Nurse by numbers: The impact of early warning systems on nurses' higher-order thinking, a quantitative study

Marie Danielle Le Lagadec; Deb Massey; Amy-Louise Byrne; Justine Connor; Tracy Flenady

doi:10.1111/jan.16235

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Nurse by numbers: The impact of early warning systems on nurses' higher-order thinking, a quantitative study

Journal article

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Nurse by numbers: The impact of early warning systems on nurses' higher-order thinking, a quantitative study

Marie Danielle Le Lagadec, Deb Massey, Amy-Louise Byrne, Justine Connor and Tracy Flenady

Journal of advanced nursing, Vol.81(9), pp.5342-5352

09/2025

DOI: https://doi.org/10.1111/jan.16235

PMID: 38733070

Appears in Recent Faculty of Health Publications

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Abstract

critical thinking

early warning system

decision‐making tools

higher‐order thinking

nurses

Aim: To 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. Design: A concurrent mixed methods study design. Method: Using 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. Results: Most 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. Conclusion: Although 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.

Details

Title: Nurse by numbers: The impact of early warning systems on nurses' higher-order thinking, a quantitative study
Creators: Marie Danielle Le Lagadec - Central Queensland University
Deb Massey - Edith Cowan University
Amy-Louise Byrne - Central Queensland University
Justine Connor - Central Queensland University
Tracy Flenady - Central Queensland University
Publication Details: Journal of advanced nursing, Vol.81(9), pp.5342-5352
Publisher: Wiley-Blackwell Publishing Ltd.
Grant note: This work was supported by a CQUniversity Internal Grant, RHS6503.
Identifiers: 991013189013002368
Copyright: © 2024 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License. Open access publishing facilitated by Central Queensland University, as part of the Wiley - Central Queensland University agreement via the Council of Australian University Librarians.
Academic Unit: Nursing; Faculty of Health
Language: English
Resource Type: Journal article

Nurse by numbers: The impact of early warning systems on nurses' higher-order thinking, a quantitative study

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