Creating a Lifesaving Lens: Developing and Validating a Tool to Test Nurses' Knowledge of Identifying Early Warning Signs of Critical Illness in Adults

ABSTRACT Background Critical illness is a major challenge in developing countries, where resources and trained personnel to support and manage critically ill patients are scarce. Many patients deteriorate while in general wards, and nurses often lack the knowledge to identify and manage early warning signs of critical illness. Enhancing this knowledge can help reduce the burden of critical illness. However, little is known about tools to assess nurses' knowledge of identifying early warning signs of critical illness in Tanzania. This study developed such a tool using standard scale development methods, like in‐depth interviews, expert review, pilot testing, validity and reliability testing. Aim The study aimed at developing a valid and reliable tool that will be used to test nurses' knowledge of identifying early warning signs of critical illness in adults. Study Design and Methods This study employed a multi‐stage study design. Questionnaire items were generated through an intensive literature review and in‐depth interviews with nine clinicians and health care providers. These items were then reviewed by seven experts and pilot tested with 20 participants from a national referral hospital in Tanzania. Face, content and construct validity of the questionnaire were established using data from a cross‐sectional study of 156 participants. Cronbach's alpha was used to assess the reliability of the developed tool. Results A 26‐item questionnaire was developed, and data from 156 nurses were used to assess its reliability and validity. Cronbach's alpha was 0.614, indicating moderate but acceptable internal consistency. Face and content validity were assessed by experts, yielding a Content Validity Index (CVI) of 1.0, which indicates strong agreement among experts regarding the questionnaire content. Construct validity was assessed using Exploratory Factor Analysis (EFA) followed by Confirmatory Factor Analysis (CFA). Nine factors with factor loadings above 0.4 were extracted, accounting for 58.81% of the total variance. The Root Mean Square Residual (RMR) was 0.012, and the Root Mean Square Error of Approximation (RMSEA) was 0.034, both indicating a very good model fit. The Goodness of Fit Index (GFI) was 0.886, the Tucker–Lewis Index (TLI) was 0.864, and the Comparative Fit Index (CFI) was 0.893. Although slightly below optimal thresholds, these indices are still considered acceptable, suggesting a moderate model fit with potential for further refinement. Conclusion Findings suggest that the tool has moderate but acceptable internal consistency and excellent content validity. The questionnaire can serve as a preliminary exploratory tool for assessing nurses' knowledge in identifying early warning signs of critical illness in adults in our context. Relevance to Clinical Practice This study supports early recognition and response to patient deterioration by ensuring nurses have the necessary knowledge to identify early warning signs of critical illness. A validated knowledge assessment tool will identify knowledge gaps and hence guide targeted training, which will improve nurses' knowledge and confidence and ultimately improve patient outcomes.