Seeing beyond the obvious: knowledge and self-reported practices of nurses in identifying early warning signs of critical illness among adult patients in general wards-a cross-sectional study

Abstract

Nurses play a crucial role in preventing deterioration-related morbidity and mortality among hospitalized patients. This study assessed nurses’ knowledge and reported practices of identifying early warning signs of critical illness among adult patients in general wards and contextual factors that influence these practices. An analytical cross-sectional study involving general ward nurses was conducted in three tertiary referral hospitals. A self-administered questionnaire was distributed to 235 randomly selected participants. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 25. Descriptive statistics and inferential tests, including independent sample t-test and ANOVA, were used to examine associations between knowledge and demographic/workplace factors. Knowledge of early warning signs was low (mean = 41.5%, SD = 10.41). Scores were significantly higher among bachelor’s-prepared nurses and those working at the national referral hospital (p = 0.007; p = 0.003, respectively). Nurses mainly identified deterioration using vital signs, monitoring, and response to deterioration practices varied, and resource availability was inconsistently perceived. Heavy workload, inadequate training, and resource constraints were common barriers despite generally positive self-ratings of ward practices. Job satisfaction was the only significant independent predictor of knowledge (B = 2.847, p = 0.006). Other variables were not significant. The model explained 6.4% of the variance (R2 = 0.064, F(5, 229) = 3.114, p = 0.010). Despite nurses’ positive reported practices in identifying patient deterioration, nurses’ overall knowledge of early warning signs of critical illness was low. Staff training, protocol standardization, and resource enhancement are essential to enhance nurses’ ability to recognize and respond effectively to early signs of deterioration and critical illness. Given the limited awareness and utilization of structured early warning systems identified in this study, there is a need for training, contextual adaptation, and phased implementation of standardized tools such as National Early Warning Score (NEWS). Not applicable.