Improving the Ability to Identify Early Sepsis Signs

Improving the Ability to Identify Early Sepsis Signs

This research work attempts to highlight the author’s learning requirement to improve the ability to identify the early signs of sepsis to escalate a deteriorating patient promptly. The learning need is based on experience within the clinical practice. Subsequently, there will be a critical analysis of two pieces of literature on interventions to handle the author’s learning needs. The critical review will examine the reliability and validity of the two pieces of literature. Consequently, the two works of literature’s findings will be compared and contrasted with those of other researchers on the topic. Besides, there will be a discussion of the relevance of the author’s findings on clinical practice. The essence of analysing the literature from Australia and Norway is to offer a gauge of clinical practice in the UK against that of similar nations. The utilisation of Rolf et al. (2011) reflective model will enhance the author’s reflection based on the clinical experience as well as research findings. The essence of the reflection is to advance the clinical practice of the author through CPPD (Continuing Personal and Professional Development). More so, the reflection will help to improve the capacity of other HCPs (Healthcare Professionals) across the patient care.

My incompetence to timely identify early sepsis signs became evident during one of my clinical encounters in the third year of the nursing programme. The ineptness was apparent across one disappointing week when I was working with a senior triage nurse. The elderly patient had peritoneum bleeding. Thus, we took him immediately to surgery. On the third post-operative day, the patient’s urine output was 20 cc per hour for four hours lapse. Based on the outcomes, I recommended an antibiotic treatment, which we carried out immediately (Johansen & Naber, 2015). During the fifth post-operative day, the patient’s analysis indicated inadequate tissue perfusion, lower cardiac output, and increased hypotension. However, we mistakenly diagnosed the patient with severe flu (Marik, 2014).On the sixth postoperative day, we diagnose the patient’s symptoms for hypothermia; common signs during sepsis’s hyperdynamic phase (Arwyn-Jones & Brent, 2019). Due to the late recognition of sepsis, we offered myocardial support and afterload reduction (Mladenova, Aptula, Yordanova & Georgieva, 2017). During the seventh postoperative day, the patient exhibited septic shock complications, which included hepatic and renal failure. He died moments later.

Generally, Sepsis is a medical condition caused by bacteria or their toxin in the tissues or blood (Alqahtani et al. 2016). Eggimann, Que, & Rebeaud (2019) define sepsis as a toxic syndrome featuring dysregulated host reaction towards a disease, thus resulting in severe organ morbidities. An inadequate biomarker is a significant challenge for nurses during the recognition of sepsis. For illustration, the body temperature, as well as the WBC “White Blood Cell” count, can be misleading. The WBC usually fluctuates from the standard value, while other infections may cause the body temperature to increase (Okeke & Uzonna, 2016).  According to Rothman et al. (2017), another major challenge is the SIRS “Systemic Inflammatory Response Syndrome” standard, which has been essential in sepsis definition, is nonspecific hence limiting its use as a diagnostic indicator. More so, a manifestation of diverse sepsis is another challenge that blur’s nurses’ capacity to diagnose the condition earlier (Huang & Cai, 2019).

Reflecting on the incidence, I realize that my inability to timely identify sepsis symptoms led to poor patient outcomes as well as the corresponding unfortunate demise (Burke, Wood, Hermon, & Szakmany, 2019). Thus, progressing on, I will utilise Rolf’s model to reflect on the occurrence and advance my capacity to recognise sepsis signs timely.

Progressing on with the critical analysis, Torsvik et al. (2016) implemented a multifaceted intervention bundle in one Mid-Norway vulnerable area between January and October 2011. The intervention comprised a flow chart for sepsis recognition, therapy and doctor reaction time as well as SOF-Triage (SIRS and Organ Failure Triage). Both the SOFA scores and χ2 tests were utilised for data analysis. The authors identified that the post-intervention participants (n=409) had higher and better chances of overcoming within 30 days period than the (n=472) set. However, the authors concluded that early identification of sepsis promoted patients’ survival rates in the hospital. Eldh et al. (2017) maintain that intervention studies bolster implementation science, which is a systematic research of methods to promote the utilisation of research findings. Nevertheless, the research methodology is constrained by challenges in implementing the participants’ inputs, uncooperative correspondents together with the dual role of the researcher (Park, Usher,& Foster, 2014). Notwithstanding the challenges, having a SOFA score (score >2) and χ2 test score (p ≤ 0.002) suggest the efficacy of research findings (Lambden, Laterre, Levy, & Francois, 2019; Bihade, 2019). Torsvik et al. (2016) study have an adequate sample size implying that the findings can be generalised (Vasileiou, BarnettThorpe,& Young, 2018).

