Date of Award

2016

Degree Name

PhD Nursing

Dissertation Committee

Cynthia D. Connelly, PhD, RN, FAAN, Chairperson; Ruth A. Bush, PhD, MPH; Laurie Ecoff, PhD, RN, NEA-BC; Karen Macauley, PhD, DNP, FNP-BC, GNP-BC

Keywords

gender, interprofessional, mortality, sepsis, shock, simulation

Abstract

Background: The influence of laboratory monitoring, fluid resuscitation, antibiotic management, gender, and interprofessional collaboration on septic patient outcomes is unclear.

Purpose: To provide conceptual clarity for the term interprofessional simulation as it pertains to collaborative work within the healthcare setting, and to identify factors and outcomes associated with sepsis management.

Conceptual Framework: Two conceptual models: Donabedian’s Model of Healthcare Quality (Donabedian, 1980; 2003) and Advancing Health Disparities Research within the Health Care System Conceptual Framework (Kilbourne, Switzer, Hyman, Crowley-Matoka, & Fine, 2006) guided the study.

Aims: 1) Identify the critical attributes, antecedents, and consequences of interprofessional simulation to improve team performance, 2) Identify factors associated with sepsis management and outcomes based on gender differences through a systematic review, and 3) Identify factors, patient characteristics, clinical variables, and care management processes that increase the odds for survival among a cohort of patients with discharge diagnoses of severe sepsis or septic shock. The methodology for the third aim included a retrospective, correlational design using a purposive sample of 482 patients who met study inclusion criteria.

Findings: Concept Analysis: Antecedents of interprofessional simulation include curriculum development, learning environment preparation, and less than optimal team collaboration; attributes include experiential and shared learning; consequences include thoughtful decision-making, collaborative team functioning, and improved patient care. The systematic review indicated clinical sepsis studies evaluating gender and sepsis-related management and mortality are inconclusive and complex. Three different outcomes exist: no difference, higher risk in females, or higher risk in males. Retrospective Study: 482 met inclusion criteria; males (248, 51.4%); (234, 48.5%) females. Logistic regression model with eight independent variables (discharge diagnosis, age, comorbidities, length of hospital stay, source of infection, first lactate level, recommended fluids administered, and gender) reliably predicted patient survival χ2 (12, 423) = 118.39, p < .001 and correctly classified 77.3% of cases. Increased odds for survival included patients: receiving recommended amount of fluids; longer length of hospital stay; and urinary tract or intra-abdominal infections versus chest infections. Limitations included manual abstraction of data and single-site setting. This investigation contributes to the body of nursing knowledge regarding predictors of septic patient outcomes.

Document Type

Dissertation: Campus Access Only

Department

Nursing

Available for download on Thursday, July 19, 2018

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