CHALLENGES IN THE IMPLEMENTATION OF EARLY WARNING SCORING SYSTEM (EWSS) BY NURSES IN DEVELOPED AND DEVELOPING COUNTRIES: SCOPING REVIEW
Abstract
Early Warning Scoring System (EWSS) digunakan secara luas untuk mendeteksi dini perburukan kondisi pasien dan mendukung eskalasi klinis secara tepat waktu. Namun, penerapannya oleh perawat di berbagai negara masih menghadapi sejumlah kendala, seperti kurangnya pelatihan, keterbatasan sumber daya, dan persepsi negatif terhadap efektivitas sistem. Artikel ini bertujuan memetakan tantangan yang dihadapi perawat dalam menerapkan EWSS, baik dalam aspek praktik klinis maupun faktor kontekstual di negara maju dan berkembang. Scoping review ini mengikuti kerangka Arksey & O’Malley serta panduan Joanna Briggs Institute (JBI). Pencarian dilakukan di ProQuest, PubMed, Google Scholar, dan repositori lokal (2017–2024, Bahasa Indonesia dan Inggris). Dari 22.103 artikel, 24 studi primer dengan desain kualitatif, kuantitatif, dan campuran memenuhi kriteria inklusi.Delapan tantangan utama yang teridentifikasi meliputi: kurangnya pelatihan dan pengetahuan, kepatuhan rendah terhadap dokumentasi dan eskalasi, beban kerja tinggi, keterbatasan staf, komunikasi dan kolaborasi antarprofesi yang belum optimal, hambatan budaya organisasi, rendahnya efikasi diri perawat, serta minimnya dukungan teknologi digital. Temuan ini memberikan dasar bagi pengembangan kebijakan dan pelatihan yang disesuaikan dengan konteks masing-masing layanan kesehatan.
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References
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10. O’Neill SM, Clyne B, Bell M, et al. Why do healthcare professionals fail to escalate as per the early warning system (EWS) protocol? A qualitative evidence synthesis of the barriers and facilitators of escalation. BMC Emerg Med. 2021;21(1):1-19. doi:10.1186/s12873-021-00403-9
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14. Nielsen PB, Schultz M, Langkjaer CS, et al. Adjusting Early Warning Score by clinical assessment: A study protocol for a Danish cluster-randomised, multicentre study of an Individual Early Warning Score (I-EWS). BMJ Open. 2020;10(1):1-10. doi:10.1136/bmjopen-2019-033676
15. Amandaty S. Analisis National Early Warning Score (NEWS) sebagai prediktor kematian pasien gagal jantung di Instalasi Gawat Darurat RSUD DR. Slamet Martodirdjo Pamekasan. Sustain. 2019;11(1):164.
16. Tanhapour M, Rostam Niakan Kalhori S. Early Warning System for Emergency Care: Designing a Timely Monitoring Mobile-Based System. Stud Health Technol Inform. 2022;291:88-102. doi:10.3233/SHTI220009
17. Yuseasmicel; Delvy RNE. Hubungan Pengetahuan Perawat Dengan Dokumentasi Pengisian Form Ews ( Early Warning Scoring ) Di Instalasi Rawat Inap. J Kesehat Lentera `Aisyiyah. 2024;7(1).
18. Alhmoud B, Bonnici T, Melley D, Patel R, Banerjee A. Performance of digital early warning score (NEWS2) in a cardiac specialist setting: Retrospective cohort study. BMJ Open. 2023;13(3). doi:10.1136/bmjopen-2022-066131
19. Purbianto P, Agustanti D, Nasihin N. Early Warning System pada Henti Jantung Berbasis Smartphone. J Kesehat Vokasional. 2024;9(1):16. doi:10.22146/jkesvo.92777
20. Ehara J, Masuda Y, Hayashi K, Norisue Y, Fujitani S. Efficacy of Early Warning Scores as the Prediction Tool for Detecting Patients With Acute Deterioration in a High Dependent Unit. 2024;2024(10):1-12. doi:10.7759/cureus.71971
21. Pujiastuti D, Purwaty E, Janah J, et al. Penerapan Early Warning System (Ews) Sebagai Deteksi Dini Kematian Di Critical Care Area. J Penelit Keperawatan. 2021;7(1):1-9. doi:10.32660/jpk.v7i1.552
