Intensive care nurses' awareness of identification of early sepsis findings

Critical care nurses' knowledge, confidence, and clinical reasoning in sepsis management: a systematic review

BACKGROUND

Sepsis is a critical condition with high global mortality, accounting for 11 million deaths annually. Nurses are central to sepsis management, and their knowledge, confidence, and clinical reasoning significantly impact patient outcomes.

AIM

This systematic review evaluates critical care nurses' knowledge, confidence, and clinical reasoning in sepsis management and examines factors influencing these competencies.

METHODS

A comprehensive search of PubMed, CINAHL, MEDLINE, Scopus, EMBASE, and the Cochrane Library was conducted, covering studies published from 2014 to 2023. Studies were included if they assessed knowledge, confidence, or clinical reasoning in sepsis management among critical care nurses using quantitative, qualitative, or mixed-methods approaches in clinical settings. Only peer-reviewed studies were considered to ensure academic rigor. The risk of bias was assessed using the JBI Checklist for quantitative studies and the CASP tool for qualitative studies, with discrepancies resolved through discussion or a third reviewer. A total of 70 records were screened, with 25 studies (sample sizes ranging from 28 to 835 nurses) meeting the inclusion criteria. Data extraction focused on study design, tools used, and key outcomes related to knowledge, confidence, and clinical reasoning in sepsis management.

RESULTS

Across 25 studies involving over 5,000 nurses globally, knowledge scores were moderate, with significant gaps in early sepsis recognition (e.g., only 52% of nurses could define sepsis). In three studies, confidence improved with sepsis-specific training, showing a 10-25% increase post-intervention. Clinical reasoning was influenced by organizational factors, experience, and the use of technology, with decision-support tools enhancing timely sepsis recognition and reducing mortality by up to 23%.

CONCLUSION

This review provides a global perspective on sepsis management among critical care nurses, strengthened by diverse study designs. However, limitations include variability in measurement tools, self-reporting bias, small sample sizes, and language-based selection bias. Continuous education, targeted training, and the integration of AI-driven decision tools are essential to improving sepsis outcomes. Addressing gaps in sepsis knowledge and promoting better clinical reasoning will enhance the overall quality of care in critical settings.

Understanding ICU Nursing Knowledge, Perceived Barriers, and Facilitators of Sepsis Recognition and Management: A Cross-Sectional Study

IMPORTANCE

Nursing workforce changes, knowledge translation gaps, and environmental/organizational barriers may impact sepsis recognition and management within the ICU.

OBJECTIVES

To: 1) evaluate current ICU nursing knowledge of sepsis recognition and management, 2) explore individual and environmental or organizational factors impacting nursing recognition and management of sepsis using the Theoretical Domains Framework (TDF), and 3) describe perceived barriers and facilitators to nursing recognition and management of patients with sepsis.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional survey was administered to nurses working in four general system ICUs between October 24, 2023, and January 30, 2024.

MAIN OUTCOMES AND MEASURES

Quantitative questions (single/multiple choice, true/false, and Likert-based questions eliciting agreement with a statement) were analyzed using descriptive statistics. Open-ended questions exploring barriers and facilitators to sepsis recognition and management were analyzed using qualitative content analysis.

RESULTS

A total of 101 completed survey responses were retained. Most nurses agreed early sepsis detection saves lives (n = 98, 97%, TDF domain Beliefs About Consequences) and that nursing care can improve patient outcomes (n = 97, 96%, TDF domain Optimism). Fewer nurses agreed it was easy to identify priority sepsis interventions based on order urgency (n = 53, 53%, TDF domain Memory, Attention, and Decision Processes). Reoccurring barriers and facilitators to sepsis recognition and management were commonly identified across the TDF domains of Knowledge, Skills, Environmental Context and Resources, and Social Influences, including competency deficit (with facilitators including support from colleagues), workload or staffing, and equipment or resource availability.

CONCLUSION AND RELEVANCE

ICU nursing sepsis recognition and management is impacted by numerous individual, environmental, and organizational factors. Recommendations include enhanced competency development or support, utilization of structured reinforcement measures (involving the interdisciplinary team and imploring the use of integrative technologies), and addressing equipment/resource-related gaps. Future research and improvement initiatives should use a theory-informed approach to overcome the pervasive, complex challenges impeding timely sepsis recognition and management.

