From recognition to action: organisational and cultural factors influencing nurse-initiated care in suspected sepsis- an interview study

Ms Alison Lemoh1, Professor Karin Thursky1, Professor Mei Krishnasamy1, Ms Jenny Motiani1 , Doctor Lisa  Guccione1

1Peter MacCallum Cancer Centre | National Centre for Infections in Cancer (PhD) University Of Melbourne

Abstract:

Background:
Sepsis carries a high burden of morbidity and mortality globally, with early recognition and management essential to preventing deterioration and optimising health outcomes. Nurses are well positioned to recognise deterioration and initiate early management when sepsis is suspected. Factors that hinder or enable nurses’ capacity to respond impact patient safety and system efficiency, particularly in undifferentiated and complex presentations.

Objective:
To explore nurses’ experiences and examine how organisational and cultural factors influence early recognition and management of suspected sepsis in the deteriorating patient.

Design:
Exploratory descriptive study.

Setting and Participants:
Registered nurses working in acute care services across metropolitan, rural-regional, and remote settings.

Methods:
Semi-structured interviews were conducted and analysed using reflexive thematic analysis.

Results:
Fifteen nurses participated. Organisational factors included training in recognition and management of deterioration; access to sepsis pathways; staffing and skill mix; and psychologically safe team environments supporting escalation. Nurses also described how patient complexity, including multimorbidity, atypical presentation, and changes from baseline, could make recognition of deterioration more difficult. Cultural factors included cultural safety influencing access to care, Aboriginal healthcare workers, gender-sensitive care, and nurses experienced in culturally safe care.

Conclusion:
These findings highlight opportunities to strengthen nurses’ capability to recognise and respond to suspected sepsis, particularly in complex clinical presentations, to support more timely care.