22. JBI 2024. JBI 2024. JBI. Published online 2024:481.
23. Kharisma Putri D, Endrian Kurniawan D, Tri Afandi A, Sri Wahyuningsih I. Studi Kasus Penerapan Early Warning Score Sebagai Upaya Keselamatan Pasien. Carolus J Nurs. 2023;5(2):87.
24. Setiyadi A, Mulyati S, Mustikowati T. Hubungan tingkat pengetahuan perawat terhadap sikap perawat dalam menindaklanjuti penilaian Nursing Early Warning Score System (NEWSS) di Gedung A RSUPN Dr. Cipto Mangunkusumo Jakarta. J Pendidik Tambusai. 2022;6(2014):1160-1166.
25. Suwaryo PAW, Sutopo R, Utoyo B. Pengetahuan Perawat Dalam Menerapkan Early Warning Score System (Ewss) Di Ruang Perawatan. J Ilm Kesehat Keperawatan. 2019;15(2):64. doi:10.26753/jikk.v15i2.376
26. Destri N, Asmicel Y, Delvy R, Avis M. Pemahaman perawat tentang dokumentasi pengisian form early warning scoring (EWS) di instalasi rawat inap RS Islam Ibnu Sina Padang. JPPI (Jurnal Penelit Pendidik Indones. 2024;10(2):450. doi:10.29210/020244094
27. Massey D, Flenady T, Byrne AL, Connor J, Le Lagadec D. ‘White lies and safety nets’: The perceptions of nurses on the use of early warning systems and the development of higher-order thinking skills. Aust Crit Care. 2024;(xxxx):6. doi:10.1016/j.aucc.2024.04.007
28. Jensen JK, Skår R, Tveit B. Introducing the National Early Warning Score – A qualitative study of hospital nurses’ perceptions and reactions. Nurs Open. 2019;6(3):1067-1075. doi:10.1002/nop2.291
29. Petersen JA, Rasmussen LS, Rydahl-Hansen S. Barriers and facilitating factors related to use of early warning score among acute care nurses: A qualitative study. BMC Emerg Med. 2017;17(1):1-9. doi:10.1186/s12873-017-0147-0
30. Pengetahuan G, Dan S, Perawat K. Fakultas Ilmu Kedokteran dan Kesehatan Universitas Jambi Abstrak - Sherly Yashinta Sameni Early Warning Score , Keterampilan , Abstract Jurnal Keperawatan Universitas Jambi , Vol …, No .., Tahun 2022. Published online 2017:25-31.
31. Ardiansyah D, Aeni LN, Avila Kurnia T, et al. Efikasi diri dan Implementasi Early Warning Scoring System (EWSS) pada Pasien Henti Jantung oleh Perawat Ruang Rawat Inap. J Keperawatan Raflesia. 2024;6(1):33-44. doi:10.33088/jkr.v6i1.940
32. Davwar PM, David NP, Imoh LC, et al. The Role of The National Early Warning Score ( NEWS ) in Identifying Critically Ill Patients at Risk of Mortality in Nigeria . A Retrospective Record Review. 2023;64(2):267-271.
