Sepsis Campaign: Research Design and Methodology

A. Description of the problem that exists in an instructional setting

Levinson et al. (2011) have asserted that severe sepsis is a potentially lethal disease because it progresses at an alarming rate. In addition, sepsis does not discriminate. Patients who suffer or die from severe sepsis or septic shock range from children to the elderly. Thus far, researchers have been unable to discover the cause of sepsis; however, sufficient research suggests that severe sepsis and septic shock are “characterized by components of hypovolemic, cardiogenic, and distributive shock” (Levinson et al., 2011, Methods of Reducing Morality para. 1). In addition, research suggests emergency care and critical care nurses have a primary role in early diagnosis. 

The Surviving Sepsis Campaign (SSC) has provided guidelines and bundles for early diagnosis and treatment. Essentially, it has been found that using the SSC’s bundles allow “early recognition and treatment of sepsis [that] is crucial for clinicians to improve outcomes and decrease sepsis-related morality” (Kleinpell et al., 2013, p. 213). Moreover, bundles provide a definitive guide on when and what nurses should do when certain criteria are established. The SSC emphasizes that if “10,000 hospitals comply with the Campaign recommendations, we could save 400,000 lives if we treat only half of the eligible patients” (About the Surviving Sepsis Campaign, para. 5).  We have a need to create SSC awareness, but that is problematic. Levinson et al. (2011) have noted that “the failure to translate evidence into practice” (p. 1) is one of our greatest barriers. Factors such as awareness and implementation are two major elements in the instructional setting. We lack educational resources for patients, nurses, and clinicians. However, because nurses play a crucial role in early diagnosis, the instructional setting will involve nurses and nursing graduate students. 

B. Discuss why this research approach is an appropriate choice for your proposal

An ongoing educational program using clinical simulation is the best way to teach awareness and implementation; however, initially, the research for this proposal will be examined within a quantitative research design based on a questionnaire. The information gained from the initial quantitative research will provide a solid background for the latter qualitative research that will involve clinical simulation education with teamwork. Tipler et al. (2010) emphasized that solid training regarding sepsis diagnosis allowed the multidisciplinary team to effectively reduce time because they quickly recognized signs of sepsis and decreased the amount of time it took to diagnose and to order, process, and administer antibiotics.

Because simulations are expensive, initial research is essential in determining the locations which need the SSC educational programs the most. After we determine the locations that seem to have low awareness or involvement with SSC, we can create ongoing educational programs for nurses of all levels. While the initial research is an audit, it is crucial to gather background information in order for the latter research to be effective. Nurses in the surrounding areas will have an invitation to participate in a questionnaire via email in order to reach a large base. The information gathered from the questionnaire will be examined within the context of an ongoing educational program and further clinical simulation research based on location. 

C. State the purpose of your research proposal

The intent of my research proposal is to find solutions to an established issue within the nursing community. Research suggests that sepsis cases will increase, and nurses play a critical role in its early diagnosis. There is substantial evidence that reveals SSC guidelines and bundles have decreased the amount of severe sepsis and septic shock mortalities and fatalities. Based on available research, it seems as though there is a lack of awareness in the nursing community. In order to implement the SSC statewide, educating nurses will need to reach out and teach nurses in their surrounding locations. After the initial audit, clinical simulations will allow participants to understand initial symptoms and practice teamwork. 

D. Describe your role and bias as the researcher in your chosen research approach

Although all researchers have certain levels of biases, my goal is to remain as objective as possible. However, with the number of lives that are lost due to misdiagnosis, I do have a level of bias towards wanting others to see sepsis as a bigger picture. Sepsis is an enigmatic syndrome, and its initial signs are subtle; however, there is solid research that suggests we can lower the fatality and mortality rates by using SSC guidelines and bundles. While I am eager to save lives, as a researcher, my role will include evaluating the initial data. I will specifically look for locations within my state that suggest a dire need for an educational awareness and simulation program.   

E. Describe the sampling techniques you will use

Research indicates that the highest levels of sepsis and severe sepsis occur in the Emergency Department (ED) and ICU, so the sampling used for further research will focus on ED, urgent care, and critical care nurses. After the initial questionnaire, a further sample will dictate specific locations. Research speculates that patients who go to lower-income hospitals are more at risk, so these locations will also be a factor. 

F. Describe your target audience or participants, including age and number of participants, gender, ethnicity, economic situation, educational level, etc.

Initially, the participants of the audit will be a diverse group. The initial focus will involve all nursing levels. The socio-economic breakdown will vary because some will be experienced nurses while others are novices or student nurses. Depending on the results from the audit, the clinical simulations may include ED and critical care novice nurses and practicing nurses in lower-income hospitals. If the clinical simulations are found to be successful in surrounding areas, it can be replicated in other portions of the state. The target audience for this research is the overall nursing community. The results of this research will create awareness within our community instead of relying on studies based in other locations. The ultimate goal is to teach nurses to understand that sepsis’s initial symptoms are subtle, but with training they can be detected and treated with bundles early on in order to decrease its progression. 

G. State an appropriate hypothesis statement, if relevant to your research approach

At the research project’s conclusion, I hope to answer the question: what is the best way to implement SSC awareness and compliance?  The initial data collected will determine if there is knowledge, but a lack of compliance, or if there is a lack of awareness altogether.  

B. Describe the data collection methods used for your research proposal

The initial data for this research proposal will come from one source. The initial sources are the questionnaires. This will be the information that determines where SSC awareness should take place. After the initial data is evaluated, the second source will be a follow-up questionnaire directed to the ED and critical care nursing community in high-risk hospitals. The second source of information will ask participants to explain their feelings towards the effectiveness of clinical simulation and educational program based on SSC guidelines and bundles. 

C. Describe the instruments used for data collection

The first instrument used to collect data will be emailed questionnaires. I expect low participation, but I feel that it is the best measure to procure further research. Participants will complete the short questionnaire about sepsis’s initial signs and symptoms and management in order to test nurses’ awareness regarding the SSC guidelines and bundles. The questionnaire will consist of ten multiple questions and two open-ended questions based on hypothetical case studies. While the multiple-choice questions will regard signs and symptoms, the open-ended questions will ask participants if the patient is suffering from sepsis and to explain their yes or no response. 

D. Describe the data you will collect through your instruments or methods

As stated above, the initial assessment via the questionnaire is vitally important to the overall study. Sepsis unawareness and lack of implementation sparked the research topic. Because nurses are a crucial element to the SSC, it is essential to reach this community. The goal is to inform nurses how to identify the early signs of sepsis and how to implement bundle care. 

E. Describe your research procedure

After the email questionnaire is designed, results will dictate which locations are in most need of further educational programs and simulations. In addition, based on their answers, participants will be recruited to take part in future clinical simulation research studies. There will be no monetary compensation for participation. Ultimately, the research will be designed to find other SSC advocates in the hopes to encourage its effective bundle method and early detection guidelines.  

References

Kleinpell, R., Aitken, L., & Achorr, C. A. (2013). Implications of the new international sepsis guidelines for nursing care. American Journal Of Critical Care, 22(3), 212-222. doi: 10.4037/ajcc2013158

Levinson, A. T., Casserly, B. P., & Levy, M. M. (2011). Reducing morality in severe sepsis and septic shock. Seminars in Respiratory and Critical Care Medicine, 32(2).

Tipler, P. S., Pamplin, J., Mysliwiec, V., Anderson, D., & Mount, C. A. (2013). Use of a protocolized approach to the management of sepsis can improve time to first dose of antibiotics. Journal of Critical Care, 28(2), 148-151. doi: 10.1016/j.jcrc.2012.08.021