Dissertationen zum Thema „Sepers Nursery“

Bakgrund: Sepsis är vanligt förekommande inom sjukvården och många patienter blir svårt sjuka och dör i svår sepsis eller septisk chock. Det är ett tillstånd som anses föreligga vid infektion och minst två SIRS-kriterier. Symtomen kan vara diffusa och svåra att identifiera. Sjuksköterskan har en viktig roll att observera försämring för att så snabbt som möjligt identifiera en sannolik sepsis. Vid tidig diagnos och behandling minskar sjuklighet och dödlighet. Syfte: Att beskriva sjuksköterskans specifika omvårdnad av patienter med sepsis. Metod: En litteraturstudie baserad på tolv vetenskapliga artiklar publicerade mellan år 1998-2008. Resultat: Analysen resulterade i fyra huvudkategorier; bedömning, specifik omvårdnad, specifik omvårdnad genom akutteam och kunskap som redskap i omvårdnaden. Specifik omvårdnad kan leda till ett gynnsamt och snabbare omhändertagande av patienter med sepsis. Diskussion och slutsats: Det krävs ökad kunskap om omvårdnad vid sepsis. Med en bred kunskap om sepsis kan sjuksköterskan ge en säkrare och tryggare omvårdnad och minska lidandet för patienten och kostader för samhället.

Background:Sepsis is common within the health care and numerous patients become severely ill and die from severe sepsis or septic chock.Sepsis is acondition which is thought to occur at infection and at least two SIRS-criterions. The symptoms can be diffuse and difficult to identify. The nurse has an important role to observe deterioration in order to quickly as possible identify a probable sepsis. At an early diagnose and treatment the mortality and morbidity decreases. Purpose: To describe the nurse-specific care of patients with sepsis.Method: A literature study based on twelve scientific articles published between years 1998-2008. Result: The analysis resulted in four main categories;assessment, specific nursing,specific nursing by an emergency team and knowledge as a tool within nursing. Specific nursing can lead to a beneficial and faster treatment of patients with sepsis. Discussion and conclusion: It is necessary with an increased knowledge of nursing of sepsis. With a wide knowledge of sepsis the nurse is able to establish a more secure and safer nursing and ease the suffering for the patient and also decrease the costs for the society.

Sepsis causes major health care problems in the United States, resulting in long hospitalizations, complications, and even patient death. Lack of nursing knowledge regarding sepsis signs and symptoms is a significant problem at a hospital in the northeast. Local hospital data showed a high patient mortality rate for patients diagnosed with sepsis. The purpose of this project was to develop an educational module on sepsis for intensive care nurses. The educational module was developed using current sepsis evidence-based guidelines. The practice-focused question for the project asked whether an educational module on sepsis would increase the intensive care nurse's knowledge on sepsis recognition and treatment guidelines. The adult learning theory was used as a conceptual model to guide project development. After development, the educational module was evaluated by a panel of 8 experts, including a nurse educator, infection control nurse, a charge nurse, a staff nurse, and an infectious disease physician. Program content evaluations included a 10-question pretest/posttest questionnaire completed by each panel member. Program content was modified based on pretest/posttest results. Results of the panel evaluation indicated agreement that the sepsis module content would benefit nurses on sepsis recognition and management for patients. Improving nursing knowledge on sepsis can provide a positive social change to improve patient outcomes, including mortality rates and complications from sepsis.

Background Neonatal infection is an important cause of morbidity and mortality in babies. The causative pathogens and their antibiotic susceptibility patterns should be monitored so that treatment regimens can be adjusted to maintain efficacy and avoid selection of resistant organisms. Objectives To compare the incidence of culture positive neonatal sepsis; and to describe the pathogens and antibiotic resistance profiles for significant organsims over a 15-year period in a tertiary nursery in Cape Town. Methods Retrospective blood culture data for 12 months were collected at three time points over a 15-year period. Blood cultures from 2004, 2013 and 2017 were analysed. All neonates with growth on blood cultures were included. Results During 2004 a total of 817 (43.3% of total admissions) blood cultures were taken, 171 (9.1% of total admissions) were culture positive. The most common invasive organisms were Klebsiella pneumoniae (31.8% of invasive organisms), S.aureus (26.1%) and enterococcus species (7.3%). There were 102 contaminants (12.5% of total cultures) of which 7.8% were due to Coagulase-negative Staphylococcus (CONS). In 2013 a total of 1070 (46.8% of total admissions) blood cultures were taken, 124 (5.4% of total admissions) were culture positive. Common invasive organisms were Klebsiella pneumoniae (53.8% of invasive organisms), E. coli (12.8%) and S. aureus (10.3% ). Forty-six blood cultures were deemed contaminated (4.3% of all cultures) and of these 2.1% were due to CONS. In 2017, there were 581 blood cultures taken (26.5% of total admissions), 56 were culture positive (2.6% of total admissions). Commonly occuring invasive organisms were Klebsiella pneumoniae (32.4% of invasive organisms), Group B streptococcus (16.2%) and Acinetobacter (13.5%). Twenty-nine blood cultures were considered contaminated (5.6% of cultures) of which 1.7% were CONS. The gram-negative organisms showed an increasing resistance to penicillin, ampicillin and aminoglycosides but remained sensitive to carbapenems. Conclusions The initial reduction in positive blood cultures from 2004 to 2013 was primarily due to the reduction of contaminants, probably reflecting improved blood sampling techniques. The large reduction in Gram-negative organisms from 2013 to 2017 suggests improved infection control measures , but gram-negative organisms remained prominent in all three cohorts. Emergence of resistant organisms is concerning and in keeping with other nurseries worldwide. These data illustrate the need for antibiotic stewardship, infection control measures and ongoing surveillance.