Secondly, Harley et al. (2019) used semi-structured interviews to collect the Emergency Department nurses’ perception and experiences in identifying and handling sepsis patients in Australia. For an exploration of the transcripts, content analysis tools were thematic and consensus-based methods. Semi-structured interviews use a mixture of open-and close-ended queries that prompt the participants to express their opinions adequately (Adams, 2015). The thematic and consensus-based content analysis combines the quantitative and qualitative techniques to outstanding text patterns (Armborst, 2017). Harley et al. (2019) claim that the facts tapped from the study is relevant in designing an academic package for nursing training for realisation of better patients’ outcomes. Harley et al. (2019) justify their use of the ATS (Australasian Triage Scale), claiming that it offers persistent standards for optimising patient time as they wait for the care in the ED. The use of a sample size of 14 RNs suggests a potential error of generalising the findings (Gentles, Charles, Ploeg,& McKibbon, 2015). The major weakness of the study was the utilisation of retrospective interviews, which might have interrupted the care delivery (Kim, 2017). Despite the challenges, exploration of the participants’ perceptions and experiences within their hospital environment adds to the research strengths, implying that the findings are authentic and reliable (Mitchell, 2015).

Nevertheless, the above study findings are from non-UK researches. Therefore, they may not be relevant to the scholar due to contextual differences (Matsumoto & Hwang, 2017). However, the findings highlight the relevance of capacity building training programmes in handling the author’s learning need to possess the expert ability to timely recognise sepsis symptoms among patients.

The findings from Torsvik et al. (2016) and Harley et al. (2019) studies correspond with the findings made by Kleinpell (2017). Kleinpell (2017) highlights the relevance of nurse-oriented sepsis procedure, which resulted in better assessment of serum lactate, evaluation of blood culture and, estimation of median time to start administration of antibiotics. Covering 472 patients across a two-year post-intervention period, 409 patients exhibited higher chances of surviving thirty days, had CI (Confidence Interval) of 95% and lower possibility of registering severe morbidity.

Hovlid et al. (2017) used a quasi-experimental study to determine the influence of inspections on healthcare facilities’ capacity to offer ideal sepsis care. The scholars utilised linear and logistic regression models to evaluate various assessments between the control period and measurements. The scholars identified that a facility’s capacity to implement change is key to the advancement of nurses’ ability to distinguish and timely handle sepsis. The most significant strength of the study is the innovative combination of both qualitative and quantitative data (Brannen, 2017; Bryman, 2017).

Through the use of exploratory, cohort, clinical, multicentre, and prospective observational study, Datta et al. (2017) used flow cytometry to evaluate the circulating biomarker profiles through cross-cohort comparison. The analysis and recruitment plans enabled reliable biomarker predictions where further validation of the markers can facilitate to early sepsis detections. The most notable strength of the study is the evaluation of leucocyte surface markers, which is an ideal approach for a prognostic study (Winkler et al., 2017; Morris et al., 2018).

Similar to the study findings, Fung et al. (2019) identified that the early identification of sepsis among sick children is crucial for ideal care. The scholars examined documents on global policies and conducted a systematic literature review, where incorporating 72 candidate analyst variables. A 26 expert’s led modified Delphi process was utilised. The experts were prompted to suggest other variables on three aspects, which are: measurement reliability, training level, and predictive capacity. The study results are reliable due to the use of the two-round version of the Delphi process, which is appropriate for consensus-building and withdrawal of direct interruption (Humphrey-Murto et al., 2019; Arias-Casais et al., 2019).

However, Nucera et al. (2018) investigated the perceptions and knowledge in sepsis management among the physicians and nurses in Milano Hospital, Italy. The quasi and cross-sectional study included professionals from both the ICU and non-ED wards. The participants’ t-tests and Chi-square were utilised, where p < 0.05 was arithmetically significant value (Sharpe, 2015; Koletsi & Pandis, 2016). The study findings indicated that expert knowledge levels and early sepsis identification are ideal for better patient care. However, the authors recommend education training and the adoption of proper sepsis guidelines for exceptional sepsis management (Nucera et al., 2018).

Likewise to Nucera et al. (2018), Goulart et al. (2019), a Brazilian study indicated that nurses do not possess adequate knowledge, adequate identification, therapeutic skills, and proper sepsis management approaches. The scholars conducted descriptive research between July and August 2018, which included (n=30) participants. Although the study covered an unsatisfactory sample group for results generalisation (Boddy, 2016), the p-value (p=0.025) on nurses’ knowledge on the organic sepsis dysfunctions render the study outcomes reliable (Gelman, 2016). The authors recommend political, institutional, and professional incentives to execute a long-term academic programme as well as an enduring sepsis protocol (Goulart et al., 2019).

