Introducing the National Early Warning Score - A qualitative study of hospital nurses' perceptions and reactions

The aim of this study was to explore hospital nurses' perceptions and reactions to the National Early Warning Score during an introduction programme.

A qualitative case study approach with participatory observations was used for this study.

In total, nine seminars and 23 simulation sessions attended by nurses were observed. An activity theory system analysis was applied to interpret the material.

The findings revealed four tensions related to the working context: (a) tension between using a standardized tool and relying on clinical judgement (the tool could be either an aid or a barrier to patient assessment); (b) tension in the community of practice (the tool could be beneficial or increase stress and anxiety); (c) tension related to rules and compliance (the tool could be perceived as optional or compulsory); and (d) tension related to the division of labour (nurses feared more work).