Background: Sepsis is a condition that can result in death by failure or lack of treatment. Mortality has decreased over the past decade and thus is due to increased awareness and improved management of disease cases. Despite this decline, the death rate is still high and increased knowledge to detect and prevent sepsis in time is needed to reduce the suffering and serious complications. Aim: The aim is to illustrate nursing knowledge of the role in caring for patients with sepsis. Method: A literature review study based on an analysis of eight quantitative and two qualitative articles of research. Results: The result showed that nurses experienced that a lack of knowledge exists, long experience in nurses are valuable and that assessment tools can improve nurses' detection of sepsis. Nurses experienced detection of sepsis as a difficult, defiant and stressful task but it could facilitate trough teamwork. Conclusion Combination of knowledge and exertion of assessment tools improve the quality of care and reduce mortality. The result showed that experience and education among nurses are important for improving the competence to early identification of sepsis.
Sjukdomstillståndet sepsis är ett globalt folkhälsoproblem med högt dödsantal vilket skapar stort lidande. Sepsis framkallar ett stört systemiskt svar av immunförsvaret som utlöser livshotande symtom och ett snabbt utvecklande sjukdomsförlopp. Sjukdomen utvecklar en inflammation i hela kroppen oavsett om infektionen finns i blodet eller inte. Studiens syfte var att belysa sjuksköterskans erfarenheter av att vårda patienter med sepsis. Bristande kunskap påverkar omhändertagandet av patienter med sepsis som leder till förseningar och i värsta fall komplikationer. Sjuksköterskors erfarenheter var att kartläggning av sjukdomsförloppet är utmanande, tidsberoende och att stort ansvar läggs på deras axlar. Det framkom att det inte finns tillräcklig kunskap hos sjuksköterskor och att de inte känner trygghet i hur en patient med sepsis skall handläggas. Utbildning och erfarenhet lyftes fram som stärkande faktorer för att kompensera bristen på kunskap. Genom att utbilda sjuksköterskor om tidiga tecken på sepsis och passande omvårdnadsåtgärder kunde professionen stärkas i vårdandet av dessa patienter. Sjuksköterskans erfarenhet belystes och ansågs vara viktigt för teamarbetet med andra professioner och behandlingen av patienter med sepsis. Lång arbetserfarenhet bland sjuksköterskor kunde effektivisera vården, inge trygghet till kolleger och öka patientsäkerheten. Ett fåtal sjuksköterskor var medvetna om bedömningsverktyg och hur de skulle användas. Resultatet visar på att efter införande av bedömningsverktyg i vårdandet av patienter med sepsis förbättrades handläggningen, vården säkerställdes och dödligheten minskade. Bedömningsverktyg är viktigt för att ställa diagnos och likaså mätning av vitalparametrar. Användning av bedömningsverktygen resulterade i att sjuksköterskor lättare kom ihåg alla omvårdnadsåtgärder och att risken för missar minimerades. Sjuksköterskor upplevde stor arbetsbelastning i vårdandet av patienter med sepsis på grund av högt tempo, stort patientflöde och stressig arbetsmiljö. Patienter fick vänta länge på akutmottagningen innan de fick tillsyn och vårdprioritet som följd av sjuksköterskornas arbetsbelastning. Erfarenheterna var att de inte hade tillräckligt med tid för patienterna och att bedömningarna blev bristfälliga på grund av underbemanning. Det kan leda till komplikationer och ökad dödlighet för patienten vilket medförde att sjuksköterskor upplevde oro och stress. Sjuksköterskor bör ha tillräcklig kompetens att identifiera och handlägga patienter med sepsis då det ofta är de som först möter dessa patienter.

