Effects of Early Warning Score (EWS) Tutorial Simulation on Nurses' Knowledge and Clinical Performance

*Roshy Damayanti  -  Master Program in Nursing, Faculty of Nursing, Universitas Padjadjaran, Indonesia
Yanny Trisyani  -  Faculty of Nursing, Universitas Padjadjaran, Indonesia
Aan Nuraeni  -  Faculty of Nursing, Universitas Padjadjaran, Indonesia
Received: 6 Aug 2019; Revised: 23 Oct 2019; Accepted: 27 Dec 2019; Published: 30 Dec 2019.
Open Access Copyright (c) 2019 Nurse Media Journal of Nursing

Citation Format:

Background: The Early Warning Score (EWS) system has been recommended for early identification tool of deterioration. However, its implementation has not been optimal; one of which is due to the low level of knowledge and understanding of EWS among nurses.

Purpose: This study aimed to determine the effects of EWS tutorial simulation on nurses’ knowledge and clinical performance.

Methods: This study employed a pretest posttest quasi-experimental design with a control group. Purposive sampling was used to recruit the samples of 42 respondents each in the intervention group and control group. The data were collected using the questionnaires to measure the knowledge and clinical performance, and analyzed using Chi square, Wilcoxon and Mann-Whitney tests.

Results: The results showed that there were differences in the pre-test and post-test of knowledge and clinical performance in the intervention group and control group (p<0.001). There was also a significant difference in clinical performance between the intervention group and the control group (p<0.001). However, no significant difference in knowledge was found between.

Conclusions: Tutorial simulation of EWS had an effect on increasing nurses’ clinical performance. Although there was no significant difference in knowledge between the intervention group and the control group, but the intervention group showed a better value than the control group. EWS tutorial simulation can be used as one of the training methods to increase nurses' knowledge and clinical performance in EWS.

Keywords: Early warning score; clinical performance; knowledge; tutorial simulation

Article Metrics:

