0.22. Guideline awareness strongly predicted compliance (χ² (1) =15.25, p=0.0001, V=0.552); recent training showed a medium association (χ² (1) =6.91, p=0.0086, V=0.372). Frequently reported barriers included lack of equipment 76%, high patient load 68% and inadequate staffing 68%; facilitators were functional equipment 73.5%, training 72%, adequate staffing 68% and clear protocols 52%. Several comparisons were non-significant, likely reflecting limited power (N=50).

Conclusions Core observations are performed consistently at ODCH, but blood pressure and pain assessment are major gaps. Strengthening guideline uptake via brief, repeated training; ensuring child-appropriate BP cuffs and validated pain scales; embedding WHO-aligned frequency job aids/PEWS, and improving equipment readiness are feasible, high-yield steps to enhance monitoring reliability and patient safety.