CHALLENGES IN THE IMPLEMENTATION OF EARLY WARNING SCORING SYSTEM (EWSS) BY NURSES IN DEVELOPED AND DEVELOPING COUNTRIES: SCOPING REVIEW

The Early Warning Scoring System (EWSS) is widely used to detect early deterioration of patients' conditions and support timely clinical escalation. However, its implementation by nurses in various countries still faces a number of obstacles, such as lack of training, limited resources, and negative perceptions of the effectiveness of the system. This article aims to map the challenges faced by nurses in implementing EWSS, both in terms of clinical practice and contextual factors in developed and developing countries. This scoping review follows the framework of Arksey & O'Malley as well as the guidance of the Joanna Briggs Institute (JBI). Searches were conducted on ProQuest, PubMed, Google Scholar, and local repositories (2017–2024, Indonesian and English). Of the 22,103 articles, 24 primary studies with qualitative, quantitative, and mixed designs met the inclusion criteria. The eight main challenges identified include: lack of training and knowledge, low compliance with documentation and escalation, high workload, limited staff, sub-optimal interprofessional communication and collaboration, organizational culture barriers, low self-efficacy of nurses, and lack of digital technology support. These findings provide the basis for policy development and training tailored to the context of individual health services.