  1. Alam, N., Vegting, I. L., Houben, E., van Berkel, B., Vaughan, L., Kramer, M. H. H., & Nanayakkara, P. W. B. (2015). Exploring the performance of the National Early Warning Score (NEWS) in a European emergency department. Resuscitation, 90, 111-115.
  2. Bambini, D., Washburn, J., & Perkins, R. (2009). Outcomes of clinical simulasi for novice nursing students: Communication, confidence, clinical judgment. Nursing Education Perspectives, 30(2), 79-82.
  3. Bick, D. E., Beake, S., Hundley, V., van Tiejlingen, E., Sheppard, Z. A., Thomas, S., & Smith, G. B. (2014). A national cross sectional survey of heads of midwifery services of uptake, benefits and barriers to use of obstetric early warning systems (EWS) by midwives. Midwifery, 30(11), 1140-1146.
  4. Billings, D. M., & Halstead, J. A. (2016). Teaching in nursing: A guide for faculty. (5thed.). United States of America: Elsevier.
  5. Boyatzis, R. E. (1982).The component Manager: A model for effective performance. New York: John Wiley & Sons.
  6. Bradshaw, M. J. & Hultquist, B. L. (2017). Innovative teaching strategies in nursing and related health professions. (7thed.). United States of America: Jones & Bartlett Learning.
  7. Cahill, H., Jones, A., Herkes, R., Cook, K., Stirling, A., Halbert, T., … Gattas, D. J. (2011). Introduction of a new observation chart and education programme is associated with better rates of vital-sign ascertainment in hospital wards. BMJ Quality and Safety, 20(9), 791-796.
  8. Corfield, A. R., Lees, F., Zealley, I., Houston, G., Dickie, S., Ward, K., & McGuffie, C. (2014). Utility of a single early warning score in patients with sepsis in the emergency department. Emergency Medicine Journal, 31(6), 482-487.
  9. Curtin, L. B., Finn, L. A., Czosnowski, Q. A., Whitman, C. B., & Cawley, M. J. (2011). Computer-based simulation training to improve learning outcomes in mannequin-based simulation exercises. American Journal of Pharmaceutical Education, 75(6), 113. doi: 10.5688/ajpe756113
  10. De Meester, K., Verspuy, M., Monsieurs, K. G., Van Bogaert P. (2013). SBAR improves nurse–physician communication and reduces unexpected death: A pre and post intervention study. Resuscitation, 84(9), 1192-1196.
  11. Fagan, K., Sabel, A., Mehler, P. S., & MacKenzie, T. D. (2012). Vital sign abnormalities, rapids respon, and adverse outcomes in hospitalized patients. American Journal of Medical Quality, 27(6), 480-486.
  12. Gantt, L. T. (2010). Using the Clark simulation evaluation rubric with associate degree and baccalaureate nursing students. Nursing Education Perspectives, 31(2), 101-105.
  13. Jeffries, P. R. (2016). The NLN Jeffries simulation theory. New York, NY: National League of Nursing.
  14. Khan, K., & Ramachandran, S. (2012). Conceptual framework for performance assessment: Competency, competence and performance in the context of assessments in healthcare-Deciphering the terminology. Medical Teacher, 34(11), 920-928.
  15. Lake, S., Moss, C., & Duke, J. (2009). Nursing prioritization of the patient need for care: A tacit knowledge embedded in the clinical decision-making literature. International Journal of Nursing Practice, 15(5), 376-388.
  16. Lapkin, S., Levett-jones, T., & Bellchambers, H. (2010). Effectiveness of patient simulation manikins in teaching clinical reasoning skills to undergraduate nursing students : A systematic review. Clinical Simulation in Nursing, 6(6), e207-e222.
  17. Law, A. M. (2014). A tutorial on design of experiments for simulation modeling. Proceedings of the Winter Simulation Conference 2014 (pp.66-80). Savanah, GA, USA: IEEE. doi: 10.1109/WSC.2014.7019878
  18. Liaw, S. Y., Chan, S. W. C., Chen, F. G., Hooi, S. C., & Siau, C. (2014). Comparison of virtual patient simulation with Mannequin-based simulation for improving clinical performances in assessing and managing clinical deterioration: Randomized controlled trial. Journal of Medical Internet Research, 16(9), e214.
  19. Liaw, S. Y., Wong, L. F., Lim, E. Y. P., Ang, S. B. L., Mujumdar, S., Ho, J. T. Y., ... & Ang, E. N. (2016). Effectiveness of a web-based simulation in improving nurses' workplace practice with deteriorating ward patients: A pre- and post intervention study. Journal of Medical Internet Research, 18(2), e37.
  20. Lindsey, P. L., & Jenkins, S. (2013). Nursing students’ clinical judgment regarding rapids response: The influence of a clinical simulation education intervention. Nursing Forum, 48(1), 61-70. doi: 10.1111/nuf.12002
  21. Ludikhuize, J., Smorenburg, S. M., de Rooij, S. E., & de Jonge, E. (2012). Identification of deteriorating patients on general wards ; measurement of vital parameters and potential effectiveness of the modified early warning score. Journal of Critical Care, 27(4), 424.e7-424.e13.
  22. Meakim, C., Boese, T., Decker, S., Franklin, A.E, Gloe, D., Lioce, L, …& Borum, J. C. (2013). Standart of the best practice: Simulation standart I: Terminology. Clinical Simulation in Nursing, 9, S3-S11. doi: 10.1016j.ecns.2013.04.001
  23. National Clinical Effectiveness Committee. (2014). Second Annual Report 2014. An Roinn Slainte Department of Health. Retrieved from https://assets.gov.ie/11508/bd7e535c192f4c49984e4fc4517cfb41.pdf
  24. Ogilvie, S., Cragg, B., Foulds, B. (2011). Perceptions of nursing students on the process and outcomes of a simulation experience. Nurse Educator, 36(2), 56-8. doi: 10.1097/NNE.0b013e31820b4fd5
  25. Ozekcin, L. R., Tuite, P., Willner, K., & Hravnak, M. (2015). Simulation education: Early identification of patient physiologic deterioration by acute care nurses. Clinical Nurse Specialist, 29, 166-173. Doi: 10.1097/NUR.0000000000000123
  26. Rabøl, L. I., Andersen, M. L., Østergaard, D., Bjørn, B., Lilja, B., & Mogensen, T. (2011). Descriptions of verbal communication errors between staff. An analysis of 84 root cause analysis-reports from Danish hospitals. BMJ Quality & Safety, 20(3), 268-274. doi: 10.1136/bmjqs.2010.040238
  27. Royal College of Physicians. (2017). National Early Warning Score (NEWS) 2. Standardising the assessment of acute-illness severity in the NHS updated report of a working party-executive summary and recommendations. Retrieved from https://www.rcplondon.ac.uk/projects/outputs/national-early-warning-score-news-2
  28. Saab, M. M., McCarthy, B., Andrews, T., Savage, E., Drummond, F. J., Walshe, N., ...& Hegarty, J. (2017). The effect of adult early warning systems education on nurses’ knowledge, confidence, and clinical performance: A systematic review. Journal of Advanced Nursing, 73(11), 2506-2521.
  29. Scalese, R. J., Obeso, V. T., & Issenberg, S. B. (2008). Simulation technology for skills training and competency assessment in medical education. Journal of General Internal Medicine, 23(Suppl 1), 46-49.
  30. Su, W. M., & Juestel, M. J. (2010). Direct teaching of thinking skills using clinical simulation. Nurse Educator, 35(5), 197-204.
  31. Taenzer, A. H., Pyke, J. B., & McGrath, S. P. (2011). A review of current and emerging approaches to address failure-to-rescue. Anaesthesiology, 115(2), 421-431.
  32. Tanner, C. A. (2006). Thinking like a nurse: A research based model of clinical judgment in nursing. Journal of Nursing Education, 45(6), 204-211.
  33. Ten Cate, O., Snell, L., Carraccio, C. (2010). Medical competence: The interplay between individual ability and the health care environment. Medical Teacher, 32(8), 669-675. doi: 10.3109/0142159X.2010.500897
  34. Thomson, C., & Dowding, D. (2002). Clinical decision-making and judgement in nursing. London: Churchill Livingstone.
  35. Zhang, Z., Luk, W., Arthur, D., & Wong, T. (2001). Nursing competencies : Personal characteristics contributing to effective nursing performance. Journal of Advanced Nursing, 33(4), 467-474.

Last update: 2021-01-24 09:28:25

No citation recorded.

Last update: 2021-01-24 09:28:25

No citation recorded.