Sepsis is a severe blood stream infection that claim the lives of almost 220,000 Americans annually. Delayed patient treatment results in multi-organ failure, morbidity, mortality, and increased hospital length of stay. Timely sepsis management enables hospitals to have decreased expenses, increased patient survival, and judicious interventions. The problem addressed in this project was the lack of sepsis- training for registered nurses (RNs) working in the emergency department (ED) of a 628-bed hospital in the southeastern United States. Under the direction of the director of the ED, 269 patient charts were reviewed during 2014 to February 2015 for data related to a sepsis diagnosis. Data showed that 19.4% (n = 103) of patients diagnosed with sepsis had the sepsis order set implemented by the ED nurse. The purpose of this project was to create an educational sepsis-training program for ED nurses. The program included a 2-hour educational module on signs and symptoms of sepsis, including guidelines from the Surviving Sepsis Campaign and the Emergency Nurses' Association. Stetler's Model of Research Utilization and Benner's Novice to Expert conceptual frameworks supported the project. The director of professional practice provided formative feedback on module content and the program evaluation tool. Director feedback indicated that content was beneficial in educating ED nurses on the signs and symptoms of early sepsis recognition. The ED director has now mandated that all ED nurses take the training module and posttest. The project has the potential to improve early sepsis recognition by ED staff and to improve patient outcomes, thus promoting positive social change for patients, families, and nurses.

Bakgrund: Sepsis är ett livshotande tillstånd med hög dödlighet som drabbar 30 miljoner människor världen över och resulterar i omkring sex miljoner dödsfall årligen. Tecken och symtom är diffusa och det finns idag ett behov av utökad kunskap om sjuksköterskans omvårdnadsåtgärder vid sepsis. Syfte: Syftet var att beskriva sjuksköterskans omvårdnadsåtgärder för att upptäcka sepsis i ett tidigt skede. Metod: Studien genomfördes som en allmän litteraturstudie med inspiration av innehållsanalys där resultatet utgörs av 15 vetenskapliga artiklar. Resultat: Resultatet presenteras i kategorierna klinisk bedömning, kunskap och övervakning. I resultatet framgår det att sjuksköterskans förmåga att kombinera klinisk observation med ett standardiserat mätinstrument möjliggör en tidig upptäckt av sepsis. Det framgår även att sjuksköterskor som har uppdaterat sin kunskap om sepsis och dess progression genom fortbildning blev mer säkra på att upptäcka och identifiera patienter med sepsis. Sjuksköterskor kan även ta hjälp av datoriserade övervakningssystem, som larmar vid misstanke om sepsis. Konklusion: Varje enskild omvårdnadsåtgärd i resultatet kan bidra till att sepsis upptäcks tidigt, framförallt när implementering av mätinstrument, kunskap och utbildning kombineras kan dödligheten och lidandet för patienten minska. Det anses att ytterligare forskning är nödvändig kring sjuksköterskans omvårdnadsåtgärder för att tidigt upptäcka sepsis.
Background:Sepsis is a life-threatening condition that affects 30 million people worldwide and results in about six million deaths annually. Signs and symptoms are diffuse and today there is a need for increased knowledge of the nurse's nursing measures in case of sepsis. Aim:The purpose was to describe the nurse's nursing measures to detect sepsis at an early stage. Method:The study was conducted as a general literature study, inspired bycontent analysisand the result is based on 15scientific articles. Results:The result is presented in the categories clinical assessment, knowledgeand monitoring.Theresult shows that the nurse's ability to combine clinical observation with a standardized measuring instrument enables an early detection of sepsis. It also appears that nurses who have updated their knowledge of sepsis and its progression through continuing education became more confident in detecting and identifying patients with sepsis. Nurses can also use computerized monitoring systemsin nursing care, which alert in case of suspicion of sepsis.Conclusion:Every single nursing measure in the resultcan help to detect sepsis early, especially when combining measuring instruments, knowledge and education. Thiscan reduce mortality and suffering for the patient,butfurther research is necessary regarding the nursing care measures to detect sepsis early.

