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Research Paper| Volume 22, ISSUE 2, P119-125, June 2019

A survey of sepsis knowledge among Canadian emergency department registered nurses

Published:February 11, 2019DOI:https://doi.org/10.1016/j.auec.2019.01.007

      Abstract

      Background

      With the rise of patients with sepsis presenting to emergency departments, emergency nurses, as frontline healthcare workers, require current clinical knowledge of sepsis. The aim of this study was to assess emergency department registered nurses’ knowledge of sepsis and their perspectives of caring for patients with sepsis.

      Methods

      A descriptive cross-sectional survey was used to survey Registered Nurses from four emergency departments in a western Canadian city (N = 312).

      Results

      The majority of nurses scored poorly on questions examining knowledge of systemic inflammatory response syndrome variables associated with sepsis, and sepsis definitions, general knowledge, and treatment (mean score 51.8%). Nurses acknowledged their lack of knowledge and indicated a desire for further sepsis education. Challenges in providing sepsis-related care concerned perceived heavy workloads and clinical implications related to the patient's status.

      Conclusions

      Educational programs and coaching approaches that maximize nurses’ abilities to enhance their decision-making with regards to early assessment and appropriate intervention for persons with sepsis are needed. Such multifaceted approaches would acknowledge nurses’ existing knowledge and provide practical supports to help nurses extend and mobilize their knowledge for everyday decision-making within the complex clinical environment of the emergency department.

      Keywords

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      References

        • Jawad I.
        • Lukšić I.
        • Rafnsson S.B.
        Assessing available information on the burden of sepsis: global estimates of incidence, prevalence and mortality.
        J Glob Health. 2012; 2: 1-9https://doi.org/10.7189/jogh.02.010404
        • Berthelot S.
        • Lang E.
        • Quan H.
        • Stelfox H.T.
        What are emergency-sensitive conditions? A survey of Canadian emergency physicians and nurses.
        CJEM. 2016; 17: 154-160https://doi.org/10.2310/8000.2014.141466
        • Bentley J.
        • Henderson S.
        • Thakore S.
        • Donald M.
        • Wang W.
        Seeking sepsis in the emergency department - identifying barriers to delivery of the sepsis 6.
        BMJ Qual Improv Rep. 2016; 5https://doi.org/10.1136/bmjquality.u206760.w3983
        • Singer M.
        • Deutschman C.S.
        • Seymour C.W.
        • Shankar-Hari M.
        • Annane D.
        • Bauer M.
        • et al.
        The third international consensus definitions for sepsis and septic shock (sepsis-3).
        J Am Med Assoc. 2016; 315: 801-810https://doi.org/10.1001/jama.2016.0287
        • Seymour C.W.
        • Liu V.X.
        • Iwashyna T.J.
        • Brunkhorst F.M.
        • Rea T.D.
        • Scherag A.
        • et al.
        Assessment of clinical criteria for sepsis: for the third international consensus definitions for sepsis and septic shock (Sepsis-3).
        J Am Med Assoc. 2016; 315: 762-774https://doi.org/10.1001/jama.2016.0288
        • Macdonald S.P.J.
        • Williams J.M.
        • Shetty A.
        • Bellomo R.
        • Finfer S.
        • Shapiro N.
        • et al.
        Review article: sepsis in the emergency department – Part 1: definitions and outcomes.
        Emerg Med Australas. 2017; 29: 619-625https://doi.org/10.1111/1742-6723.12886
        • Lane D.
        • Ichelson R.I.
        • Drennan I.R.
        • Scales D.C.
        Prehospital management and identification of sepsis by emergency medical services: a systematic review.
        Emerg Med J. 2016; 33: 408-413https://doi.org/10.1136/emermed-2015-205261
        • Turi S.K.
        • Von Ah D.
        Implementation of early goal-directed therapy for septic patients in the emergency department: a review of the literature.
        J Emerg Nurs. 2013; 39: 13-19https://doi.org/10.1016/j.jen.2011.06.006
        • Francis M.
        • Rich T.
        • Williamson T.
        • Peterson D.
        Effect of an emergency department sepsis protocol on time to antibiotics in severe sepsis.
        CJEM. 2010; 12: 303-310https://doi.org/10.1017/S1481803500012380
        • Assunção M.
        • Akamine N.
        • Cardoso G.S.
        • Mello P.V.C.
        • Teles J.M.M.
        • Nunes A.L.B.
        • et al.
        Survey on physicians’ knowledge of sepsis: do they recognize it promptly?.
        J Crit Care. 2010; 25: 545-552https://doi.org/10.1016/j.crc.2010.03.012
        • Cowan S.L.
        • Holland J.A.A.
        • Frost I.
        • Kane A.
        Recognition and management of sepsis by junior doctors.
        Fut Hosp J. 2016; 3: 99-102https://doi.org/10.7861/futurehosp.3-2-99
        • Horvat L.
        • Fry M.
        • Fong J.
        • Plowes J.
        To explore the nursing assessment and initial management of septic patients in the emergency department.
        Australas Emerg Nurs J. 2011; 14: S17https://doi.org/10.1016/j.aenj.2011.09.043
        • Jeffery A.D.
        • Steffen Mutsch K.
        • Knapp L.
        Knowledge and recognition of SIRS and sepsis among pediatric nurses.
        Paediatr Nurs. 2014; 40: 271-278
        • Robson W.
        • Beavis S.
        • Spittle N.
        An audit of ward nurses’ knowledge of sepsis.
        Nurs Crit Care. 2007; 12: 86-92
        • Stamataki P.
        • Papazafiropoulou A.
        • Kalaitzi S.
        • Sarafis P.
        • Kagialari M.
        • Adamou E.
        • et al.
        Knowledge regarding assessment of sepsis among greek nurses.
        J Infect Prevent. 2014; 15: 58-63https://doi.org/10.1177/1757177413513816
        • van den Hengel L.C.
        • Visseren T.
        • Meima-Cramer P.E.
        • Rood P.P.M.
        • Schuit S.C.E.
        Knowledge about systemic inflammatory response syndrome and sepsis: a survey among Dutch emergency department nurses.
        Int J Emerg Med. 2016; 9: 19https://doi.org/10.1186/s12245-016-0119-2
        • Sungkar Y.
        • Considine J.
        • Hutchinson A.
        Implementation of guidelines for sepsis management in emergency departments: a systematic review.
        Australas Emerg Care. 2018; 21: 111-120https://doi.org/10.1016/j.auec.2018.10.003
        • Dellinger R.P.
        • Levy M.M.
        • Rhodes A.M.
        • Annane D.
        • Gerlach H.
        • Opal S.M.
        • et al.
        Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock 2012.
        Crit Care Med. 2013; 41: 580-637
      1. 19. Alberta Health Services. Suspected sepsis patient protocol ≥ 14 years of age (Protocol and screening tools for emergency nurses). Emergency Unit Manual. Emergency Unit Manual 2013. Edmonton, AB: Alberta Health Services.