However, similarities in the findings from the above studies highlight the appropriateness of capacity-building training programmes towards addressing the learning needs of the author. Kim and Park (2019) maintain that early detection and adequate interventions promote the survival likelihood of sepsis patients. WHO (2018) identifies the need for the training programmes to enhance early detection and management of sepsis through effective leadership, capacity building as well as technical guidance. However, the educational programmes offer the nursing staff visual reminders to execute the care bundle, along with feedback and audit (The George Institute, 2019; CPSI, 2019).

Moreover, other studies highlight the relevance of capacity training programmes to enable early identification of sepsis for better patient outcomes, especially those with severe rates of the disease. Plata-Menchaca and Ferrer (2018) emphasise the need for academic programmes on procedural care for adequate shock resuscitation and early sepsis identification. Deep et al. (2019) claim that there is a need for a training toolkit to enable reliable recognition and monitoring of sepsis among affected children presented in Eds. Similarly, Nursing Times (2019) recognises the crucial need for improving the ED nurses’ capacity for sufficient early identification of sepsis.

PSM (2019) maintains that the training programme requires adequate hospital governance commitment, together with suitable administrative leadership for better results. Owing to the high mortality rate that corresponds to septic shock and severe sepsis, one of the most crucial elements for quality care is further training that elucidates on lactate meter calibration (Grover, Vacarelli, Williams, & Cabanas, 2019; Merkey, 2017). Lactate meters are measurement tools for assessing the entire body’s blood lactate relative to laboratory blood evaluation for patients with severe sepsis (Baig, Shahzad, Hussain, & Mian, 2017). More so, the tool offers an adequate measure of the severity of sepsis and guides the implementation of early treatment (Morris et al., 2017; Asati, Gupta, & Behera, 2018).

In contrast, Schorr et al. (2016) emphasise the essence of a multicentre programme for performance improvement for suitable early detection and treatment of patients with deteriorating sepsis. Such a plan helps to foster observance of resuscitation and sepsis care bundles, thus the minimised mortality rates among the patients (Damiani et al., 2015). The findings by Damiani et al. (2015) are reliable due to the use of random-effects models. Random-effects models help in the simulation and synthesis of sets of real data within the study (Bhuyan, 2019). However, the multicentre programmes should feature the use of electronic systems, which minimises triage-to-treatment time as well as diagnosis-to prescription time among the patients (Westphal et al., 2018; Amland & Hahn-Cover, 2014).

A pilot training programme across the UK covered 69 sepsis patients who received antibiotic treatment within 49 minutes. The adequate training programme comprised various elements such as an introductory video, learning sessions with CSO (Clinical Support Officer), actual blood culture sampling training as well as personal feedback to each expert (NHS 2019). Rather than reporting on training programmes, NHS England (2015) informs of CSAP (Cross-System Action Plan), which concentrates on preventable sepsis cases, improving awareness among physicians, promotion of sepsis diagnosis and treatment and, excellent standards consistency. However, NICE (2016) promotes the need for triage professionals to receive training on sepsis stratification strategies, local treatment protocols, and escalation pathways.

In contrast, Gallagher et al. (2019) emphasise training intervention, which consists: communication aid, department oriented sepsis procedure, and academic sessions. After the intervention, TTABx reduced to 1.7 p<0.001, thus the reliability of the approach. Similarly, Frankling, Yeung, Dark, and Gao (2016) inform on the training costs, which include: government funding, financial and industrial donations, as well as bequests from organisations and individuals. Other costs are such as prevention of the infection, aggressive and early management bundles as well as prevention of sepsis readmissions learning programmes (Posa & Arbor, 2019). Other essential elements of a successful sepsis identification training programme include video on nursing education, education on aspects of sepsis, follow up learning as well as miscellaneous instruction (CHA, 2018).

A study on the effectiveness of capacity building programme towards the promotion of early recognition of sepsis unearthed the relevance of such an approach in the reduction of mortality rates (Westphal& Lino, 2015). More so, the training programme reduces diagnosis time, promotes teamwork, raise motivation, and participation among team members, together with their satisfaction (Candel et al., 2018). Capacity building training approaches boost the usage of machine learning model, which enhances performance improvement (Masino et al., 2019). Besides, training programmes enhance the early isolation of vulnerable risk groups (Calvert et al., 2016; Bergeron et al., 2017).

