factors hindering the early identification of adults with severe sepsis in the UK

There has been a continuous increase in the morbidity and mortality rates due to sepsis, such that the inability of the clinicians and nursing professionals to diagnose sepsis results in further deterioration in the clinical conditions of the adult patients. The early diagnosis of sepsis is beneficial for improving the health conditions of the adult inpatients. This research aims to identify the factors hindering the early identification of adults with severe sepsis in the UK. The literature to be included in this research was systematically searched by using electronic databases. Furthermore, specific presence and prohibiting measures were surveyed for extracting the most relevant study papers articles related to the research topic. (N=10) study papers were measured for this investigation, and the use of thematic examination conducted data analysis. The study results showed that the knowledge and awareness levels of nursing professionals and other clinicians play a considerable role in the sepsis diagnosis during the initial stages. Also, insufficient team audits, feedback, poor communication between team members, and concerns related to the utilization of resources for the diagnosis of sepsis were barriers to implementation of the protocols for diagnosing sepsis during the initial stages. This systematic review presented that healthcare organizations are required to focus on arranging training opportunities for clinicians and implement the contracts for the diagnosis of sepsis during the initial stages.

CHAPTER 1- INTRODUCTION

Introduction to Chapter 1

This essay aims to review the previously published literature related to factors which hinder the initial identification of sepsis in the adult inpatient surroundings. This research will assess and discuss the barriers to the early identification of sepsis in the adult inpatient setting. Furthermore, it will address the recurrent themes related to the impacts of information levels of the nursing experts in the identification of sepsis, as well as barriers towards effective implementation of protocols for identifying sepsis, and the effects of early identification of sepsis on the lifespan of adult inpatients.

Rationale

The evidence from previously published research articles revealed a continuous increase in the rates of mortality and morbidity because of sepsis (McPherson et al. 1). The previously published research articles mentioned that during some of the cases, the adult patients have already been suffering from sepsis at the time of hospital admission (Fernandes, Maria, and Isabel 73). However, the inability of the clinicians and nursing professionals to diagnose sepsis results in further deterioration in the clinical conditions of adult patients. In this regard, the early diagnosis of sepsis is beneficial for improving the health conditions of the adult inpatients. Early printed literature has acknowledged the obstructions to the early identification of sepsis amongst patients. However, there is a research gap related to barriers to early identification of sepsis concerning the knowledge of nurses and ineffective implementation of protocols of sepsis management. In this regard, this study contributes to assessing the impacts of acquaintance levels of nurses and the effective implementation of protocols in managing sepsis. Besides, this research will also provide to analyzing the effects of early diagnosis of sepsis on the health of patients.

Background to Research Topic

Sepsis, which is also recognized as septicemia and blood poisoning, refers to the life-threatening bloodstream infection, such that sepsis confirms the presence of infectious sources, including fungi, viruses, or bacteria in the blood. Immediate diagnosis and treatment of sepsis are crucial for the health and well-being of the patients. The cases in which the signs and clinical sepsis symptoms remain undiagnosed (Tazbir 205; Johnston and Knight 2). Furthermore, is results in deterioration in the function of internal body organs, including lungs, heart, kidneys, leading towards the complete failure of these body organs?

According to the study directed by (McPherson et al., 3) mentioned that analyzing from the context of the United Kingdom (UK), within the last two decades, one out of every twenty deaths in the UK was due to sepsis. Approximately 27% of all hospital admissions within the Wales and England are because of unembellished sepsis, such that nearly half of the patients admitted in the Intensive Care Unit (ICU) due to sepsis failed to survive for the most extended period (Johnston and Knight 2). The evidence reported that within the UK, the average cost of treatment of the patients with sepsis was approximately six times greater than the patients without sepsis. In addition, it was also found that despite increased expenditure on the treatment of sepsis patients, the rate of mortality was high among the individuals living with sepsis.

Analysing significant growth in the mortality rates of individuals due to sepsis, the Ongoing Sepsis Fight was launched as an international enterprise for improving existence and reducing the morbidity rate related to sepsis (Torsvik et al., 244).

This global initiative highlighted the role of healthcare professionals in managing care for the people living with sepsis, by focusing on the symptoms of sepsis and initiating the treatment response as early as possible. In the light of the available evidence, the nurses working in the emergency unit, and wad nurses are referred to as the critical position for the identification of sepsis and the risk of organ failure (Johnston and Knight 4). Despite the strategies taken for the diagnosis of sepsis at the initial stages, the rate of morbidity and mortality of the adult inpatients due to late diagnosis has been highlighted by the researches. In this regard, there is further required to recognize the primary identification of sepsis on the health outcomes of the adult inpatients.

Research Question

This research aims to answer the following research question.

What factors hinder the early identification of sepsis in adult inpatient settings?

The research question for this research was formulated by using the PICO framework, such that the PICO framework explains Population, Intervention, Comparison, and Outcome. For this research, the population was adult sepsis inpatients, the intervention was early sepsis diagnosis, and outcomes were barriers to identification of sepsis in initial stages. There was no comparator about the research goals and objectives.

