ArticleJournal of advanced nursing2025
Nurse by numbers: The impact of early warning systems on nurses' higher-order thinking, a quantitative study.
Article in Journal of advanced nursing, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
What it found
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
6 citing papers in PubMed.
- Digital resilience of clinical nurses: a concept analysis.BMC nursing · 2025Article
- Nurse by numbers: The impact of early warning systems on nurses' higher-order thinking, a quantitative study.Journal of advanced nursing · 2025Article
- Critical Points of Risk in Registered Nurses' Use of a National Early Warning Score-Perceptions and Challenges.Journal of advanced nursing · 2025Article
- When Nurses Worry: A Concept Analysis of Intuition in Clinical Deterioration.Journal of advanced nursing · 2025Review
- Factors influencing patient safety competence among Chinese vocational nursing students: A mixed-methods study using COM-B model and theoretical domains framework.International journal of nursing studies advances · 2025Article
- Variation in nurses' compliance with an Early Warning Score protocol: A retrospective cohort study.Heliyon · 2024Article
Corrections and comments
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Authors and funding
5 authors.
Funding
Abstract
aimTo evaluate registered nurses' perceptions of whether the mandated use of the early warning system vital signs tool impacts the development of nurses' higher-order thinking skills.
designA concurrent mixed methods study design.
methodUsing an online survey, registered nurses' perceptions were elucidated on whether early warning system algorithmic tools affected the development of their higher-order thinking. Likert-type matrix questions with additional qualitative fields were used to obtain information on nurse's perceptions of the tool's usefulness, clinical confidence in using the tool, compliance with escalation protocols, work environment and perceived compliance barriers.
resultsMost of the 305 (91%) participants included in the analysis had more than 5 years of nursing experience. Most nurses supported the early warning tool and were happy to comply with escalation protocols if the early warning score concurred with their assessment of the patient (63.6%). When the score and the nurse's higher-order thinking did not align, some had the confidence to override the escalation protocol (40.0%), while others omitted (69.4%) or inaccurately documented vital signs (63.3%) to achieve the desired score. Very few nurses (3.6%) believe using early warning tools did not impede the development of higher-order thinking.
conclusionAlthough experienced nurses appreciate the support of early warning tools, most value patient safety above the tools and rely on their higher-order thinking. The sustained development and use of nurses' higher-order thinking should be encouraged, possibly by adding a critical thinking criterion to existing algorithmic tools. IMPACT: The study has implications for all nurses who utilize algorithmic tools, such as early warning systems, in their practice. Relying heavily on algorithmic tools risks impeding the development of higher-order thinking. Most experienced nurses prioritize their higher-order thinking in decision-making but believe early warning tools can impede higher-order thinking. PATIENT OR PUBLIC CONTRIBUTION: Registered nurses participated as survey respondents.
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