Bakgrund: Sepsis är ett kritiskt tillstånd och kan drabba alla individer. Sepsis är en vanlig orsak till morbiditet och mortalitet världen över. Snabb identifiering samt behandling är centrala delar för att lindra lidande samt att öka chansen för överlevnad. Syftet med denna litteraturstudie var att beskriva sjuksköterskors kliniska bedömningar och omvårdnadsåtgärder för att upptäcka och behandla sepsis. Metod: En litteraturstudie med deskriptiv design. Resultatet baseras på 12 vetenskapliga artiklar med kvantitativ och kvalitativ design. Artiklarna söktes via databasen Medline via Pubmed. Huvudresultat: Resultatet visade att sjuksköterskor kliniska bedömningar gällande symtom, kännetecken och riskfaktorer bidrog till en tidig upptäckt av sepsis. Bedömningsinstrument var bra hjälpmedel och provtagningar där bland annat blododling var av stor betydelse för identifiering av sepsis. Betydelsefulla omvårdnadsåtgärder var antibiotika, vätska och att patientens tillstånd övervakas för att tidigt kunna identifiera försämring. Slutsats: Denna litteraturöversikt visade att sjuksköterskors kliniska bedömningar och goda omvårdnadsåtgärder var till god grund för att upptäcka och behandla sepsis i tidigt skede. Detta för att bromsa sjukdomstillståndets utveckling samt förhindra mortalitet. Sjukdomstillståndet är diffust och vanligt förekommande inom sjukvården. Vidare forskning bör därför fokusera på att tydliggöra hur verksamheter inom vården ska kunna skapa riktlinjer gällande tidiga symtom och kännetecken och hur behandling ska hanteras.
Background: Sepsis is a critical condition and can effect affect any individual. Sepsis is a common causes of morbidity and mortality worldwide. Rapid identification and treatment are key elements in relieving suffering and increasing the chance of survival. Aim: To describe nurses clinical assessments and nursing measures to detect and treat sepsis. Method: A literature study with a descriptiv design. The results are based on 12 scientific articles with quantitative and qualitative approach. The articles were searched in the database medline via pubmed. Main Result: The results showed that the nurses clinical assessments regarding symtoms, characteristics and risk factors contributed to an early detection of sepsis. Assessment instruments were good aids and samples where, among other things, blood culture was of great importance for the identification of sepsis. Significant nursing measures where antibiotics, fluids and that the patients condition is monitored in order to be able to identify deterioration at an early stage. Conclusion: This literature review showed that nurses clinical assessments and good nursing interventions were a good basis for detecting and treating sepsis at an early stage. This is to slow down the development of the disease state and prevent mortality. The disease state is diffuse and common in healthcare. Further research should therefore focus on clarifying how healthcare activities should be able to create guidelines regarding early symtoms and characteristics and how treatment should be handled.

Bakgrund: Diagnosen sepsis drabbar 48,9 miljoner människor i världen varje år och svår sepsis är den 10:e vanligaste dödsorsaken i världen. Varje år dör 15-20 % av de 40,000 människor som drabbas i Sverige. Sepsis Surviving Campaign (SSC) har tagit fram riktlinjer som handlar om att screena sepsis och att detta ska minska mortaliteten och förbättra prognosen för patienten. Sjuksköterskan har ansvar för att ge en god omvårdnad och har en viktig roll vid bedömning av sepsis. Det finns svårigheter och brister i att identifiera och bedöma diagnosen sepsis vilket resulterar i fördröjning av att snabbt kunna initiera behandlingsåtgärder.    Syfte: Syftet med denna studie var att undersöka sjuksköterskans erfarenheter av att identifiera och bedöma sepsis hos vuxna patienter inom sjukhusvård.     Metod: Studien genomfördes som en litteraturöversikt baserat på 15 vetenskapliga artiklar från databaserna CINAHL, PubMed och Scopus. Artiklarna hade kvalitativ och kvantitativ design.    Resultat: Resultatet presenteras i tre olika kategorier: erfarenheter kring den egna kunskapen, erfarenheter kring faktorer som påverkar identifiering och bedömning, erfarenheter att använda bedömningsinstrument.    Slutsats: Slutsatsen av denna litteraturöversikt visade att sjuksköterskan upplever att det finns brister och svårigheter att identifiera och bedöma sepsis. Sjuksköterskornas erfarenhet och kunskaper skiljer sig åt och resultatet tyder på att mer utbildning krävs för att kunna ge en säkrare vård. Ett bedömningsinstrument kan hjälpa sjuksköterskor att bedöma och identifiera patienter med misstänkt sepsis i ett tidigt stadium.
Background: Diagnosing sepsis affects 48.9 million people in the world every year and severe sepsis is the 10th most common cause of death in the world. Each year, 15-20 % of the 40,000 people diagnosed with sepsis die in Sweden. The Sepsis Surviving Campaign (SSC) has developed guidelines on screening for sepsis and that this will reduce deaths and improve prognosis for patients. The nurse is responsible for providing good nursing care and has an important role in the assessment of sepsis. There are difficulties and shortcomings in identifying and assessing sepsis diagnosis which result in a delay of being in treatment initiation.    Aim: The aim of this literature review was to investigate the nurses' experiences of identifying and assessing sepsis in adult patients in hospital care.    Method: The study was conducted as a literature review based on 15 scientific articles from the databases CINAHL, PubMed and Scopus. The articles are of qualitative and quantitative method.     Results: The results are presented in three different categories, which are experiences about their own knowledge, experiences regarding factors that identify and assessment, the experiences of using assessment instruments.    Conclusion: The conclusion of this literature review showed that the nurse feels that there are shortcomings and difficulties in identifying and assessing sepsis. Nurses experience and skills differ and the results indicates that more education is required to provide a more secure care. An assessment tool can help nurses assess and identify patients with suspected sepsis at an early stage.

