Introducing the National Early Warning Score – A qualitative study of hospital nurses’ perceptions and reactions

AIM: The aim of this study was to explore hospital nurses’ perceptions and reactions to the National Early Warning Score during an introduction programme. DESIGN: A qualitative case study approach with participatory observations was used for this study. METHODS: In total, nine seminars and 23 simulation sessions attended by nurses were observed. An activity theory system analysis was applied to interpret the material. RESULTS: The findings revealed four tensions related to the working context: (a) tension between using a standardized tool and relying on clinical judgement (the tool could be either an aid or a barrier to patient assessment); (b) tension in the community of practice (the tool could be beneficial or increase stress and anxiety); (c) tension related to rules and compliance (the tool could be perceived as optional or compulsory); and (d) tension related to the division of labour (nurses feared more work).