The role of the nurse in caring for the critical patient with sepsis

Branco, Maria João Chambel; Lucas, Ana Paula Mirco; Marques, Rita Margarida Dourado; Sousa, Patrícia Pontífice

doi:10.1590/0034-7167-2019-0031

Brasil

home Sumário navigate_before Anterior Atual Seguinte navigate_next

home Sumário

REVIEW • Rev. Bras. Enferm. 73 (4) • 2020 • https://doi.org/10.1590/0034-7167-2019-0031 linkcopy

The role of the nurse in caring for the critical patient with sepsis

El papel del enfermero ante el paciente crítico con sepsis

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objectives: to know the nursing interventions in the identification, prevention and control of sepsis in critical patients.

Methods: integrative review of the literature, with two parallel researches using different MesH terms, using the EBSCO database and Google Scholar. Nine studies were included in the sample.

Results: nursing interventions are centered on the creation/implementation of protocols for the early recognition of sepsis, the training of teams to ensure a safe and effective approach and the adoption of measures for infection prevention and control as a way to prevent sepsis.

Final Considerations: the evidence shows that nurses are fundamental in the early identification, control and prevention of sepsis, preventing disease progression and contributing to decreased morbidity and mortality.

Descriptors: Nurse’s Role; Critical Care; Patient; Prevention and Control; Sepsis

Selection criteria	Inclusion criteria	Exclusion criteria
1^st research step (application of criteria in the search engines)	• Full articles available online; • Articles in English and Portuguese.	• Documents prior to the year 2013.
2^nd research step (adequacy of title and abstract)	• Inclusion of adults/older adults in the study; • Nursing approach to the patient with sepsis.	• Documents written in a language other than those in the inclusion criteria; • Inclusion of patients under 18 years of age; • Operating room context; • Duplicated articles.
3^rd research step (full reading)	• Study partially answers the research questions.	• Study does not answer the research questions.

Title	Year/Country	Design/sample	Interventions	Level of evidence (JBI) ⁽¹²⁾
Knowledge of the professional nurse about sepsis ⁽²⁰⁾ (Article 1)	2013, Brazil	Descriptive, cross-sectional, quantitative and qualitative study. n = 9 nurses	Identify the knowledge of nurses from an intensive care unit about sepsis.	4.b
Implications of the New International Sepsis Guidelines for nursing care ⁽⁵⁾ (Article 2)	2013, United States	Systematic review of expert opinion.	Present recommendations for the treatment of adult patients with sepsis.	5.a
Nurses can help improve outcomes in severe sepsis ⁽²¹⁾ (Article 3)	2016 United States	Opinion piece (from an expert).	Discuss the nurse's role in the early identification of sepsis, considering existing guidelines.	5.c
Scripting Nurse Communication to improve sepsis care ⁽¹⁶⁾ (Article 4)	2016 United States	Quasi-experimental study (pre-test/post-test, one group). n = 681 nurses of a Trauma Hospital	Identify the role of nurses in the development a sepsis treatment program.	2.d
Early identification of sepsis in hospital inpatients by ward nurses increases 30-day survival ⁽¹⁴⁾ (Article 5)	2016 Norway	Quasi-experimental prospectively controlled study. Pre-intervention group n = 472 patients Post-intervention group n = 409 patients	Investigate whether implementation of a clinical tool for triage of systemic inflammatory response syndrome and organ failure could improve clinical observations in an emergency hospital.	2.c
Early Sepsis Identification ⁽¹⁵⁾ (Article 6)	2017 United States	Quasi-experimental prospectively controlled study.	Facilitate early recognition of signs and symptoms of sepsis through utilization of a screening tool for nurses on medical and surgical units.	2.c
Performance of emergency nurses in sepsis control ⁽¹⁷⁾ (Article7)	2018 Brazil	Systematic literature review. 13 articles	Analyze the actions of emergency nurses in sepsis control.	4.a
Sepsis: importance of early identification by nursing ⁽¹⁸⁾ (Article 8)	2018 Brazil	Integrative literature review. 11 articles	Demonstrate the importance of nursing in the diagnosis and treatment of sepsis.	4.a
Nursing care for patients with sepsis in intensive care units: a literature review ⁽¹⁹⁾ (Article 9)	2018 Brazil	Integrative literature review. 10 articles	Analyze the care provided to people with sepsis in an intensive care unit.	4.a

