Table 2 Quotes from interviewed participants are listed according to the four main themes and codes

Workflow and workload

Nurse to patient ratio

Q1

“It varies depending on the situation. Ideally, one nurse should have one patient. However, there are times when we have fewer nurses on duty, and we may have to take care of more patients. So, we share the workload.”

8

Tasks and responsibilities

Q2

“When I assess a patient and notice deterioration, it’s crucial to take immediate action. If oxygen is deemed necessary, I administer it without awaiting a doctor’s consultation. After the necessary actions, I can communicate to the staff.”

6

Staff shortages

Q3

“During regular shifts, there should be six nurses, but shortages are common. Today, only three of us are on duty.”

7

Prioritisation

Clinical experience

Q4

“Apart from observing the patient’s vital signs, we can often discern changes in their condition simply by looking at them. We are familiar with these patients and their guardians, and we can notice if a child’s health has deteriorated compared to their previous state.”

6

Prioritisation elements

Q5

“If there are too many sick patients at the same time, we prioritise the ones we feel can survive.”

3

Clinical judgement

Q6

“Because of these educational differences, my approach differs from how others would respond to the same problem in the same patient. I wish there was a standardised approach. My reaction to the problem should be consistent with how other nurses would react, regardless of who is on duty.”

17

Interaction with guardians

Guardian’s involvement in care

Q7

‘Guardians can provide assistance with feeding, and if the nasal gastric tube is not fitting correctly, we offer guidance to the mother on how to adjust it properly. The guardians’ help and support have been invaluable in our efforts.’

11

Guardian’s knowledge

Q8

“Some guardians can quickly recognise when a baby is not feeling well, while others may find it challenging to notice subtle signs, like when a child is trying to communicate but has difficulty. Some guardians may call and report that their child is experiencing jerking movements, indicating a potential problem, while others may simply say that their child is doing well without mentioning any concerns.”

11

Perspective on predictive algorithms

Baseline knowledge

Q9

“I’ve heard that prediction tools help predict whether a baby’s condition will progress positively. This involves determining if there’s a risk of sepsis or an impending infection.”

1

Support clinical decision-making

Q10

“When caring for a patient, certain parameters can be continuously monitored. If the reading exceeds a threshold, the system asks you to take a specific action. Without this automated system, you might overlook trends and miss crucial details.”

6

Preventive intervention and early detection

Q11

“I think these systems can be valuable. When a patient’s condition deteriorates, it can quickly become an emergency. It would give us time to prepare by placing essential equipment at the bedside. This preparation means that if something happens, we can intervene quickly and prevent further deterioration.”

7

Trust, transparency and traceability

Q12

“We shouldn’t just rely on them. We can also do our own assessment so that you can compare the results and see if the prediction is correct or wrong.”

3

Preferences—prediction option

Q13

“Typically, when patients experience changes in cardiac or respiratory rates, it takes us some time to notice. (…) In the case of children, their bodies can compensate up to a certain point. However, they might suddenly deteriorate, which is different from adults. For patients who are unwell or experiencing deterioration, or even those doing relatively well, we can infer their condition from these output from the algorithm, indicating whether the patient’s health is declining.”

6

Preferences—location

Q14

“In terms of monitoring patients, it would be very useful to have technology that allows us to monitor patients outside the ward (nurses’ station). We often face challenges when we are on break, and no one is available to watch patients. […] Therefore, it would be advantageous to have an overview of patient monitoring at the nurses’ station.”

2

Guardians’ involvement

Q15

“To avoid causing fear, it would be more reasonable to display a simplified score or lights instead of showing all the dangerous vital signs. While many guardians possess the necessary knowledge, we cannot be certain about everyone’s level of understanding.”

2