Srour Maria, Ali Shamim, Hodge Matthew, Kwobah Charles, McHenry Megan, Etling Mary Ann, Nafiseh Amira, Khan Babar, Prohaska Clare C, Navuluri Neelima
Division of Pulmonary, Critical Care, Sleep, and Occupational Medicine, Indiana University School of Medicine, Indianapolis, USA.
Department of Medicine, Moi University, Eldoret, KEN.
Cureus. 2025 Feb 14;17(2):e78980. doi: 10.7759/cureus.78980. eCollection 2025 Feb.
Background and objectives Sepsis and septic shock are conditions of high mortality across the globe. Despite the efforts of the Surviving Sepsis Campaign, improvements in outcomes for patients with sepsis and septic shock have been mostly seen in high-income countries (HICs), leaving low- and middle-income countries (LMICs) to bear most of the global disease burden. This paper utilizes a socio-ecological model to describe the lived experiences of local healthcare workers treating sepsis and septic shock at a large referral hospital in Western Kenya. These perspectives shed light on barriers and strengths in care, gaps in knowledge, and areas of high-yield improvement. Materials and methods This is a descriptive analysis focused on providers caring for patients with sepsis and septic shock. Twenty-seven interviews with a wide variety of purposively sampled patient-facing and ancillary medical staff were performed. Concurrent thematic analysis took place as interviews were being conducted. The concept presented was inductively and deductively reasoned and analyzed using a socio-ecological framework. We chose to present three levels of influence on the individual provider. Results We present our results using a socio-ecological model. At the health system level, we found that most patients do not have healthcare coverage, which drives up out-of-pocket expenses for individuals. At the hospital level, capacity limits, particularly personnel shortages and small intensive care unit (ICU) spaces, influence care. At the interdisciplinary level, relationships between providers and other members of the healthcare team can present challenges. Lastly, these system-, hospital-, and interdisciplinary-level challenges make guideline adherence difficult and not always feasible for individual providers. Conclusions To our knowledge, this is the first study to give voice to local providers treating patients with sepsis at a referral center in Western Kenya. By presenting findings in the socio-ecological model, we are able to organize potential interventions for the improvement of care at various levels. We found high-yield areas for improving care including establishing clear protocols for task assignments and communication, increasing the number of trained personnel both in the general wards and in the ICU, and, on a broader scale, advocating for expanded healthcare coverage for all Kenyans. This work provides a framework for further investigation into elements of sepsis care and the creation of locally relevant treatment guidelines in sub-Saharan Africa and across LMICs.
背景与目标 脓毒症和脓毒性休克在全球范围内都是死亡率很高的病症。尽管开展了拯救脓毒症运动，但脓毒症和脓毒性休克患者的治疗效果改善主要见于高收入国家，低收入和中等收入国家承担了全球大部分疾病负担。本文运用社会生态模型来描述肯尼亚西部一家大型转诊医院中治疗脓毒症和脓毒性休克的当地医护人员的实际经历。这些观点揭示了护理中的障碍与优势、知识差距以及高收益改进领域。
材料与方法 这是一项描述性分析，重点关注护理脓毒症和脓毒性休克患者的医护人员。对经过目的抽样的各类面向患者的医护人员和辅助医务人员进行了27次访谈。在访谈过程中同步进行主题分析。所呈现的概念运用社会生态框架进行归纳、演绎推理和分析。我们选择呈现对个体医护人员的三个影响层面。
结果 我们运用社会生态模型展示结果。在卫生系统层面，我们发现大多数患者没有医保，这增加了个人的自付费用。在医院层面，能力限制，尤其是人员短缺和重症监护病房空间狭小，影响了护理。在跨学科层面，医护人员与医疗团队其他成员之间的关系可能带来挑战。最后，这些系统层面、医院层面和跨学科层面的挑战使得个体医护人员难以遵循指南，且并不总是可行。
结论 据我们所知，这是第一项让肯尼亚西部转诊中心治疗脓毒症患者的当地医护人员发声的研究。通过在社会生态模型中呈现研究结果，我们能够梳理出在各个层面改善护理的潜在干预措施。我们发现了改善护理的高收益领域，包括制定明确的任务分配和沟通方案、增加普通病房和重症监护病房的训练有素人员数量，以及在更广泛层面倡导为所有肯尼亚人扩大医保覆盖范围。这项工作为进一步研究脓毒症护理要素以及在撒哈拉以南非洲和其他低收入和中等收入国家制定与当地相关的治疗指南提供了框架。
