Background or Introduction
Sepsis is a serious and potentially fatal cascade of events during a serious infection. Nurses need to be able to recognize the early signs and symptoms of sepsis before it becomes too late to help our patients. The journal I chose states that the study was conducted to evaluate the effectiveness of sepsis education among nurses in the critical care and emergency department setting. The study included eighty-two nurses, those nurses were tested prior to education to assess their ability to recognize the early signs and symptoms of sepsis; and then following education the nurses were tested again to assess the effectiveness of multimodal education.
Review of the Literature
The study examined other studies that assessed similar education, it was found that typically confidence of assessing signs and symptoms increased with years of experience, as well as increased education levels. It was found that time in the classroom as well as time in simulation labs proved to be most effective.
Discussion of Methodology
In the journals research they strived to answer three questions. #1 “Is there a difference in knowledge regarding sepsis before and after the sepsis education program?” #2 “Is there a difference between the nurses’ self-assessed competence scores before and after the sepsis education program?” #3 “Is there a relationship between the posttest knowledge score and the nurses’ self-assessed post educational program competence scores”. Prior to education there was a preassessment to assess the nurses’ baseline knowledge. The education was presented in two parts, the first part being an interactive online module consisting of four sections using International Healthcare Improvement bundles (IHI), Health Literacy and Cultural Competence (HLCC) and TeamSTEPPS communication and teamwork concepts; and the second part being a simulation that recorded the nurse’s performance with a debriefing following. After completion of the program a post assessment is taken to show the effectiveness of education.
Data Analysis
As stated above the researcher wanted to answer three questions.
- The first being “Is there a difference in knowledge regarding sepsis before and after the sepsis education program?”. For IHI, staging sepsis and TeamSTEPPS there was a significant improvement following education, however for HLCC there was not any significant difference.
- The second question was “Is there a difference between the nurses’ self-assessed competence score beforehand after the sepsis education program?”. For this question a scale called “Nurse Competence Scale” (NCS) was created to display the pre and post level of self-assessed competence, a total of seven questions were asked to rate self-competence. Overall when assessed as a whole there was not a significant amount of improvement, but when each individual question of the NCS was compared improvement was observed.
- The final question was “Is there a relationship between the posttest knowledge score and the nurses’ self-assessed post educational program competence scores?”. For this question they used a smaller sample size of only fifty-three nurses, all with BSN degrees and varying years of experience. Overall it was found that the post assessment scores were higher following the four education sections.
Researcher’s Conclusion
There was not a specific section designated to the researcher’s conclusion, however the data given showed that additional education in sepsis recognition proved to be beneficial. The researcher does discuss the limitation of the study as well as recommendation for further research.
– Critique evidence presented in each section, did it support the researcher’s conclusion?
o The journal did not have a specific section dedicated to the researcher’s conclusion. However, it is shown in the data that sepsis education is indeed beneficial to not only new nurses but seasoned nurses as well.
– Explain the protection of human subjects and cultural consideration of the article.
o For this journal there wasn’t really a need to “protect” human test subjects, there were not any assessments conducted that could have caused physical harm. Nurses were able to provide the researcher with a self-assessment as well as an actual test of knowledge before and after the education and simulations were provided.
o Cultural considerations for this article included gender, age, and experience. There were mostly female nurses with a mean age of 27, all had their BSN, with varying years of experience in the ER and ICU.
– Identify strength and limitations of this study.
o Limitations included similar education levels and background experience.
o Strengths included using multiple ways of assessing knowledge as well as using multiple education modes. Sepsis is a growing problem, being able to show that this specific way of educating our nurses does show improvement from before and after.
– Describe how evidence informs nursing practice.
o Nurses are the first line for patient safety, we need to be aware of any changes taking place in our patient’s bodies. Septic shock can develop very quickly and can be detrimental if not caught early. Continued education is important for staying up to date on early detection.
B1 Qualitative Article: Antimicrobial Stewardship: A qualitative study of the development of national guidelines for antibiotic use in hospitals.
Background or Introduction
Antibiotics are just as helpful as they can be harmful. With correct use they save lives, and with miss use they can create superbugs. This article discusses the importance of antibiotic regulation by reviewing methods being used in Norway. The government with help from the Norwegian department of health have developed rules and regulation for antibiotic prescribing and have created a way to monitor use in not only outpatient settings but in the hospitals as well.
Review of the Literature
This article discusses the importance of the correct use of antibiotics, further it discusses that the miss use creates the superbugs and antibiotic resistance. In Norway this process is already underway, this article assesses their processes and guidelines and when their processes were implemented. Norway has a low rate of antimicrobial resistant organisms (AMR) however they are on the rise, with increased resistance our antibiotics may become a limited resource, thus showing the need for implementation of such processes.
Discussion of Methodology
Data from the Norwegian Directorate of Health (including official documents containing pertinent laws, official reports and strategies), as well as documents from the National Advisory unit for Antibiotic Use in Hospitals and Norwegian Institute of Public Health. In addition, background data was collected to understand the reasoning and interpretation. Eight Clinicians were interviewed, five of those eight were used to create guidelines (they were chosen based on experience and knowledge of this process). Their questions were based on the AGREE II model (a tool used internationally to assess the quality and reporting of practice guidelines), open ended answers were allowed to convey personal experiences and perspectives to collect all information possible.
Data Analysis
Using the interviews collected they analyzed the data and categorized it into different sections based on the AGREE II tool. Overall the people interviewed agreed with this implementation and agreed with the regulations. They discussed that the regulations are evaluated and revised as needed in order to keep up with ever changing medicine. The guidelines are published electronically, and are concise for easy reading, different recommendations are presented based on evidence, patient need, risk of resistance, patient preference and cost effectiveness.
Researcher’s Conclusion
The researcher reports that countries who have implemented regulations and guidelines for antibiotic use have been successful. Through an agreement on purpose can contribute to a rise of readiness as well as including a range of physicians in the development group. Collection of evidence and evaluation of evidence increases credibility, and should new evidence come into play reevaluation should take place. With all of these taken into consideration the guidelines implemented in Norway and other countries have been successful thus far.
– Explain the protection of human subjects and cultural considerations of the journal article.
o The protection of human subjects is explained throughout the article, with rise of antimicrobial resistance means increased disease that we cannot treat with our standard antibiotics. Meaning we need to use heavier duty antibiotics in order to treat infections, then later down the line this can cause further antibiotic resistance to the heavy-duty antibiotics. Stopping the misuse early by implementing standards of use can save us potential harm down the road.
o Cultural considerations included the physicians being interviewed as well as the population being affected.
– Identify strengths and limitations of this study.
o Some limitations included; they used a small sample group and, in their group, included some of the doctors used to create these guidelines. Some of their data collected from these groups could potentially be skewed due to that.
o Strengths to me included weighing the importance of this issue. AMR is a rising problem and eventually we could have superbugs that are resistant to all of our antibiotics. Where would we be then? Realizing that this is a problem and doing further research into another countries management of this issue is important and brings light and attention to this growing problem.
– Describe how the evidence informs nursing practice.
o It is important to be aware as a nurse to what antibiotics our patients are being prescribed as well as being aware of any exposure to AMR’s. Correctly relaying culture and sensitivity results, making sure we are using the correct antibiotics for our patients’ infections. Keeping in mind that we do not prescribe antibiotics, but this is important to keep in mind.