Running head: NATIONAL EARLY WARNING SCORE 1

APPRAISAL OF ARTICLES

Student’s name

Institution:
NATIONAL EARLY WARNING SCORE 2

Increased mortality rate reported in various healthcare settings has been attributed to the inability

of healthcare professionals to detect early signs of patient deterioration (Jensen et al. 2019).

Early warning score (EWS) systems are being recommended for integration in healthcare

settings to help caregivers predict patient potential deterioration. The aim is to minimize

unplanned intensive care unit admissions and reduce the mortality rate. However, the

effectiveness of EWS systems is found to be dependent on user engagement, motivation, and

clinical adherence (Wong et al. 2017). Various studies (Pimentel et al. 2019; Jensen et al. 2019)

have identified that while some users may acknowledge the importance of the tool in assessing

patient deterioration, it also undermines the value of the user’s clinical judgment. One such study

was conducted by Jensen, Skar, and Tveit (2019). The study examines the perception and

reaction of nurses in the implementation of the National Early Warning Score (NEWS). The

study was part of a qualitative case study that explored the integration of NEWS in hospitals and

experiences from healthcare professionals. Eligible nurse participants selected into the sample

had three key characteristics including 3-year degree education, were aged between 20 and 50

years, and their experience ranged from newly qualified to nurses with an experience of about 25

years. The female nurse participant rate was higher compared to male nurses where only six

nurses were male.

A group of doctors and nurses organized training programs that lasted of 4-hr each and were

divided into seminars and simulation sessions. A total of nine seminars with 79 nurses and 23

simulation sessions with 52 nurses were organized for the study. A total of 296 nurses drawn

from eight participating units in the medical, surgical, and rheumatology wards in a state-funded

hospital in Norway were engaged in the seminars and simulation sessions. Simulations on the

application and use of NEWS was conducted by qualified simulation facilitators. In the sessions,
NATIONAL EARLY WARNING SCORE 3

nurse participants were trained on how to use the tool to appraise and interpret cases that

involved patients that depicted chest pains, infections, and deterioration. Themes such as how to

apply NEWS, applying new charts, reading the scores, and response based on the scores

describing patient signs of deterioration. Qualitative methods that involved participatory

observations were used to gather needed data. Nurse reactions expressed through comments,

questions, discussions, and informal reactions during nurse interactions and activities while in

pairs or in small groups were gathered for analysis. This study was a single qualitative study with

an extensive review of literature hence has a level three evidence based on the Johns Hopkins

model.

Most nurses acknowledged that NEWS could be beneficial in identifying and clarifying potential

vital signs that should be measured to determine whether a patient is deteriorating. While the

experience was identified as crucial in the use of NEWS, nurses agreed that the tool could be

used to develop more uniform patient assessments that did not require experience to identify

changes in the vital signs. It was also found that the application of NEWS could be extended

beyond the hospital settings to community settings. In community practice, nurses could use the

tool to appraise patients and determine those that need close monitoring. However, based on

nurses’ experience with standardized tools integrated into the hospital, concerns were raised on

the effectiveness of the tool. Some nurses felt that NEWS could overlook spatial vital signs of

patient deterioration such as skin status, urine output, and facial expression as well as undermine

their clinical judgment. Also, while acknowledging the importance of NEWS responses in

determining patient ICU needs, some nurses perceived that compliance of NEWS responses is

optional based on the situation. Other nurses were concerned that applying the tool could

contribute to nursing stress and anxiety when scores indicated patient deterioration.
NATIONAL EARLY WARNING SCORE 4

The limitation of this study is that its findings could only be a reflection of Norway and may not

reflect the perception of nurses in other geographical areas. Participants past experiences with

standardized tools were found to shape and influence their perception and opinions about NEWS.

In this context, participants drawn from different geographical regions could have had varying

experiences with standardized tools based on the tools’ success level when implemented in their

respective settings. As such, their views on introduction of NEWS shaped by their past

experiences may differ from the ones presented in this study. The strength of this study lies in

the ability to an insider view of the phenomenon. Participants involved in this study work in an

environment where patient safety is emphasized. Their recollections and account of their

experiences and opinions allowed for comparison with the views of participants in other studies

as well as the researcher’s preconception about the phenomena. This increases the credibility of

the study.

The findings of this study depict varying perceptions and commitments by users of NEWS in the

healthcare setting. The target population is patients with intensive care needs. The intervention

involves healthcare professionals working with patients applying the National Early Warning

Score (NEWS) System in hospitals to identify, clarify and measure vital signs of potential patient

deterioration. Possible alternative to NEWS is professionals using their experience and clinical

judgment of the users to assess patient deterioration. The outcomes of the tool are likely to help

users develop a more uniform patient assessments and can accurately determine whether the

patient is need of ICU care or not. The outcomes are real-time to alert users of patient

deterioration.
NATIONAL EARLY WARNING SCORE 5

REFERENCES

Jensen, J.K., Skar, R., & Tveit, B. (2019) Introducing the National Early Warning Score – A
qualitative study of hospital nurses’ perceptions and reactions. Nursing Open, 6(3), 1067-
75

Pimentel, M.A.F., Redfern, O.C., Gerry, S., Collins, G.S., Malycha, J. et al. (2019) A
comparison of the ability of the National Early Warning Score and the National Early
Warning Score 2 to identify patients at risk of in-hospital mortality: A multi-centre
database study. Resuscitation, 134, 147-156.

Wong, D., Bonnici, T., Knight, J., Gerry, S., Turton, J., & Watkinson, P. (2017) A ward-based
time study of paper and electronic documentation for recording vital sign
observations. Journal of American Medical Information Association, 24(4), 717-721.