Using clinical simulation to assess a new paediatric ESCALATION system education package: Empirical research mixed methods

AIM

The aim of the study was to assess the suitability of an online education package to prepare health professionals to use a new paediatric early warning system.

DESIGN

Quasi-experimental mixed methods using co-production.

METHODS

Participants completed the Package and participated in up to four clinical scenarios. Data were collected using self-report surveys, and during clinical scenarios; escalation of care, documentation, family involvement, communication handovers were assessed, and recorded debriefings were thematically analysed. Data were integrated using tabulated joint displays.

RESULTS

Eleven nurses and three doctors were recruited from three mixed adult and paediatric hospitals. Following completion of the Package and clinical scenarios 13/14 (93%) participants agreed preparedness and confidence to use the ESCALATION System had increased. For 53% handovers, the communication framework was followed, for 79% charts, documentation was complete. Participants engaged with the parent (actor) for 97% scenario interactions. The Package was effective and participation in clinical scenarios appeared to enhance learning.

PATIENT OR PUBLIC CONTRIBUTION

Consumers participated in the steering group overseeing the study and in the expert panel who reviewed the education package and clinical scenarios.

Nurses' knowledge and confidence in recognizing and managing patients with sepsis: A multi-site cross-sectional study

AIMS

(1) To examine registered nurses' knowledge and confidence in recognizing and managing to patients with sepsis and (2) identify nurse and workplace factors that influence their knowledge on sepsis.

DESIGN

A multi-site, cross-sectional survey.

METHODS

An online survey was developed and content validated. Data was collected from registered nurses working in the inpatient wards and emergency departments of three hospitals of a single healthcare cluster in Singapore during August 2021. Statistical analyses of closed-ended responses and content analysis of open-ended responses were undertaken.

RESULTS

A total of 709 nurses completed the survey. Nurses possessed moderate levels of knowledge about sepsis (mean score = 10.56/15; SD = 2.01) and confidence in recognizing and responding to patients with sepsis (mean score = 18.46/25; SD = 2.79). However, only 369 (52.0%) could correctly define sepsis. Nurses' job grade, nursing education level and clinical work area were significant predictors of nurses' sepsis knowledge. Specifically, nurses with higher job grade, higher nursing education level or those working in acute care areas (i.e. emergency department, high dependency units or intensive care units) were more likely to obtain higher total sepsis knowledge scores. A weak positive correlation was observed between sepsis knowledge test scores and self-confidence (r = .184). Open comments revealed that participants desired for more sepsis education and training opportunities and the implementation of sepsis screening tool and sepsis care protocol.

CONCLUSION

A stronger foundation in sepsis education and training programs and the implementation of sepsis screening tools and care bundles are needed to enhance nurses' knowledge and confidence in recognizing and managing patients with sepsis.

IMPACT

The findings of this study are beneficial to administrators, educators and researchers in designing interventions to support nurses in their role in recognizing and responding to sepsis.

Recent nanoengineered diagnostic and therapeutic advancements in management of Sepsis

COVID-19 acquired symptoms have affected the worldwide population and increased the load of Intensive care unit (ICU) patient admissions. A large number of patients admitted to ICU end with a deadly fate of mortality. A high mortality rate of patients was reported with hospital-acquired septic shock that leads to multiple organ failures and ultimately ends with death. The patients who overcome this septic shock suffer from morbidity that also affects their caretakers. To overcome these situations, scientists are exploring progressive theragnostic techniques with advanced techniques based on biosensors, biomarkers, biozymes, vesicles, and others. These advanced techniques pave the novel way for early detection of sepsis-associated symptoms and timely treatment with appropriate antibiotics and immunomodulators and prevent the undue effect on other parts of the body. There are other techniques like externally modulated electric-based devices working on the principle of piezoelectric mechanism that not only sense the endotoxin levels but also target them with a loaded antibiotic to neutralize the onset of inflammatory response. Recently researchers have developed a lipopolysaccharide (LPS) neutralizing cartridge that not only senses the LPS but also appropriately neutralizes with dual mechanistic insights of antibiotic and anti-inflammatory effects. This review will highlight recent developments in the new nanotechnology-based approaches for the diagnosis and therapeutics of sepsis that is responsible for the high number of deaths of patients suffering from this critical disease.