        • Dillman D.A.
        • Smyth J.D.
        • Melani Christian L.
        Internet, mail, and mixed-mode surveys: the tailored design method.
        third ed. John Wiley & Sons, Inc., Hobeken, NJ2009
        • Hsieh H.-F.
        • Shannon S.E.
        Three approaches to qualitative content analysis.
        Qual Health Res. 2005; 15: 1277-1288https://doi.org/10.1177/1049732305276687
      2. 21. Mount Royal University. Advanced studies in critical care nursing (ACCN). 2015-16 Academic Calendar 2015: 104.

        • Delaney M.M.
        • Friedman M.I.
        • Dolansky M.A.
        • Fitzpatrick J.J.
        Impact of a sepsis educational program on nurse competence.
        J Cont Educ Nurs. 2015; 46: 179-186https://doi.org/10.3928/00220124-20150320-03
        • Bruce H.R.
        • Maiden J.
        • Fedullo P.F.
        • Kim S.C.
        Impact of nurse-initiated ED sepsis protocol on compliance with sepsis bundles, time to initial antibiotic administration, and in-hospital mortality.
        J Emerg Nurs. 2015; 41: 130-137https://doi.org/10.1016/j.jen.2014.12.007
        • Burney M.
        • Underwood J.
        • McEvoy S.
        • Nelson G.
        • Dzierba A.
        • Kauari V.
        • et al.
        Early detection and treatment of severe sepsis in the emergency department: identifying barriers to implementation of a protocol-based approach.
        J Emerg Nurs. 2012; 38: 512-517https://doi.org/10.1016/j.jen.2011.08.011
        • Reich E.N.
        • Then K.L.
        • Rankin J.A.
        Barriers to clinical practice guideline implementation for septic patients in the emergency department.
        J Emerg Nurs. 2018; 44: 552-562https://doi.org/10.1016/j.jen.2018.04.004
        • Damiani E.
        • Donati A.
        • Serafini G.
        • Rinaldi L.
        • Adrario E.
        • Pelaia P.
        • et al.
        Effect of performance improvement programs on compliance with sepsis bundles and mortality: a systematic review and meta-analysis of observational studies.
        PLoS ONE. 2015; : 10https://doi.org/10.1371/journal.pone.0125827
        • Tarrant C.
        • O’Donnell B.
        • Martin G.
        • Bion J.
        • Hunter A.
        • Rooney K.D.
        A complex endeavour: an ethnographic study of the implementation of the Sepsis Six clinical care bundle.
        Implement Sci. 2016; : 11https://doi.org/10.1186/s13012-016-0518-z
        • Romero B.
        • Fry M.
        • Roche M.
        The impact of evidence-based sepsis guidelines on emergency department clinical practice: a pre-post medical record audit.
        J Clin Nurs. 2017; 26: 3588-3596https://doi.org/10.1111/jocn.13728
        • Steinmo S.H.
        • Michie S.
        • Fuller C.
        • Stanley S.
        • Stapleton C.
        • Stone S.P.
        Bridging the gap between pragmatic intervention design and theory: using behavioural science tools to modify an existing quality improvement programme to implement “Sepsis Six”.
        Implementation Science. 2016; : 11https://doi.org/10.1186/s13012-016-0376-8
        • Tromp M.
        • Hulscher M.
        • Bleeker-Rovers C.P.
        • Peters L.
        • van den Berg D.T.N.A.
        • Borm G.F.
        • et al.
        The role of nurses in the recognition and treatment of patients with sepsis in the emergency department: a prospective before-and-after intervention study.
        Int J Nurs Stud. 2010; 47: 1464-1473https://doi.org/10.1016/j.ijnurstu.2010.04.007
        • Levett-Jones T.
        • Hoffman K.
        • Dempsey J.
        • Jeong S.Y.-S.
        • Noble D.
        • Norton C.A.
        • et al.
        The ‘five rights’ of clinical reasoning: an educational model to enhance nursing students’ ability to identify and manage clinically ‘at risk’ patients.
        Nurs Educ Today. 2010; 30: 515-520https://doi.org/10.1016/j.nedt.2009.10.020