Effectiveness of Evidence‑Based Nursing Intervention Program on Nurses’ Readiness Regarding Early Warning Systems in Critical Care Units

Abstract

Introduction: Clinical deterioration in critical care settings remains a major patient safety concern, with physiological warning signs often detectable hours before adverse events occur. Early Warning Systems (EWS), especially the National Early Warning Score 2 (NEWS2) and SBAR communication framework, are essential for early detection and a timely escalation of deterioration. Nevertheless, in many healthcare settings, the readiness of nurses to implement early warning systems effectively is still suboptimal.
Aim of the Study: To evaluate the effectiveness of an evidence-based nursing intervention program on nurses’ clinical readiness — defined as knowledge, attitudes, and self-confidence — regarding the application of NEWS2 and SBAR in critical care units.
Methods: A quasi-experimental, non-equivalent control group design was conducted in governmental hospitals in Najaf Governorate, Iraq, from October 2025 to February 2026. A total of 162 critical care nurses participated (study group n=90, comparative group n=72). A structured educational program (EWS-RPP) was delivered to the study group. Nurses' readiness was evaluated before and after the intervention through a questionnaire comprising three components: a knowledge questionnaire, an attitudes scale, and a self-confidence scale.
Results: At baseline, both groups demonstrated comparable poor knowledge (study: 80.0% poor; comparative: 86.1% poor), balanced-to-supportive attitudes, and moderate self-confidence, with no statistically significant between-group differences. Following the intervention, the study group achieved a 100% good knowledge rate (vs. 20.8% in the comparative group; p<0.001), with 97.8% displaying supportive attitudes (vs. 16.7%; p<0.001), and 42.2% demonstrating high moderate self-confidence (vs. 1.4%; p<0.001).
Conclusion: The structured educational program significantly improved nurses' readiness for applying NEWS2 and SBAR.
Recommendation: Integration of an Evidence‑Based Nursing Intervention Program into critical care nursing practice to enhance nurses' readiness for early detection of patient deterioration and improve patient safety outcomes.