Sepsis är ett tidskritiskt tillstånd med hög mortalitet om det inte identifieras i tid. På en akutmottagning är det sjuksköterskor som är den yrkesgrupp som ofta i första skedet möter patienter med sepsis. Författarna ser det intressant att studera hur sjuksköterskorna ser på sin erfarenhet av att identifiera denna patientgrupp. Litteraturen stödjer att oerfarna läkare och sjuksköterskor på akutmottagningar inte identifierar patienter med sepsis inom rimliga tidsramar. Syftet med denna intervjustudie var att beskriva sjuksköterskors erfarenheter av att identifiera patienter med en misstänkt sepsis på en akutmottagning. Metoden som användes var av kvalitativ deskriptiv design. Intervjuerna genomfördes i form av två fokusgrupper, grupperna bestod av tre sjuksköterskor i varje grupp och samtliga hade minst tre års klinisk erfarenhet av att arbeta på en akutmottagning. Materialet som transkriberades har sedan analyserats med hjälp av en innehållsanalys enligt Graneheim och Lundman (2004). Intervjuerna genomfördes under januari månad 2016. Resultatet visade att samtliga sjuksköterskor beskrev att ökad kunskap om sepsis och dess behandling skulle leda till att sjuksköterskorna på akutmottagningen tidigare identifierade patienter med sepsis. I resultat framkom även att sjuksköterskorna ansåg att pga. hög arbetsbelastning på akutmottagningen försvårades identifieringen av patienter med sepsis.   Slutsatser som kan dras av resultatet är, för att kunna identifiera en patient med sepsis bör sjuksköterskor på en akutmottagning inneha goda kunskaper och yrkeserfarenheter av att vårda patienter med sepsis, då detta är ett tidkritiskt tillstånd.
Sepsis is a time critical condition with a high mortality rate if not detected in time. In the emergency setting, nurses are most often the first healthcare professionals in line to attend to patients presenting with signs of sepsis in the primary stages of their visit to the emergency department. The authors were therefore interested in studying how nurses perceive their experience of identifying this patient population. The literature supports that inexperienced doctors and nurses in the emergency department (ED) do not identify patients with sepsis within reasonable time-frames. The purpose of this study was to describe nurses experience of identifying patients with suspected sepsis in the emergency department. The method used was qualitative descriptive design. The interviews were carried out using two focus groups with three participants in each group. All participants were nurses with least three years experience working in the emergency department. The transcribed material was then analyzed using Graneheim and Lundman (2004) model of content analysis. The interviews were carried out in January 2016. The results showed that all participants agreed that increased knowledge of sepsis and its treatment would promote the early identification of patients with sepsis attending the ED. The results also revealed that the nurses felt that overcrowding in the ED was a factor in delaying the early identification of patients with sepsis. Conclusions to be drawn from the results of this study are that nurses require a strong knowledge and clinical experience of caring for patients with sepsis in order to early identify this time critical condition in patients attending the ED.

Många patienter anländer till akutmottagningen med tecken på sepsis. Andra försämras under tiden de ligger på avdelning av samma orsak. Sepsis är ett allvarligt tillstånd i behov av omedelbar behandling och ofta svårt att identifiera. Internationella och nationella riktlinjer består av tidskritiska åtgärder men riktar sig mot den medicinska behandling läkare ska utföra trots att sjuksköterskor ofta är de som först kommer i kontakt med patienten, både på akutmottagningen och på avdelningen. Sjuksköterskans roll är knapphändigt undersökt i forskningen.   Syftet med studien var därför att belysa sjuksköterskors upplevelser av att identifiera och omhänderta patienter med misstänkt sepsis.   Metoden var induktiv, genom 12 semistrukturerade intervjuer med sjuksköterskor på en akutmottagning och på en generell medicinavdelning och det erhållna materialet analyserades sedan med hjälp av kvalitativ innehållsanalys.   Resultatet visade att sjuksköterskor ser sig som ansvariga för att identifiera patienter med sepsis och som de som utför större delen av de åtgärder som är nödvändiga för snabb behandling. Vidare uttryckte sjuksköterskorna att denna process flyter bra fram till ordinationen av antibiotika där dröjsmål ofta uppstår. Ett annat problem som identifierades var de resurser som behövs för den kontinuerliga övervakning septiska patienter är i behov av.   Slutsatsen var att riktlinjer bör rikta sig mot all involverad personal med tanke på den stora roll sjuksköterskor förefaller ha för utförande av vården. Metoder för att uppnå god övervakning bör undersökas.
A lot of patients arrives at the emergency department with signs of sepsis. Some deteriorate while being in a ward for the same reason. Sepsis is a serious condition that needs immediate treatment and is often hard to identify. International and national guidelines include timecritical actions but they are directed towards the medical treatment delivered by doctors despite the fact that nurses often are the ones that first get in contact with the patient, both at the emergency department and in the ward. The role of the nurse is briefly explored in research. The aim of this study was therefore to illustrate the experiences of nurses involved in identifying and caring for patients with suspected sepsis. The method used was inductive, through 12 semistructured interviews with nurses at an emergency department and in a general medical ward and the data retrieved was then analyzed using qualitative data analysis. The result showed that nurses see themselves as having responsibility for the identification of patients suffering from sepsis and as being the ones who perform the majority of actions necessary for their timely treatment. Furthermore, they expressed that the process runs smoothtly until the point of ordering antibiotics where a delay often occurs. Another problem identified was the resources necessary for the continious monitoring that septic patients need. In conclusion, guidelines should be directed towards all of the personell involved, based on the big role nurses seem to have for the delivery of care. Ways to achieve good monitoring should be explored.

