Difficult but doable: Health professional perspectives of assessing clinical deterioration in children with dark-coloured skin

BACKGROUND: Observable signs of clinical deterioration may present differently in children with dark-coloured skin, leading to potential missed or delayed recognition. It is unknown how health professionals approach assessment in children with dark-coloured skin. OBJECTIVE: The aim of this study was to explore how health professionals assess for signs of clinical deterioration in children with dark-coloured skin and identify factors that influence their assessment. METHODS: A multisite interpretive descriptive approach involved semistructured focus groups and interviews conducted at a specialist children's hospital and regional hospital in Western Australia. Participants included doctors and nurses with varied levels of experience caring for children with dark-coloured skin. Data were audiorecorded, transcribed verbatim, and analysed inductively through thematic analysis. Study reporting followed the Consolidated Criteria for Reporting Qualitative Research checklist. FINDINGS: A total of 99 participants (62 nurses and 37 doctors) participated in one of nine focus groups or 19 interviews. Three themes and eight subthemes were constructed. (i) Deterioration can look different highlighted differences in the observable signs of deterioration. (ii) Accommodating assessment described strategies to adjust assessment to obtain an accurate clinical status. (iii) An informally learned skill emphasised that assessment can be learned at the bedside, although not formally taught. Participants found, overall, assessment of clinical deterioration was "difficult but doable". CONCLUSIONS: The challenge of assessing clinical deterioration in children with dark-coloured skin was recognised. Approaches to overcome the challenges were suggested. Findings support valuing parent input and the need for appropriate educational resources to address health professionals' knowledge gap. TERMINOLOGY: Multiple descriptive terms for skin colour exist. Following consultation with stakeholders and the consumer and community research advisory group, dark-coloured skin was selected and refers to Fitzpatrick skin types V-VI. This term is used solely as a physical description within a medical context and makes no reference to race or ethnicity.