Sepsis assessment and management in critically Ill adults: A systematic review

Abstract

Background Early assessment and management of patients with sepsis can significantly reduce its high mortality rates and improve patient outcomes and quality of life. Objectives The purposes of this review are to: (1) explore nurses’ knowledge, attitude, practice, and perceived barriers and facilitators related to early recognition and management of sepsis, (2) explore different interventions directed at nurses to improve sepsis management. Methods A systematic review method according to the PRISMA guidelines was used. An electronic search was conducted in March 2021 on several databases using combinations of keywords. Two researchers independently selected and screened the articles according to the eligibility criteria. Results Nurses reported an adequate of knowledge in certain areas of sepsis assessment and management in critically ill adult patients. Also, nurses’ attitudes toward sepsis assessment and management were positive in general, but they reported some misconceptions regarding antibiotic use for patients with sepsis, and that sepsis was inevitable for critically ill adult patients. Furthermore, nurses reported they either were not well-prepared or confident enough to effectively recognize and promptly manage sepsis. Also, there are different kinds of nurses’ perceived barriers and facilitators related to sepsis assessment and management: nurse, patient, physician, and system-related. There are different interventions directed at nurses to help in improving nurses’ knowledge, attitudes, and practice of sepsis assessment and management. These interventions include education sessions, simulation, decision support or screening tools for sepsis, and evidence-based treatment protocols/guidelines. Discussion Our findings could help hospital managers in developing continuous education and staff development training programs on assessing and managing sepsis in critical care patients. Conclusion Nurses have poor to good knowledge, practices, and attitudes toward sepsis as well as report many barriers related to sepsis management in adult critically ill patients. Despite all education interventions, no study has collectively targeted critical care nurses’ knowledge, attitudes, and practice of sepsis management.

Nurses’ knowledge, attitudes, practice, and decision-making skills related to sepsis assessment and management

“…A second factor may be attributed to the inadequate ongoing training and staff development workshops for naïve nurses on sepsis management [3,33]. Also, a wide variety of perceived barriers related to sepsis assessment and management are prevalent among critical care nurses [29]. These barriers include a lack of awareness of antibiotic use and a knowledge deficit regarding evidence-based protocols for sepsis management [29].…”

“…Also, a wide variety of perceived barriers related to sepsis assessment and management are prevalent among critical care nurses [29]. These barriers include a lack of awareness of antibiotic use and a knowledge deficit regarding evidence-based protocols for sepsis management [29]. These barriers were found to impede the ability of nurses to assess and promptly manage sepsis in critical care patients effectively.…”

“…These barriers were found to impede the ability of nurses to assess and promptly manage sepsis in critical care patients effectively. Moreover, the lack of an evidence-based sepsis protocol implementation and hesitancy to prescribe strong antibiotics complicates the sepsis practice [29].…”

“…Furthermore, the information mentioned in the sepsis vignette is multidimensional and needs multicomponent interventions. The complexity of sepsis assessment and management, as highlighted in the vignette, led the participating nurses to integrate their theoretical and practical knowledge in a long and complex process of analysis and synthesis until the treatment decision was achieved [29].…”

“…He was drowsy with unstable vital signs as follows respiratory rate of 30, partial pressure of oxygen equal to 88% on three liters per minute by nasal cannula, blood pressure of 90/64, and body temperature of 35 o C. His urine output was 25-30 ml per hour for the past four hours. The researchers of the present study developed the vignette after reviewing the literature on sepsis assessment and management [29]. A panel of two nursing scholars holding PhD degrees and having extensive clinical experience in sepsis management reviewed the vignette for clarity, readability, and relevance.…”