Bakgrund: Sepsis är ett akut sjukdomstillstånd med varierande symtom och är därför svårt att upptäcka. Tillståndet innebär lidande för patienten och mortaliteten bland drabbade är hög. Snabb identifiering och behandling är av betydelse för patientens hälsa och överlevnad. Sjuksköterskan har ansvar för omvårdnaden, såväl för beroende som oberoende omvårdnadsåtgärder. För att möjliggöra god och säker vård ska sjuksköterskan arbeta förebyggande med patientsäkerhetsarbete. Syfte: Syftet var att undersöka faktorer i sjuksköterskans arbete som är viktiga för att tidigt upptäcka och behandla patienter med sepsis. Metod: Artiklar med kvantitativ design har sammanställts till en litteraturöversikt och analyserats med deduktiv ansats. I urval och datainsamling har Polit och Becks niostegsmodell används och totalt gick 11 artiklar vidare från kvalitetsgranskning till resultat. Resultat: Tre faktorer hittades; Utbildning, screeningverktyg samt riktlinjer för behandling vid sepsis. Utbildning ledde till ökad kunskap och ökade sjuksköterskans förmåga att identifiera sepsis. Vid användning av riktlinjer ökade följsamheten till behandlingsåtgärder och tiden till behandling minskade. Screeningverktyg och riktlinjer för behandling minskade mortaliteten. Slutsats: Sjuksköterskans är central i arbetet för tidig upptäckt och behandling, då sjuksköterskan screenade patienter för sepsis, initierade till och utförde behandlingsåtgärder. För att säker vård ska möjliggöras vid sepsis krävs såväl kunskap, screeningverktyg samt riktlinjer för behandling.
Background: Sepsis is a critical condition with varying symptoms that makes it difficult to detect. The mortality is high and the condition causes the patient suffering. Early identification and rapid treatment is important for the patient's health and survival. The nurse is responsible for nursing care, both independent interventions and ordered by physicians.  The nurse needs to work preventing regards patients and providers safety to provide good care. Aim: To survey factors for early detection and treatment in the nurse's work with patients having sepsis. Method:  A literature overview with quantitative articles and a deductive approach. For selection and collection of data Polit and Becks nine-way model was used. A total of 11 articles was quality reviewed and included to the result.  Results: Three factors were found; Education, screening tools and guidelines for treatment of sepsis. Education led to increased knowledge and increased the nurse's ability to identify sepsis. When using guidelines, adherence to treatment measures increased and time to treatment decreased. Furthermore, screening tools and treatment guidelines were found to reduce mortality. Conclusion: The nurse is central in the work of early detection and treatment. The nurse screened patients for sepsis, initiated and fulfilled treatment measures. Knowledge, screening tools and guidelines for treatment are required to enable safe care in the case of sepsis.

