Assessing nurses’ knowledge and confidence in adult sepsis: evidence from two hospitals in eastern China

Sepsis continues to pose a serious worldwide health issue, with considerable rates of illness and death, making early identification and rapid management essential for improving patient outcomes. Nurses, being the first point of patient care, have a pivotal responsibility in recognizing sepsis early and initiating timely interventions. Nevertheless, even with evidence-based frameworks like Sepsis-3 available, nurses still show knowledge deficiencies, reduced confidence, and inconsistent management practices, which can lead to delays in diagnosis and compromised care. This research set out to evaluate registered nurses' knowledge and self-rated confidence in identifying and handling adult sepsis, while also examining factors that may influence these skills. An online cross-sectional survey was carried out with 355 registered nurses from Nanjing Brain Hospital and Jiangsu Provincial Hospital of Traditional Chinese Medicine in eastern China. The survey included demographic data, a 15-item multiple-choice knowledge assessment aligned with Sepsis-3 guidelines, a 5-point Likert scale for confidence (range 5-25), and an open-ended item on organizational support needs. The data analysis employed descriptive statistics, independent t-tests, ANOVA, and multiple linear regression. The mean sepsis knowledge score was 10.04 ± 3.17 (out of 15), with notable gaps in recognizing early clinical signs and managing septic shock. Nurses practicing in high-acuity areas such as the ED, ICU, and the Respiratory Infection and Critical Care Unit (RICU) demonstrated significantly higher knowledge and confidence than ward-based nurses (p < .05). Higher education, senior job grade, and clinical exposure were independent predictors of better knowledge (R² = 0.156). The mean confidence score was 17.22 ± 3.62, showing a weak positive correlation with knowledge (r = .213, p = .007). Thematic analysis highlighted strong demand for structured sepsis training and standardized workflows. Significant gaps in sepsis knowledge and confidence persist among nurses, particularly in general wards. Integrating structured education, simulation-based training, and standardized protocols may enhance early recognition and improve patient outcomes.