Abstract
Introduction: Sepsis remains a leading cause of death worldwide [1], significantly because life-saving interventions require to be delivered
within a short period of time [2]. Evidence-based guidelines offer useful
information for the prompt recognition of sepsis. Guidelines provide
a common ground for clinical decision-making, irrespective of
one’s expertise [2]. However, the recognition of complex patients who
do not fit a specific disease definition and might benefit from treatment
remains unclear [2, 3]. This lack of understanding may hinder
educational efforts to improve recognition of sepsis and derive potential
benefits from advances in sepsis treatment.
Objectives: The aim of the study was to examine the lived experiences
of a group of nurses to understand what constitutes early recognition
of sepsis in a wide spectrum of clinical situations.
Methods: Semi-structured interviews were conducted with 26 nurses
with various levels of experience in caring for patients with sepsis
from different hospital settings, including intensive care, medical,
surgical, research, oncology, neurosurgery, sepsis and practice development
departments. The interviews were phenomenographically
analysed [4]. Findings were categorised according to the Cynefin
framework [5].
Results: The study identified several reasoning pathways that made
use of various sorts of knowledge, depending on the level of clinical
complexity. Nurses adopted reasoning based on protocol-based care when dealing with a clear disease pattern. However, the same
generalised approach was abandoned when exposed to complex
patients who do not fit a specific disease definition. Nurses
embraced personalised management of these patients, adapting
’recommended’ care based on each patient’s individual needs. In
protocol-based care, nurses made use of knowledge that is commonly
known. Whereas in complex contexts, the knowledge was
not fully known and had to be learned by monitoring the patient
individual response to intervention and evaluating whether a preset
target had been reached. Based on that knowledge, nurses
decided whether to keep or change the intervention according to
the patient individual needs.
Conclusion: Our findings suggest that sepsis is clearly a multidimensional
construct where ’one size does not fit all’. Therefore,
determining the correct forms of knowledge to define ‘best practice’
may be of limited value. Guidelines can serve as a principal Reference
document when exposed to a clear disease pattern that fits
a specific sepsis definition. Yet, individualised management needs
to be adopted as the basic principle of complex patient care. This
approach demands personnel and bedside expertise; however,
unless we learn to adopt the approach that is appropriate to the
level of complexity, significant improvements in sepsis recognition
might not be seen.
within a short period of time [2]. Evidence-based guidelines offer useful
information for the prompt recognition of sepsis. Guidelines provide
a common ground for clinical decision-making, irrespective of
one’s expertise [2]. However, the recognition of complex patients who
do not fit a specific disease definition and might benefit from treatment
remains unclear [2, 3]. This lack of understanding may hinder
educational efforts to improve recognition of sepsis and derive potential
benefits from advances in sepsis treatment.
Objectives: The aim of the study was to examine the lived experiences
of a group of nurses to understand what constitutes early recognition
of sepsis in a wide spectrum of clinical situations.
Methods: Semi-structured interviews were conducted with 26 nurses
with various levels of experience in caring for patients with sepsis
from different hospital settings, including intensive care, medical,
surgical, research, oncology, neurosurgery, sepsis and practice development
departments. The interviews were phenomenographically
analysed [4]. Findings were categorised according to the Cynefin
framework [5].
Results: The study identified several reasoning pathways that made
use of various sorts of knowledge, depending on the level of clinical
complexity. Nurses adopted reasoning based on protocol-based care when dealing with a clear disease pattern. However, the same
generalised approach was abandoned when exposed to complex
patients who do not fit a specific disease definition. Nurses
embraced personalised management of these patients, adapting
’recommended’ care based on each patient’s individual needs. In
protocol-based care, nurses made use of knowledge that is commonly
known. Whereas in complex contexts, the knowledge was
not fully known and had to be learned by monitoring the patient
individual response to intervention and evaluating whether a preset
target had been reached. Based on that knowledge, nurses
decided whether to keep or change the intervention according to
the patient individual needs.
Conclusion: Our findings suggest that sepsis is clearly a multidimensional
construct where ’one size does not fit all’. Therefore,
determining the correct forms of knowledge to define ‘best practice’
may be of limited value. Guidelines can serve as a principal Reference
document when exposed to a clear disease pattern that fits
a specific sepsis definition. Yet, individualised management needs
to be adopted as the basic principle of complex patient care. This
approach demands personnel and bedside expertise; however,
unless we learn to adopt the approach that is appropriate to the
level of complexity, significant improvements in sepsis recognition
might not be seen.
| Original language | English |
|---|---|
| Pages | 268 |
| Number of pages | 1 |
| DOIs | |
| Publication status | Published - 19 Oct 2022 |
| Event | European Society of Intensive Care Medicine Annual Congress: ESICM LIVES 2022 - Palais des Congrès de Paris, Paris Duration: 23 Oct 2022 → 26 Oct 2022 https://www.esicm.org/events/35th-annual-congress/generalinfo/ |
Conference
| Conference | European Society of Intensive Care Medicine Annual Congress |
|---|---|
| City | Paris |
| Period | 23/10/22 → 26/10/22 |
| Internet address |