Development of a Shock Early Warning Assessment Model Using Modified Early Warning Score Combined with Nurse Concern in Medical Patients
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Abstract
Abstract
This research and development study aimed to identify factors associated with shock, develop an early warning assessment tool, and evaluate its implementation among medical patients. The study comprised four phases: (1) retrospective review of 160 medical records selected through systematic random sampling; (2) development of the NICE-Shock Early Warning Tool; (3) competency development for 48 registered nurses; and (4) implementation evaluation among 134 category 4 patients. Research instruments included an early warning recording form, the NICE-Shock assessment tool, a competency assessment, and an opinion questionnaire. The NICE-Shock tool demonstrated content congruence indices ranging from 0.80 to 1.00. Data were analyzed using descriptive statistics, logistic regression, and area under the receiver operating characteristic curve (AUROC).
The findings showed that NICE-Shock combined the Modified Early Warning Score (MEWS) with a nurse concern indicator for circulatory changes (NC2), assigning two additional points when NC2 was present. MEWS scores were associated with shock (OR = 1.17, 95% CI = 1.02–1.35, p = .02). Incorporating NC2 increased the AUROC from 0.67 to 0.71. At a cutoff score of ≥5, sensitivity and specificity were 77.50% and 41.25%, respectively. Following competency development, nurses achieved mean scores of 77.81, 76.42, and 78.96 out of 100 for knowledge, tool-use skills, and clinical interpretation and decision-making, respectively. All patients received complete assessments, while 97.79% of at-risk patients received monitoring and responses according to the guidelines. Nurses reported high satisfaction (M = 4.80, SD = 0.37).
The NICE-Shock tool may support nurses' clinical assessment, monitoring, and decision-making for early recognition of shock in medical patients. Further validation is recommended before wider implementation.
Keywords Shock, Modified Early Warning Score, Nurse Concern, Early Warning Assessment Tool
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