ABSTRAKT   Hermodsson V och Jeppsson R. Sjuksköterskans möjligheter och begränsningar för att upptäcka sepsis hos vuxna patienter. En litteraturstudie. Examensarbete i omvårdnad 15hp. Malmö universitet: Fakulteten för hälsa och samhälle, institutionen för vårdvetenskap, 2021.   Bakgrund: År 2017 avled cirka 11 miljoner människor av sepsis världen över. Sepsis definieras som ett tillstånd med livshotande organdysfunktion som orsakas av stört systemiskt svar på en infektion. Dödligheten vid sepsis är cirka 24% efter 30 dagar. Den största bidragande faktorn till överlevnad vid sepsis är tidiga interventioner. Sjuksköterskan är vital för att tidigt identifiera begynnande sepsis eftersom hen arbetar närmast patienten. Syfte: Studiens syfte var att sammanställa sjuksköterskans möjligheter och begränsningar för att upptäcka sepsis hos vuxna patienter. Metod: En litteraturstudie med kvantitativ design. Datainsamlingen gjordes via databaserna Pubmed och Cinahl. Litteraturstudien baserades på tio vetenskapliga studier som relevansgranskades, kvalitetgranskades och analyserades efter lämplig mall. Studierna var publicerade mellan 2006-2021. Resultat: Tre kategorier framkom; bristande kunskap, utbildning i kombination med protokoll samt mätinstrument och screening. Sjuksköterskorna hade en låg generell kunskap om sepsis- och SIRS-kriterier men med ökad utbildning kombinerat med protokoll samt olika mätinstrument för screening sjönk mortaliteten bland patienterna med sepsis. Konklusion: Sammanfattningsvis påvisade studien att sjuksköterskans brist på kunskap kring sepsis och aktuella kriterier, patofysiologi och rekommenderad behandling var en begränsning vilket resulterade i lägre upptäckt av de patienter som drabbats, högre mortalitet och sämre vård. Möjligheter för sjuksköterskan att upptäcka sepsis visade sig vara utbildning kring tillståndet i kombination med protokoll för interventioner samt mätinstrument som kan ge tidiga indikationer på sepsis. Dessa möjligheter ökade överlevnaden och förbättrade vården. Nyckelord: begränsningar, litteraturstudie, möjligheter, sepsis, sjuksköterska.
ABSTRACT   Hermodsson V och Jeppsson R. The nurse’s possibilities and limitations in the discovery of sepsis in adult patients. A literature study. Bachelor thesis in nursing 15hp. Malmö University. The faculty of health and society, the institution of healthcare science, 2021.    Background: During 2017 about 11 million people around the world died of sepsis. Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to an infection. The mortality rate of sepsis is about 24% after the course of 30 days. The biggest contributing factor to surviving sepsis is early detection. The nurse who works closest to the patient is therefore vital in the early discovery of an incipient sepsis.  Purpose: The purpose of the thesis was to illustrate the nurse’s possibilities and limitations in discovering sepsis in adult patients.  Method: A literature review with a quantitative design. Collection of data was made with the help of the databases Pubmed and Cinahl. The study was based on ten scientific studies which were audited for relevance and quality, as well as analyzed with the use of an appropriate template.   Result: Three categories were found; insufficient knowledge, education in combination with protocol, and measuring instruments and screening. The nurses generally lacked knowledge in sepsis and SIRS criteria, but with additional education combined with protocols and different measuring instruments the mortality rate sank amongst the patients with sepsis.  Conclusion: The lack of knowledge regarding sepsis and current relevant criteria, pathophysiology and recommended treatment turned out to be a limitation for the nurse which resulted in lower detection rate, inferior care and higher mortality. One possibility for the nurse to discover and treat sepsis turns out to be education concerning the disease, protocol for interventions and measuring instruments that can give early indications for sepsis. These possibilities increase the survival rate and enhance care.  Keywords: Limitations, review, nurse, possibilities, sepsis.

碩士
國立臺北護理健康大學
醫護教育研究所
104
Background: As the mortality rate of sepsis is extremely high, early assessment and the provision of proper care are extremely important for the survival prognoses of patients. How to make use of teaching strategies that enable clinical nurses to acquire effective learning amidst their busy work schedules has become a pressing issue. Purpose: To investigate the effects of using a concept map for nurses’ learning of sepsis care. Methods: The subjects of this study were nurses from the intensive care units of regional teaching hospital in Taiwan, selected by means of random assignment based on cluster sampling.This study was conducted from October 21, 2015 to March 31, 2016. A structured questionnaire was developed to evaluate the results, adopting expert-reviewed content validity (CVI 0.93) pretests (N=10) to test the reliability of the questionnaire (the reliability of the cognitive test on sepsis care, the attitudinal scale, and the behavioral self-efficacy scale was .87, .72, and .91, respectively), and an analysis of the difficulty level and discrimination of question items. Sepsis care course content was based on the Surviving Sepsis Campaign (SSC) Third Edition. The subjects were informed of and consented to the study. Concept map teaching was used for the experimental group, with such teaching strategies as the HELP ME ( Harmful bacteria、Empirical Tx.、Lactate、Pressure、Moniter、Early weaning) mnemonic and demonstration of clinical cases while the control group participated in the traditional self-learning courses through PPT. This study adopted the SPSS 19.0 statistical analysis. Results: Finally, the experimental group and control group were 26, 25 people.After the introduction of concept map teaching, scores of the experimental group, gauged in terms of sepsis care knowledge, attitude, and behavioral self-efficacy, were significantly higher than pretest scores (t = 5.67, p < .001; t = 2.15, p < .05; t = 2.87, p < .01) while there was no significant difference in the control group. Covariance analysis was performed on the pretest results of both groups, which showed that the experimental group had higher scores than the control group, overall (F = 6.14, p < 0.05; F = 14.18, P < 0.001; F = 14.07, P <0.01). Conclusions: The results indicate that the introduction of concept map teaching has a significant effect on nurses’ sepsis care knowledge, attitude and behavioral self-efficacy, which can be used as a reference for health organizations in their related education and training in order to achieve the best model of clinical judgment. It is also recommended that teaching contents be immediately revised according to the empirical evidence. Keywords: nurses, concept map, sepsis care, HELP ME, learning effect

