School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, QLD, Australia.
Child Health Research Centre, The University of Queensland, and Paediatric Intensive Care Unit, Queensland Children's Hospital, QLD, Brisbane, Australia.
BMC Health Serv Res. 2021 Oct 26;21(1):1161. doi: 10.1186/s12913-021-07128-2.
Several health care systems internationally have implemented protocolised sepsis recognition and treatment bundles for children to improve outcomes, as recommended by the Surviving Sepsis Campaign. Successful implementation of clinical pathways is challenging and dependent on nurse engagement. There is limited data on knowledge translation during implementation of sepsis quality improvement programs.
This cross-sectional, multicentre observational survey study evaluated knowledge and perceptions of Emergency Department nurses in relation to the recognition, escalation and management of paediatric sepsis following implementation of a sepsis pathway. The study was conducted between September 2019 and March 2020 across 14 Emergency Departments in Queensland, Australia. The primary outcome was a sepsis knowledge score. An exploratory factor analysis was conducted to identify factors impacting nurses' perceptions of recognition, escalation and management of paediatric sepsis and their association with knowledge. Using a logistic mixed effects model we explored associations between knowledge, identified factors and other clinical, demographic and hospital site variables.
In total, 676 nurses responded to the survey and 534 were included in the analysis. The median knowledge score was 57.1% (IQR = 46.7-66.7), with considerable variation observed between sites. The exploratory factor analysis identified five factors contributing to paediatric sepsis recognition, escalation and management, categorised as 1) knowledge and beliefs, 2) social influences, 3) beliefs about capability and skills delivering treatment, 4) beliefs about capability and behaviour and 5) environmental context. Nurses reported strong agreement with statements measuring four of the five factors, responding lowest to the factor pertaining to capability and skills delivering treatment for paediatric sepsis. The factors knowledge and beliefs, capability and skills, and environmental context were positively associated with a higher knowledge score. Years of paediatric experience and dedicated nurse funding for the sepsis quality improvement initiative were also associated with a higher knowledge score.
Translation of evidence to practice such as successful implementation of a sepsis care bundle, relies on effective education of staff and sustained uptake of protocols in daily practice. Our survey findings identify key elements associated with enhanced knowledge including dedicated funding for hospitals to target paediatric sepsis quality improvement projects.
国际上有几个医疗保健系统已经实施了针对儿童的规范化败血症识别和治疗方案，以改善败血症的治疗效果，这是“拯救败血症运动”（Surviving Sepsis Campaign）的建议。成功实施临床路径具有挑战性，并且取决于护士的参与。在实施败血症质量改进计划期间，有关知识转化的相关数据有限。
本横断面、多中心观察性调查研究评估了澳大利亚昆士兰州 14 家急诊科的急诊护士在实施败血症途径后，对儿童败血症的识别、升级和管理的知识和看法。研究于 2019 年 9 月至 2020 年 3 月进行。主要结局是败血症知识评分。进行了探索性因素分析，以确定影响护士对儿童败血症识别、升级和管理的看法的因素，以及它们与知识的关联。使用逻辑混合效应模型，我们探讨了知识、确定的因素以及其他临床、人口统计学和医院地点变量之间的关联。
共有 676 名护士对调查做出了回应，其中 534 名被纳入分析。知识评分中位数为 57.1%（IQR=46.7-66.7），各医院之间存在显著差异。探索性因素分析确定了五个因素，可分为 1）知识和信念、2）社会影响、3）对提供治疗的能力和技能的信念、4）对能力和行为的信念、5）环境背景。护士对测量五个因素中的四个因素的陈述表示强烈同意，对与儿童败血症治疗相关的能力和技能的因素的回答最低。知识和信念、能力和技能以及环境背景这三个因素与较高的知识评分呈正相关。儿科经验年限和专门用于败血症质量改进计划的护士资金也与较高的知识评分相关。
将证据转化为实践，例如成功实施败血症护理方案，依赖于对员工进行有效的教育以及在日常实践中持续采用方案。我们的调查结果确定了与增强知识相关的关键要素，包括为医院提供专门资金以针对儿科败血症质量改进项目。
