Effectiveness of an Instructional Program on Nurses’ Skills Regarding the InternationalPediatric Early Warning Scoring System in Mosul Hospitals: A Randomized Controlled Trial

Abstract

Objective: To evaluate the effectiveness of an instructional program in improving nurses’ skills related to the
International Pediatric Early Warning Scoring System (IPEWS) in pediatric wards.
Study Design: Randomized controlled trial study
Place and Duration of Study: This study was conducted at the Pediatric Wards of Five Major Governmental Hospitals in Mosul City, Iraq, from 23 February to 23 April 2026.

Methods: Mosul General Hospital, Ibn Al-Atheer Teaching Hospital, and Al-Khansa Teaching Hospital were assigned to the experimental group, while Al-Salam Teaching Hospital and Ibn Sina Teaching Hospital served as the
control group.

Methods: Registered nurses were randomly allocated to either an experimental group or a control group. The experimental group received a structured instructional program consisting of four educational sessions on the International Pediatric Early Warning Scoring System (IPEWS), while the control group received routine practice. Nurses’ skills were assessed before and after the intervention using a researcher-developed observational
questionnaire. Content validity was established by a panel of 20 experts, and reliability was confirmed through a pilot study (Cronbach’s α = 0.810). Data was analyzed using descriptive statistics, independent and paired t-tests, and analysis of variance (ANOVA), with statistical significance set at p ≤ 0.05.

Results: The instructional program produced a significant improvement in nurses’ IPEWS skills in the experimental group. The proportion of nurses with unacceptable skill levels declined from 60.0% at baseline to 0% after the intervention, while 56.7% achieved an excellent level of performance. In contrast, the control group demonstrated minimal changes between pretest and posttest assessments. Statistical analyses confirmed significant improvements in the experimental group (p ≤ 0.05), whereas no significant differences were observed in the control group.

Conclusion: The structured instructional program was effective in significantly enhancing nurses’ skills related to the International Pediatric Early Warning Scoring System. Incorporating similar educational interventions into continuing nursing education programs may strengthen pediatric patient assessment and contribute to improved quality of care.