33. B A, T B, R P, Melley D, Hicks L, Banerjee A. Implementation of a digital early warning score (NEWS2) in a cardiac specialist and general hospital settings in the COVID-19 pandemic: A qualitative study. BMJ Open Qual. 2023;12(1):1-10. doi:10.1136/bmjoq-2022-001986
34. Yulianti ID, Suryaningsih Y, Jember UM, Kesehatan FI, Studi P, Keperawatan I. Hubungan Motivasi Dengan Kepatuhan Perawat Dalam Pendokumentasian Early Warning Score System Di Rawat Inap Rsud Dr. Soebandi Jember. J Ilmu Kesehat. 2024;3(4). doi:10.5455/mnj.v1i2.644
35. Langkjaer CS, Bove DG, Nielsen PB, Iversen KK, Bestle MH, Bunkenborg G. Nurses’ Experiences and Perceptions of two Early Warning Score systems to Identify Patient Deterioration—A Focus Group Study. Nurs Open. 2021;8(4):1788-1796. doi:10.1002/nop2.821
36. Triwijayanti R, Rahmania A. Pengetahuan Perawat Dalam Penerapan Early Warning System (Ews) Di Ruang Rawat Inap. J Ilmu Keperawatan dan Kebidanan. 2022;13(1):12-15. doi:10.26751/jikk.v13i1.887
2. Yahya IM, Dareda K, Soebagio J. Hubungan Penerapan Sistem National Early Warning Score (News) Dengan Penilaian Mortalitas Pasien Di Instalasi Gawat Darurat Di Rumah Sakit Tk. II Robert Wolter Mongisidi. J Sisthana. 2020;5(2):76-80.
3. Armanto A, Lesmana H, Ose MI, Pujianto A, Tukan RA, Hasriana H. Faktor – Faktor yang Berhubungan dengan Kepatuhan Perawat dalam Pendokumentasian Early Warning Score System (EWSS) di RSUD dr. JUSUF SK. MAHESA Malahayati Heal Student J. 2024;4(7):2959-2969. doi:10.33024/mahesa.v4i7.14762
4. Kholis AH, Hidayah N, Priyanti RP, Asri A, Ellina AD. Understanding Nurses Experiences and Perception about The Implemention of Emergency Monitoring : A Qualitative Study. J Pendidik Keperawatan Indones. 2020;6(2):113-121. doi:10.17509/jpki.v6i2.25032
5. Astuti LP, Trisyani Y, Mirwanti R. Implementasi Early Warning System (Ews) dalam Mendeteksi Perburukan Akut pada Pasien Dewasa di Ruang Rawat Inap Rumah Sakit. J Telenursing. 2023;5(2):1590-1603. doi:10.31539/joting.v5i2.6356
6. Brangan E, Banks J, Brant H, Pullyblank A, Le Roux H, Redwood S. Using the National Early Warning Score (NEWS) outside acute hospital settings: A qualitative study of staff experiences in the West of England. BMJ Open. 2018;8(10). doi:10.1136/bmjopen-2018-022528
7. Wahyudi JT, Fadillah A, Ramadhani DR. Pengembangan Aplikasi National Early Warning Score 2 ( NEWS2 ) Berbasis Web dalam Penilaian Awal Pasien dengan Penyakit Akut Development of Web-Based National Early Warning Score 2 ( NEWS2 ) Application in the Initial Assessment of Patients with Acute Ill. J Masker Med. 2023;11(2):346-353.