Research Aims and Objectives

This study targets to identify the factors hindering the early identification of adults with severe sepsis in the UK. The objectives are as follows

• To determine the impacts of knowledge of nurses to early identification for adults with severe sepsis in the UK.
• To assess the barriers to implementing standardized protocols of sepsis management in adult inpatient settings.
• To explore the impacts of early identification of sepsis on the survival rate of the adult inpatients.

Literature Search and Parameters

The literature examination for this research was conducted out by the use of electronic databases, such that the automated databases comprises of the up to current literature associated with the study issue. The following electronic catalogs were used as information foundations for this study.

• PubMed
• Medline
• CINAHL

EBSCO host.

Search Terms and Keywords

Despite considering the specific enclosure and exclusion measures, the literature search was explicit. For this reason, the keywords or examination expressions were sued for examining relevant literature for further refining the literature search process. The search terms or keywords for this research included ‘sepsis,’ ‘sepsis in adult patients,” sepsis in inpatients,’ ‘early identification of sepsis,” obstacles to sepsis identification,’ and ‘factors preventing the diagnosis of sepsis.’

Findings and Results

The literature search for this research revealed approximately (N=125) pertinent research articles, such that after the removal of duplicate research articles (N=90), research articles were analyzed by the analysis. Additionally, various research articles were uninvolved after examining the summaries of the study articles and critically analyzing the research articles based on inclusion and exclusion criteria. Complete literature of (N=15) research articles was analyzed, resulting in the inclusion of approximately (N=10) most relevant researchers

Criteria for Including or Excluding Research Articles

The research articles measured for this study were selected based on specific enclosure and exclusion measures presented below

Enclosure Measures

It was ascertained that the study articles measured for this investigation were:

• Printed after 2010.
• Printed in English
• A primary study conducted worldwide.
• Dealing with sepsis among adult patients,

Also, the exclusion measures measured for this study ascertained that this investigation does not consider the studies which were:

• Published before 2010.
• Printed in different languages than English
• Secondary research or review
• Dealing with the conditions other than sepsis.

Critical Appraisal and Data Analysis

The severe assessment of the selected study papers was conducted using the checklist provided Critical Appraisal Skilled Programme (CASP) for critically analyzing the strengths and weaknesses of the considered research articles. The CASP tool is useful to ascertain the methodological quality, credibility, and validity of research findings (Refer to appendix C).

The study papers measured for this investigation will be analyzed by extracting themes from the considered research articles and carrying out the thematic examination. The thematic survey pays to converge the outcomes of the research articles carried out by the use of various organizational methods according to the objectives and aims and of the study.

CHAPTER 2- CRITICAL REVIEW OF LITERATURE

Introduction to Chapter 2

This chapter presented a critical review of the research articles dealing with the ambiguities associated with the late diagnosis of sepsis among the adult inpatients. The data extracted as a result of the literature search has been categorized into different themes, which are presented in this chapter. The topics included impacts of knowledge of nursing professionals on early sepsis identification, the implementation obstacles of standardized protocols for diagnosis and sepsis management, as well as the sepsis first identification impacts on the rate of survival of sepsis patients. Despite the presence of standardized protocols and a range of interventions for sepsis management, the price of morbidity and mortality due to sepsis is competitively high; therefore, these themes were considered to analyze possible obstructions to sepsis early diagnosis by the clinicians. These themes provided a detailed overview of the personal and professional factors, which hinder the ability of clinicians to carry out the diagnosis of sepsis during the initial stages.

Impacts of Knowledge of Nurses on Early Identification of Sepsis in Adult Inpatient Setting

Burney et al. demonstrated that due to sepsis, the mortality and morbidity rates have been increasing; therefore, various procedures for the diagnosis, management, and identification of sepsis have been introduced within the healthcare (512). This research mentioned that the early goal-focused treatment for the individuals living with sepsis had been declared as an effective therapy by the researchers; however, the healthcare professionals have been not practicing this therapeutic approach. This research intended to classify and assess the specific obstacles related to the sepsis treatment initiatives, by evaluating the knowledge, behaviors, and attitudes of nurses while dealing with the sepsis patients. The research had described the research aims, which is the inherent strength of this research. A clear demonstration related to the research aims provides a clear reflection of the research process (Doody and Bailey 4).

This research was directed using the cross-sectional study design for gaining the knowledge levels of staff nurses and physicians related to sepsis management. The cross-sectional research design is most appropriate in assessing the outcomes and exposure in the research participation simultaneously (Setia 261).

Burney et al. collected data by conducting an online survey, such that the study was conducted by using the questionnaire consisting of approximately fourteen items for nursing professionals and thirteen items for the doctors, such that eight problems were similar in both inquiries (515).

The survey questionnaire was valid to examine the standard information as well as personal-reported assurance between the healthcare professionals in identifying the symptoms of sepsis, current practices related to the treatment of sepsis, and potential difficulties in managing sepsis patients. Also, the questionnaire survey assessed the perceived implementation obstacles of the medical pathways and recommendations related to the development of sepsis treatment. The survey research contributes to collecting and evaluating data collected from several research participants at a time, providing to managing a range of data from the research participants (Ponto 168).