Article	Outcomes
Article 1 ⁽²⁰⁾	- All nurses showed an adequate knowledge of the concept of sepsis, however, 33.3% demonstrated lack of scientific knowledge about signs of infection, systemic inflammatory response syndrome, severe sepsis, septic shock, and forms of treatment; - Only 11.1% of nurses recognized hypothermia as a sign of sepsis; - The nurses indicated the need to support continuing education and create/implement sepsis bundles, improving quality of care and reducing mortality rates.
Article 2 ⁽⁵⁾	- The new guidelines indicate that lack of early recognition of sepsis is a major obstacle to initiation of treatment; - It is important to manage patient/family expectations, establish realistic treatment and promote communication; - Integration of the new recommendations into nursing practice ensures specialized quality care, preventing advanced stages of sepsis.
Article 3 ⁽²¹⁾	- The early identification of sepsis by nurses contributes to better outcomes for the patient; - Nurses have the important role of coordinating communication between the multidisciplinary team and the patient/family. Lack of communication can delay diagnosis and treatment; - Training/education of nurses is essential for the provision of better care; - Better ratios allow a correct assessment of the person and an early identification of sepsis.
Article 4 ⁽¹⁶⁾	- In the post-test period, nurses rated themselves as significantly more experienced about sepsis than at baseline; - In the post-test, there was a decrease in the number of patients who did not receive the correct screening (40.6% to 8.9%); - Having trained nurses able to implement sepsis protocols based on current evidence results in lower variability in screening and reduces diagnostic errors.
Article 5 ⁽¹⁴⁾	- During the hospital stay, more patients in the pre-intervention group had deterioration of their general condition compared to the post-intervention group; - At 7 days after analytical confirmation of infection, 4.6% of patients in the pre-intervention group had died compared to 3.4% in the post-intervention group; - At 30 days after analytical confirmation of infection, 12.5% of the patients in the pre-intervention group had died compared to 7.1% in the post-intervention group; - A more accurate assessment in the post-intervention group reduced the need for advanced treatment, decreasing admissions to intensive care units.
Article 6 ⁽¹⁵⁾	- The number of identified sepsis cases increased from 6.7% to 84.2% in Hospital 1, and from 22.6% to 45.2% in Hospital 2; - Time of notification decreased by 42 minutes in Hospital 1, while in Hospital 2 the mean was 138 minutes.
Article 7 ⁽¹⁷⁾	- The nurse is an important professional in the control of sepsis, through the implementation of preventive measures and monitoring of clinical parameters: signs of hypoperfusion, decreased level of consciousness, altered body temperature, decreased urinary output, blood pressure and oxygen levels; - The nurse should be aware of the precautions that must be taken when performing invasive procedures in order to prevent the risk of infection caused by microorganisms in the hospital environment.
Article 8 ⁽¹⁸⁾	- An important factor for determining sepsis: sources of contamination, that is, the conditions of the hospital environment, quality of materials, asepsis, implementation of standards and routines, and use of personal protective equipment; - Knowing the characteristics of the disease helps in early diagnosis, providing more accurate and safe interventions that contribute to the prevention of complications.
Article 9 ⁽¹⁹⁾	- Pain relief and management of other unpleasant symptoms are the main care practices for the patient with sepsis; - It is important that nurses recognize the signs and symptoms of sepsis so that they can intervene in quickly and appropriately manners; - As prevention, it is important to know the mechanisms of infection transmission and the importance of hand washing, proper aseptic technique and use of personal protective equipment.

vertical_align_top file_download show_chart

more_horizclose
- image
- translate
- link
- article
- vertical_align_top
- file_download
- show_chart
- image
- translate
- link
- article

location_on

Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
E-mail: reben@abennacional.org.br

rss_feed Acompanhe os números deste periódico no seu leitor de RSS

Acessibilidade / Reportar erro