8. Megawati SWM, Sujana W, Khotimah NIHK. Pengalaman Perawat Dalam Penerapan Early Warning Score Di Ruang Rawat Inap. J Keperawatan ’Aisyiyah. 2023;10(2):151-160. doi:10.33867/jka.v10i2.378
9. Mulyati DS, Safitri A. Hubungan Beban Kerja Mental dengan Tingkat Kepatuhan Perawat dalam Penerapan Early Warning Score System (EWSS) di Ruang Rawat Inap. J Manag Nurs. 2024;3(3):349-359. doi:10.53801/jmn.v3i3.167
10. O’Neill SM, Clyne B, Bell M, et al. Why do healthcare professionals fail to escalate as per the early warning system (EWS) protocol? A qualitative evidence synthesis of the barriers and facilitators of escalation. BMC Emerg Med. 2021;21(1):1-19. doi:10.1186/s12873-021-00403-9
11. Guan G, Lee CMY, Begg S, Crombie A, Mnatzaganian G. The use of early warning system scores in prehospital and emergency department settings to predict clinical deterioration: A systematic review and meta-analysis. PLoS One. 2022;17(3 March):1-16. doi:10.1371/journal.pone.0265559
12. Iannello J. Improving Unadjusted and Adjusted Mortality With an Early Warning Sepsis System in the Emergency Department and Inpatient Wards. Fed Pract. 2021;(38 (11)). doi:10.12788/fp.0194
13. Ye C, Wang O, Liu M, et al. A real-time early warning system for monitoring inpatient mortality risk: Prospective study using electronic medical record data. J Med Internet Res. 2019;21(7):1-13. doi:10.2196/13719
14. Nielsen PB, Schultz M, Langkjaer CS, et al. Adjusting Early Warning Score by clinical assessment: A study protocol for a Danish cluster-randomised, multicentre study of an Individual Early Warning Score (I-EWS). BMJ Open. 2020;10(1):1-10. doi:10.1136/bmjopen-2019-033676
15. Amandaty S. Analisis National Early Warning Score (NEWS) sebagai prediktor kematian pasien gagal jantung di Instalasi Gawat Darurat RSUD DR. Slamet Martodirdjo Pamekasan. Sustain. 2019;11(1):164.
16. Tanhapour M, Rostam Niakan Kalhori S. Early Warning System for Emergency Care: Designing a Timely Monitoring Mobile-Based System. Stud Health Technol Inform. 2022;291:88-102. doi:10.3233/SHTI220009
17. Yuseasmicel; Delvy RNE. Hubungan Pengetahuan Perawat Dengan Dokumentasi Pengisian Form Ews ( Early Warning Scoring ) Di Instalasi Rawat Inap. J Kesehat Lentera `Aisyiyah. 2024;7(1).
18. Alhmoud B, Bonnici T, Melley D, Patel R, Banerjee A. Performance of digital early warning score (NEWS2) in a cardiac specialist setting: Retrospective cohort study. BMJ Open. 2023;13(3). doi:10.1136/bmjopen-2022-066131
19. Purbianto P, Agustanti D, Nasihin N. Early Warning System pada Henti Jantung Berbasis Smartphone. J Kesehat Vokasional. 2024;9(1):16. doi:10.22146/jkesvo.92777
20. Ehara J, Masuda Y, Hayashi K, Norisue Y, Fujitani S. Efficacy of Early Warning Scores as the Prediction Tool for Detecting Patients With Acute Deterioration in a High Dependent Unit. 2024;2024(10):1-12. doi:10.7759/cureus.71971
21. Pujiastuti D, Purwaty E, Janah J, et al. Penerapan Early Warning System (Ews) Sebagai Deteksi Dini Kematian Di Critical Care Area. J Penelit Keperawatan. 2021;7(1):1-9. doi:10.32660/jpk.v7i1.552
22. JBI 2024. JBI 2024. JBI. Published online 2024:481.
23. Kharisma Putri D, Endrian Kurniawan D, Tri Afandi A, Sri Wahyuningsih I. Studi Kasus Penerapan Early Warning Score Sebagai Upaya Keselamatan Pasien. Carolus J Nurs. 2023;5(2):87.
24. Setiyadi A, Mulyati S, Mustikowati T. Hubungan tingkat pengetahuan perawat terhadap sikap perawat dalam menindaklanjuti penilaian Nursing Early Warning Score System (NEWSS) di Gedung A RSUPN Dr. Cipto Mangunkusumo Jakarta. J Pendidik Tambusai. 2022;6(2014):1160-1166.
