Heath, SamanthaClayton, Tarryn2026-10-202026-10-202026https://hdl.handle.net/10289/18715Background: The paediatric early warning system (PEWS) was introduced as a nationally standardised tool in New Zealand to identify and escalate clinical deterioration in the paediatric population. Although the PEWS is implemented across the country, audit data at Te Whatu Ora, Waikato indicate that there is variability to adherence to the mandatory escalation pathway. There is limited research from the New Zealand context that explores the experiences of nurses using the PEWS in practice and what factors influence decision making when using the PEWS. Objective: To explore the factors that influence nurses’ use of the PEWS assessment tool and mandatory escalation pathway in a paediatric inpatient ward at Te Whatu Ora, Waikato, and to identify any educational requirements to support the use of the PEWS. Participants: Participants were registered nurses employed in the paediatric medical ward (E5) and paediatric surgical ward (E4) at Waikato Hospital. Thirteen nurses participated in three focus groups and 31 nurses completed a quantitative survey. Methods: This research is a pragmatic exploratory mixed methods design. Phase One involved three semi structured focus groups, with data analysed using Braun and Clarke’s (2022) thematic analysis. The focus groups findings informed the development of a quantitative Likert scale survey used in Phase Two. Descriptive statistics were used to analyse the surveys, and the qualitative and quantitative findings were integrated to provide a comprehensive understanding of the factors that influence use of the PEWS. Results: Five key themes were identified: Clinical Judgement and Experience, Time Pressures, Professional Responses and Communication, Unique Factors Presented by Children, and Adherence to PEWS and Education. The survey findings validated these themes, highlighting how workload pressures, communication processes, clinical judgement, and paediatric-specific factors influence nurses’ use of the PEWS. Conclusion: Nurses view the PEWS as a valuable tool that supports patient safety, communication, and recognition of deterioration in paediatric patients. However, the use of the PEWS was influenced by factors that include the balance between clinical judgement and mandatory escalation, workload and time pressures, interprofessional communication, paediatric assessment challenges, and documentation requirements. While participants felt adequately educated in the PEWS use, education alone was not enough to ensure consistent adherence to the PEWS escalation pathways. Successful implementation requires ongoing simulation-based and interprofessional education, organisational support, adequate staffing, and understanding how clinical judgement can be utilised with the standardised pathway. These findings highlight the need for a systems-based approach to improve the use of the PEWS and enhance paediatric patient safety.enAll items in Research Commons are provided for private study and research purposes and are protected by copyright with all rights reserved unless otherwise indicated.paediatric early warning system (pews)clinical deteriorationpatient deteriorationescalation of carepaediatric nursingearly warning systemsclinical judgementinterprofessional communicationpatient safetydeteriorating childThesis