Massey Deb, Flenady Tracy, Byrne Amy-Louise, Connor Justine, Le Lagadec Danielle
Edith Cowan University, NSW, Australia.
School of Nursing Midwifery and Social Sciences, CQUniversity, Qld, Australia.
Aust Crit Care. 2025 Jan;38(1):101062. doi: 10.1016/j.aucc.2024.04.007. Epub 2024 Jun 5.
Algorithmic tools such as early warning systems (EWSs) have been embedded into clinical practice globally to facilitate the early recognition of patient deterioration and to guide the escalation of care. Concerns have been raised that the mandated use of these EWS tools may impact the development of nurses' higher-order thinking. However, the relationship between EWS tools and the development of higher-order thinking is poorly understood.
This paper provides the qualitative results of a larger study that sought to explore the impact of EWS tools on the development of nurses' higher-order thinking. The objective of this component of the study was to ascertain the thoughts and perceptions of nurses on the use of EWSs and how this related to the development of higher-order thinking skills.
A mixed-method, concurrent study design was used to explore the concept of the development of nurses' higher-order thinking in the context of EWS tools. The qualitative responses from a Qualtrics survey were thematically analysed and presented.
Two major themes were uncovered: White Lies and Safety Nets. Our analysis of the data suggested that some nurses amend their documentation practice to accommodate the EWS's escalation process, uncovering a view that the tool did not account for clinical reasoning. Parallel to this, some nurses found that these systems supported clinical decision-making and helped to build confidence, thus acting as a safety net for their practice.
Reliance on EWSs can both hinder and/or support the development of higher-order thinking. Early warning systems are useful tools in ensuring patient safety but should be used in conjunction with nurses' higher-order thinking.
诸如早期预警系统（EWS）之类的算法工具已在全球临床实践中广泛应用，以促进对患者病情恶化的早期识别并指导护理级别升级。有人担心，强制使用这些EWS工具可能会影响护士高阶思维的发展。然而，EWS工具与高阶思维发展之间的关系尚不清楚。
本文提供了一项大型研究的定性结果，该研究旨在探讨EWS工具对护士高阶思维发展的影响。本研究这一部分的目的是确定护士对使用EWS的想法和看法，以及这与高阶思维技能发展的关系。
采用混合方法、同期研究设计，在EWS工具的背景下探讨护士高阶思维发展的概念。对Qualtrics调查中的定性回答进行了主题分析并呈现。
发现了两个主要主题：善意谎言和安全网。我们对数据的分析表明，一些护士会修改他们的记录做法以适应EWS的升级流程，这揭示了一种观点，即该工具没有考虑临床推理。与此同时，一些护士发现这些系统支持临床决策并有助于建立信心，因此成为他们实践的安全网。
对EWS的依赖既可能阻碍也可能支持高阶思维的发展。早期预警系统是确保患者安全的有用工具，但应与护士的高阶思维结合使用。