Background: Severe sepsis is a life-threatening condition caused by the body’s overwhelming immune response to an infection. It can lead to organ failure and death if immediate treatment, such as intravenous (IV) fluids and antibiotics, are not commenced within the first hour. While a large number of studies have analysed the administration of first-dose antibiotics, the time-critical initiation of IV fluids has not always been given its deserved priority. To date, studies have not explored factors that inhibit timely IV fluid administration and the experience of emergency nurses relating to initiating early goal-directed fluid resuscitation (EGDFR). Purpose: To explore the experiences of emergency nurses related to initiating EGDFR in the care of patients with sepsis Methods: A qualitative exploratory approach, encompassing face-to-face semi-structured interviews, was used for data collection. Ten registered nurses were interviewed, who were currently practicing in emergency settings across New South Wales (NSW). Braun and Clarke’s (2006) thematic analysis framework guided the data analysis. Findings: Three themes and associated subthemes were identified. The three themes are (i) Nurses’ perceptions and experiences regarding IV fluid administration in sepsis, (ii) Challenges related to initiating IV fluid, and (iii) Strategies to improve compliance with EGDFR. Participants described various factors they found that inhibited timely initiation of IV fluids, including busyness of the department, delayed diagnosis of sepsis, complex patient presentations and limited scope of nurses’ practice to initiate IV fluids. Conclusion: It is anticipated that the outcomes of this research will provide an impetus for re-evaluating current protocol guidelines to provide a positive impact on the scope of emergency nurse practice for initiating EGDFR.

The thesis is focused on the assessment of nurse's knowledge in the prevention of catheter sepsis. The aim of the study was to expertise knowledge in the prevention of catheter sepsis among nurses working in intensive care units. Map out the latest theoretical and practical possibilities of nurses working in intensive care units in the prevention of catheter-related sepsis of hospitalized patients. The work is divided into theoretical and practical part. The theoretical part consists of three chapters. In the first chapter, we focused on a theoretical overview of nosocomial and bloodstream infections. The second chapter is focused on an overview of invasive inputs. The third chapter focuses on prevention of catheter sepsis. Practical part was divided into two chapters. In the first section of the empirical part of the diploma thesis, which is the fourth chapter, we characterized the survey sample, the evaluation of the survey data that have been collected through the questionnaire. Practical part was divided into two chapters. The fifth chapter consists of discussion and suggestions. Key words: sepsis, prevention, nursing, catheter, nurse, hospitalization.

Sepsis represents a serious medical, but also social problem. Hundreds of thousands of patients die from serious sepsis and septic shock every year. Patients with serious sepsis are treated at intensive care units and their treatment is long, costly and low efficient. These are the reasons why prevention of sepsis focused on prevention and effective treatment of nosocomial infections or timely solution of another problem, e.g. a shock is so much stressed. Nosocomial infections affect about 30 per cent of patients at intensive care units and may cause serious diseases, sepsis or even death. This thesis deals with the possibilities nurses have to influence sepsis, particularly by adherence to aseptic procedures and prevention of nosocomial infection, which might consequently develop in nosocomial sepsis. Combination of quantitative and qualitative methods was used for the research. There were two goals set for the quantitative research. 1. To find whether obstacles occur in adherence to proper aseptic procedures in nursing work as prevention of nosocomial infection occurrence and subsequent septic conditions in patients hospitalized at intensive medicine workplaces. 2. To map the weak points in adherence to proper aseptic procedures in nursing work in intensive care. The goals led to hypotheses H1 Obstacles obstructing thorough adherence to proper aseptic procedures in nursing work exist in intensive care. H2 Non-adherence to aseptic procedures occurs in nursing work at intensive medicine workplaces as a consequence of lack of time for particular interventions. The research sample consisted of nurses from the intensive care workplaces ARD and ICU from 8 hospitals. Questioning method through the questionnaire technique was used for data collection. 342 questionnaires were distributed in total. Hypothesis 1 was refuted, hypothesis 2 was refuted. We found that no obstacles obstructing adherence to proper aseptic methods occur, we mapped the weak points in adherence to proper aseptic procedures in nursing work in intensive care. There were two goals set for the qualitative research. GOAL 3 To find what measures preventing occurrence of nosocomial infection and subsequent septic conditions in patients hospitalized at intensive medicine workplaces are taken by department managements. GOAL 4 To find out how department management deals with possible occurrence of nosocomial infection and subsequent septic conditions in patients hospitalized at intensive medicine workplaces. The following research questions were set. 1. What are the measures preventing occurrence of nosocomial infection and subsequent septic conditions in patients hospitalized at intensive medicine workplaces taken by department managements? 2. How does department management solve possible occurrence of nosocomial infection and subsequent septic conditions in patients hospitalized at intensive medicine workplaces? The research sample consisted of 5 departmental nurses and 5 head nurses from intensive care workplaces from the same hospitals where the quantitative research took place. The research was performed by semi-standardized interview. The research questions were answered. A manual for nurses called ?Recommendation for nurses in prevention of nosocomial infection and nosocomial sepsis not only at intensive care units? was elaborated upon study of these issues and the performed research. A thought map for department management illustrating prevention and solution of nosocomial infection and nosocomial sepsis was also elaborated. Both the document and the research results will be provided particularly to the managements of the hospitals that took part in our research. The thesis may also be helpful to nurses, students and other interested people to gain overall insight into the issue.