Effects of implementing a nursing practice guideline for early warning signs on clinical deterioration in a community hospital inpatient ward

Abstract

Critical illness is a severe and life-threatening condition. Monitoring symptom changes before a patient’s condition deteriorates can enable rapid intervention and reduce severe complications prior to progression to critical illness. This quasi-experimental study, employing a two-group pretest–posttest design, aimed to examine the effectiveness of implementing clinical nursing practice guidelines (CNPG) for early warning sign monitoring in the patient ward at Wiang Chiang Rung Hospital, Chiang Rai Province. The study was guided by Soukup’s conceptual framework, which consists of four phases: (1) problem identification, (2) evidence synthesis, (3) development and feasibility testing of the CNPG, and (4) implementation of the refined guidelines. The sample consisted of eight registered nurses and ninety hospitalized patients, selected through purposive sampling and divided equally into control and experimental groups (n=45 per group). The research instruments included (a) nursing practice guidelines for modified early warning sign monitoring, validated with a content validity index of 0.90; (b) an unexpected clinical deterioration incident report form, validated with a content validity coefficient of 0.80; and (c) a nurse satisfaction questionnaire regarding the use of the guidelines, validated for reliability with a Cronbach’s alpha coefficient of .80. Data were analyzed using descriptive statistics, Chi-square test, and Fisher’s exact test. The results revealed that the experimental group, who received the nursing practice guidelines, had a significantly lower incidence of clinical deterioration compared to the control group, who received standard care (χ²=5.40, p<.05). Furthermore, nurses reported a high overall level of satisfaction with the implementation of the CNPG ( =4.19, SD=0.58). Therefore, nursing practice guidelines for monitoring early warning signs prior to the onset of critical illness should be implemented in inpatient wards to reduce the incidence of clinical deterioration and prevent progression to critical conditions.