Understanding registered nurses' practice utilising a (modified) early warning scoring system in Australia: A grounded theory study

 Background: The Medical Emergency Team (MET) expanded the role of the traditional cardiac arrest team with the intent to encourage rapid assessment of and response to deterioration of the patient before a cardiopulmonary arrest occurred on the hospital ward. The (Modified) Early Warning Scoring (MEWS/EWS) system was introduced to supplement the MET as a secondary means of supporting the ward nurse to be able to undertake an early identification of the deteriorating patient. Nurses play a vital role in accurately completing this tool. Previous studies have neither explained, nor explored nurses' understanding of using early warning scoring systems nor the importance and relevance of doing so. 

Aim: This dissertation reports on a study aimed at discovering Registered Nurses' understandings of using (Modified) Early Warning Scoring (MEWS/EWS) systems in Australian hospitals. 

Research Design A Grounded Theory approach was used to explore Registered Nurses' understanding of the MEWS/EWS system. The constant comparative method of data analysis was untaken to develop a substantive theory to explain this process. A sample of 14 Registered Nurses from Australian hospitals provided the data from which a substantive theory emerged. 

Findings The study identified the central category of shared understanding. Shared understanding was central to Registered Nurses using a MEWS/EWS system designed to "track" signs of deterioration and "trigger" a rapid response. This shared understanding requires a common agreement between health professions and healthcare facilities on the benefit of the system. When the shared understanding was absent, Registered Nurses were circumnavigating the system to achieve a desired response, which was to essentially achieve a positive outcome for the patient. They circumnavigated the process by calling the medical emergency team (MET) to ultimately keep the patient safe and to ensure the patient was seen. 

Conclusion In unveiling the substantive theory to prevent clinical deterioration and optimise patient outcomes the multidisciplinary team require a shared understanding of the MEWS/EWS system it became apparent that when the central issue of a shared understanding was diminished or missing, efficient use of the Track and Trigger systems (TTS) could be compromised. The study contributes to the body of knowledge about MEWS/EWS systems but in an area not previously addressed, furthering insight into the factors that affect nurses when utilising the MEWS/EWS systems. This research has the potential to shape research on MEWS/EWS systems use in the future.