25. Suwaryo PAW, Sutopo R, Utoyo B. Pengetahuan Perawat Dalam Menerapkan Early Warning Score System (Ewss) Di Ruang Perawatan. J Ilm Kesehat Keperawatan. 2019;15(2):64. doi:10.26753/jikk.v15i2.376
26. Destri N, Asmicel Y, Delvy R, Avis M. Pemahaman perawat tentang dokumentasi pengisian form early warning scoring (EWS) di instalasi rawat inap RS Islam Ibnu Sina Padang. JPPI (Jurnal Penelit Pendidik Indones. 2024;10(2):450. doi:10.29210/020244094
27. Massey D, Flenady T, Byrne AL, Connor J, Le Lagadec D. ‘White lies and safety nets’: The perceptions of nurses on the use of early warning systems and the development of higher-order thinking skills. Aust Crit Care. 2024;(xxxx):6. doi:10.1016/j.aucc.2024.04.007
28. Jensen JK, Skår R, Tveit B. Introducing the National Early Warning Score – A qualitative study of hospital nurses’ perceptions and reactions. Nurs Open. 2019;6(3):1067-1075. doi:10.1002/nop2.291
29. Petersen JA, Rasmussen LS, Rydahl-Hansen S. Barriers and facilitating factors related to use of early warning score among acute care nurses: A qualitative study. BMC Emerg Med. 2017;17(1):1-9. doi:10.1186/s12873-017-0147-0
30. Pengetahuan G, Dan S, Perawat K. Fakultas Ilmu Kedokteran dan Kesehatan Universitas Jambi Abstrak - Sherly Yashinta Sameni Early Warning Score , Keterampilan , Abstract Jurnal Keperawatan Universitas Jambi , Vol …, No .., Tahun 2022. Published online 2017:25-31.
31. Ardiansyah D, Aeni LN, Avila Kurnia T, et al. Efikasi diri dan Implementasi Early Warning Scoring System (EWSS) pada Pasien Henti Jantung oleh Perawat Ruang Rawat Inap. J Keperawatan Raflesia. 2024;6(1):33-44. doi:10.33088/jkr.v6i1.940
32. Davwar PM, David NP, Imoh LC, et al. The Role of The National Early Warning Score ( NEWS ) in Identifying Critically Ill Patients at Risk of Mortality in Nigeria . A Retrospective Record Review. 2023;64(2):267-271.
33. B A, T B, R P, Melley D, Hicks L, Banerjee A. Implementation of a digital early warning score (NEWS2) in a cardiac specialist and general hospital settings in the COVID-19 pandemic: A qualitative study. BMJ Open Qual. 2023;12(1):1-10. doi:10.1136/bmjoq-2022-001986
34. Yulianti ID, Suryaningsih Y, Jember UM, Kesehatan FI, Studi P, Keperawatan I. Hubungan Motivasi Dengan Kepatuhan Perawat Dalam Pendokumentasian Early Warning Score System Di Rawat Inap Rsud Dr. Soebandi Jember. J Ilmu Kesehat. 2024;3(4). doi:10.5455/mnj.v1i2.644
35. Langkjaer CS, Bove DG, Nielsen PB, Iversen KK, Bestle MH, Bunkenborg G. Nurses’ Experiences and Perceptions of two Early Warning Score systems to Identify Patient Deterioration—A Focus Group Study. Nurs Open. 2021;8(4):1788-1796. doi:10.1002/nop2.821
36. Triwijayanti R, Rahmania A. Pengetahuan Perawat Dalam Penerapan Early Warning System (Ews) Di Ruang Rawat Inap. J Ilmu Keperawatan dan Kebidanan. 2022;13(1):12-15. doi:10.26751/jikk.v13i1.887
Authors
Powa, N. Y., Lestari, R., & Suryanto, S. (2025). CHALLENGES IN THE IMPLEMENTATION OF EARLY WARNING SCORING SYSTEM (EWSS) BY NURSES IN DEVELOPED AND DEVELOPING COUNTRIES: SCOPING REVIEW. JURNAL RISET KESEHATAN POLTEKKES DEPKES BANDUNG, 17(2), 565–576. https://doi.org/10.34011/juriskesbdg.v17i2.2918
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