Understanding the processes involved in sepsis recognition across clinical contexts to guide individualised management: A phenomenographic study

BACKGROUND: Sepsis is a highly heterogeneous condition, yet it is commonly recognised by application of standardised criteria, irrespective of clinical context. Understanding the complexity of sepsis recognition in the heterogeneous populations of patients with sepsis is critical to better target our resources to the needs of patients. Our aim was to examine nurses' clinical experiences to understand the processes involved in sepsis recognition across clinical contexts. METHODS: Semi-structured interviews were conducted with 26 nurses with various levels of experience in caring for patients with sepsis from multiple hospital settings. The interviews were phenomenographically analysed using the Arkelind method. The Cynefin framework was used to inform the organisation of findings according to contextual complexity. FINDINGS: We identified four categories of description that represent different ways of experiencing sepsis recognition: recognise sepsis by following protocol-based care, recognise sepsis by following disease-specific care, recognise sepsis according to emergent care, and recognise sepsis according to emergency care. The categories emerged from various clinical contexts, ranging from the simple to the highly complex. This variability directed clinical management by helping nurses decide whether guidelines apply to the individual patient and how they should be integrated into clinical decision-making. CONCLUSIONS: Despite its apparent simplicity, sepsis recognition is complex and context-dependent. Rather than relying on an identical strategy for all patients, effective clinical decisions require personalisation based on the characteristics of the clinical contexts. Our findings show that considering the availability of data, predictability and cause-and-effect relationships can inform the selection of an appropriate approach to sepsis recognition. This approach demands adaptability; however, unless we adopt an approach that is appropriate to the level of clinical complexity, significant improvements in sepsis recognition may not be seen. Prospective research is required to validate our findings.