EFFECTIVENESS OF AN EARLY WARNING SCORE TRAINING PROGRAM ON NURSES' RECOGNITION OF CLINICAL DETERIORATION AT NISHTAR HOSPITAL, MULTAN: A QUASI-EXPERIMENTAL STUDY

Abstract

Background: Failure to recognize clinical deterioration in hospitalized patients remains a significant patient safety concern, contributing to preventable adverse events, unplanned intensive care unit admissions, and increased mortality. Early Warning Score (EWS) systems have been developed as systematic tools to identify physiological instability, yet their effectiveness depends critically on nurses' knowledge and competency in applying these protocols. In resource-constrained tertiary care settings like Nishtar Hospital, Multan, gaps in EWS training often compromise timely recognition and escalation of deteriorating patients.

Objective: To evaluate the effectiveness of a structured Early Warning Score training program on nurses' knowledge and ability to recognize clinical deterioration at Nishtar Hospital, Multan.

Methodology: A quasi-experimental single-group pre-test post-test design was employed. A total of 120 registered nurses working in medical and surgical wards were recruited from Nishtar Hospital, Multan, using purposive sampling. Data were collected using a validated 30-item knowledge questionnaire and a 5-scenario clinical vignette assessment tool before and four weeks after the educational intervention. The intervention comprised comprehensive didactic sessions, interactive case-based workshops, and provision of educational materials covering EWS parameters, scoring methodology, and escalation protocols. Data were analyzed using SPSS version 26.0, employing descriptive statistics and paired t-test.

Results: The mean pre-test knowledge score was 14.23 ± 3.12, which significantly increased to 22.84 ± 2.51 at post-test (t = 23.41, p < 0.001). Similarly, the mean clinical vignette assessment score improved from 4.52 ± 1.83 pre-intervention to 8.76 ± 1.14 post-intervention (t = 21.92, p < 0.001). The percentage of nurses correctly identifying clinical deterioration and appropriate escalation increased from 45.2% to 87.8%. The educational intervention demonstrated highly statistically significant improvement in both theoretical knowledge and practical clinical recognition skills.

Conclusion: The Early Warning Score training program significantly enhanced nurses' knowledge and clinical recognition abilities. Integrating structured EWS training into routine continuing education for nursing staff is strongly recommended to improve patient safety and reduce preventable adverse events in tertiary care hospitals.