Effect of a Pediatric Early Warning System Educational Program on Nurses' Capacity to Detect Clinical Deterioration:...

Pediatric early warning system (PEWS) supports the early recognition of clinical deterioration in hospitalized children. However, inadequate nurse training may limit their effective implementation in clinical practice. This study evaluated the effect of a PEWS-based educational program on nurses' knowledge and clinical performance in a pediatric acute care setting.

A quasi-experimental study design was conducted among the pediatric nurses working in Tanta University Hospital and Kafr El-Sheikh Main University Hospital. A convenience sample was selected from the target population, amounting to 114 pediatric nurses, who were divided into intervention and control groups. The data were collected using the Pediatric Early Warning Signs Questionnaire, Modified Pediatric Early Warning Score, and British Columbia PEWS observational checklist. The outcome variables were measured at baseline, immediately after the intervention, and during the follow-up period. Descriptive statistics, chi-square or Fisher's exact test, independent samples t-test, Pearson's correlation, and multiple linear regression were performed to analyze the data using SPSS statistical software. The statistical significance level was set at p < 0.05.

Baseline evaluation showed no statistically significant variations between intervention and control groups among theoretical knowledge and clinical performance. Immediately postintervention, high knowledge levels were attained by 94.7% of nurses in the intervention group versus 24.6% in the control group (p < 0.001), while satisfactory clinical performance was observed in 91.2% and 22.8% of nurses, respectively (p < 0.001). At follow-up, high knowledge levels were observed in 87.7% of nurses in the intervention group compared with 10.5% in the control group (p < 0.001), and satisfactory clinical performance was observed in 87.7% and 19.3%, respectively (p < 0.001). In the intervention group, the level of education and years of experience were significantly associated with both knowledge and clinical performance levels at follow-up. Knowledge and clinical performance scores were positively correlated in the intervention group (r = 0.317, p = 0.016).

The findings suggest that structured PEWS education can improve knowledge of clinical deterioration and clinical performance in applying PEWS assessments among pediatric nurses, with improvements largely maintained at follow-up. Incorporating structured PEWS education into continuing nursing education may strengthen nurses' capacity to respond to clinical deterioration in pediatric acute care settings.

Nursing managers should consider integrating structured PEWS education into workforce-development programs to strengthen nurses' knowledge and clinical performance in recognizing pediatric deterioration and support timely escalation of care.