In a study that characterised behavioural science approach, insufficient training was one of the significant challenges limiting realisation of ideal care (Roberts et al., 2017). However, implementation of a robust capacity building training programme requires massive resource investment such as finance and time (Schultz et al., 2017). Alongside the capacity building training programmes, there is a need for professional collaboration and motivation, as well as the provision of behavioural prompts (Tarrant et al., 2016; Brizuela et al., 2019). However, Raynovich and Duckworth (2019) inform that education programmes have not fully attained ideal standards, thus, the prevailing rampant missed assessments, recognition, and poor treatment of deteriorating sepsis patients. Therefore, there is a need for further investments to bolster the relevance of capacity building training methods.

Reflecting on the above research findings, I have noted, despite my commitment to advance my ability of early identification of sepsis, there is a dire need to engage in professional collaborations (Tedesco et al., 2017; Schell-Chaple & Lee, 2014). However, the roles and responsibilities of team members must be elaborate within the professional collaborations (Medalen & Thorp, 2019; MacMillan et al., 2019). The reflections apply to me since I grew in a society that fosters partnerships and teamwork. However, multimodal and multidisciplinary teams result in minimized sepsis mortality (Penoyer, Cheatham, & Inderwiesen, 2016; Picard, O’Donoghue, Young-Kershaw,& Russell, 2016).

Nevertheless, multidisciplinary teams are crucial to proper adherence to surviving sepsis campaign guidelines (Nates, Pereira, Neto,& Silva, 2017; Balamuth et al., 2017). Moreover, effective communication between receiving hospitals and ambulance services are crucial to optimised care (Fitzpatrick et al., 2014). However, the sepsis working team enhances proper education to junior nurses and doctors through teaching sessions and the use of posters (Adcroft, 2014). Across the multidisciplinary teams, early activation of SSRT enhances appropriate and timely care (Franco, Bansal, Mangi,& Festic, 2016). More so, as hospitals engage multidisciplinary teams, they adequately better communications between physicians and nurses, deliver adequate care and input from the patients’ caregivers (Sunderland, 2017).

Some of the attributes that bolster multidisciplinary team engagement are analytical, interpersonal, execution proficiency, information processing, and change capacity (Finegold & Notabartolo, 2019). Soukup et al. (2018) emphasise the need for firm multidisciplinary team leadership for better patient experiences and outcomes. The assertion implies that as a nursing student, I must develop passion, optimism sense, capacity to maintain relationships, excellent mentorship as well as crisis management proficiency (Scully, 2015; Adams, Djukic, Gregas, & Fryer, 2018). For instance, studies find a positive correlation between long-term utilisation effective leadership styles and the value of patient care (Sfantou et al., 2017; Lorber, Treven, & Mumel, 2016).

For effective progression as a nursing student and a professional, I will participate in both capacity building training programmes as well as up-tuning my skills for active multidisciplinary engagement. Moreover, I will commit myself to suppress qualities that limit the delivery of quality care. Additionally, I will foster my capacity to timely identify sepsis as well as its early treatment through collaborations with team members. The strategies will enhance skills-sharing as well as learning within the ever-challenging EDs. At the same time, I will improve my leadership skills to mentor others on an effective strategy for timely identification and management of sepsis, especially among the deteriorating patients.

In conclusion, through clinical experience reflection, the assignment has identified the learning need of the author. The learning need is to foster the capacity to early detection and monitoring of sepsis among the deteriorating patients. Besides, the research work entailed a critical analysis of two studies that feature the need for improved proficiency in identifying, diagnosing, and treating sepsis. More so, the research work includes a comparison of the two studies with other researches that evaluated the relevance of capacity building training programmes for effective attainment of the learner’s need. The similarities and differences of the other research findings have been explored through critical analysis. Through the critical reflection of the findings, the author identifies the need for multidisciplinary teams for the adequate realisation of the student’s need. However, the multidisciplinary teams must feature attributes such as proper leadership, effective communication, and collaboration between ambulance services and ED departments. Furthermore, the critical analysis explores the essential qualities for active multidisciplinary team engagement. The characteristics include passion, optimism sense, capacity to maintain relationships, excellent mentorship as well as crisis management proficiency. Furthermore, the emphasis is raised on the need to suppress the qualities that blur the effectiveness of multidisciplinary teams. Lastly, the relevance of long-term utilisation of effective leadership styles is emphasised for the better attainment of adequate sepsis patients’ outcomes.

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