Knowledge, Attitudes and Practice of Nurses in Assessing Patients using Early Warning Sign (EWS) Scoring in a teaching hospital in Kuantan Pahang, Malaysia

Abstract

Introduction: Early Warning Sign (EWS) is a tool made up of vital signs chart and scoring to detect any changes in patient so that immediate and appropriate care can be further determined and provided. The objectives of the study are to assess the level of knowledge, attitudes, and practice of nurses in assessing patient using EWS scoring and to identify association between socio-demographic with knowledge, attitudes, and practice, as well as to determine the associations between knowledge with attitudes, attitudes with practice and knowledge of nurses in assessing patient using EWS scoring. Methods: A quantitative cross- sectional study with convenience sampling study was conducted on 132 nurses from medical, surgical and orthopedics wards in Sultan Ahmad Shah Medical Centre (SASMEC) from November 2020 until January 2021. Printed questionnaires were distributed to the nurses in English language. The questionnaire consisted of two parts. Part A was about socio-demographic data (area and on years of nursing practice, & service, area of practice, educational level, as well as whether holding post-basic/ advance course certificate, attending life support training and ICU outreach participant). Part B was about knowledge, attitudes, and practices of EWS. Data analysis was interpreted in descriptive and inferential analysis using Statistical Package for the Social Sciences (SPSS) version 20.0. Results: A total of 108 respondents involved in the study represents 82% response rate. Majority of respondents scored low in knowledge questions with grade F (n=106, 98.3%). One respondent scored grade D, correctly answering 8 over 13 questions (62%). Only one respondent obtained grade B with 85% score. Based on the result, there are more participants (n=58, 53.7%) achieving good attitudes while respondents with poor attitudes were (n=50, 46.3%). Moreover, 59 respondents (54.6%) have higher practice level than mean score, indicating good EWS practice. The remaining 49 respondents (45.4%) scored below the mean score cut off point indicating poor practice. The mean values are different depending on working areas in terms of attitudes and practice. The association between attitudes and practice (r= 0.641, p-value<0.01) is confirmed having a positive and strong correlation. Conclusion: The study revealed that despite having poor knowledge on EWS, the nurses have demonstrated good attitudes and practice in detecting patients’ progressive deteriorating conditions; thus, confirming that there are associations in area of practice with attitudes and practice. The results also shows that there is a significant difference between attitudes and practice of nurses in assessing patient using EWS with (p- value< 0.05).