Augmenting knowledge regarding Pediatric Septic Shock and golden-hour management practices among Pediatric Emergency department nurses: Impact of a structured teaching program in a tertiary-care teaching institution in South India
DOI:
https://doi.org/10.31305/rrijm.2025.v10.n5.012Keywords:
Pediatric nurse, Knowledge, Pediatric sepsis, Golden-hour management, Structured teaching program, Pediatric Emergency ServicesAbstract
Background: Clinical practice guidelines of the American Heart Association’s Pediatric Advanced Life Support program indicate that early recognition and treatment of pediatric septic shock significantly decreases mortality. Despite the mandatory requirement of Continuing Nursing Education in pediatric sepsis management among Pediatric Emergency Services (PES) nurses, few studies have quantified teaching program effectiveness. Aims and Objectives: This study aimed to assess the impact of a structured teaching program in improving knowledge regarding pediatric sepsis, shock and golden-hour management, among PES nurses of a tertiary-care teaching institution in South India Materials and Methods: Pre-experimental one-group pretest-posttest design with purposive sampling was used. Data was collected from 38 PES nurses; including 30 General Nurse and Midwife (GNM) and eight Bachelor of Science degree (BSc) nurses. A self-constructed structured validated questionnaire was used, comprising of 10 theory-based and 20 clinical scenario-based ‘binary/multiple-choice with single-correct answer’ questions. Mean knowledge scores were calculated and interpreted as adequate (>80%), moderately adequate (60-79%) and inadequate (<60%). SPSS 21 and Epidata software were used for data management, with paired t-test used to compare pre and posttest means. Results: In the pretest, 27/38(71.1%), 10/38(26.3%) and only 1/38(2.6%) had inadequate, moderately adequate and adequate knowledge respectively; whereas in the posttest, 37/38(97.4%) and 1/38(2.6%) had adequate and moderately adequate knowledge. Overall, pretest mean scores were significantly lower than posttest (58.77±9.723 vs 98.16±2.28) (P<0.0001). On comparison of means of correctly answered questions among GNM and B.Sc nurses, the pretest means of 17.40±2.69 and 19.88±3.04 respectively were significantly lower than posttest means of 29.47±.681 and 29.38±.744 respectively (P<0.0001). Conclusion: Structured teaching program is an effective method for improving knowledge regarding pediatric sepsis, shock and golden-hour management practices among PES nurses.
References
La Via L, Sangiorgio G, Stefani S, Marino A, Nunnari G, Cocuzza S, et al. The Global Burden of Sepsis and Septic Shock. Epidemiol Basel Switz. 2024 Jul 25;5(3):456–78. https://pubmed.ncbi.nlm.nih.gov/39189251/
Watson RS, Carrol ED, Carter MJ, Kissoon N, Ranjit S, Schlapbach LJ. The burden and contemporary epidemiology of sepsis in children. Lancet Child Adolesc Health. 2024 Sep 1;8(9):670–81. https://pubmed.ncbi.nlm.nih.gov/39142741/
Carter MJ, Carrol ED, Ranjit S, Mozun R, Kissoon N, Watson RS, et al. Susceptibility to childhood sepsis, contemporary management, and future directions. Lancet Child Adolesc Health. 2024 Sep 1;8(9):682–94. https://pubmed.ncbi.nlm.nih.gov/39142742/
Prasad L, Penugonda AJ, Kompithra RZ, Santha NJ, Ravindran V. Evolving Definitions and Current Perspectives in Pediatric Sepsis: A Narrative Review. Int Res Med Health Sci. 2024 Aug 3;7(3):39–51. https://www.irmhs.com/index.php/irmhs/article/view/145
Topjian AA, Raymond TT, Atkins D, Chan M, Duff JP, Joyner BL, et al. Part 4: Pediatric Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020 Oct 20;142(16_suppl_2):S469–523. https://pubmed.ncbi.nlm.nih.gov/33081526/
Weiss SL, Peters MJ, Alhazzani W, Agus MSD, Flori HR, Inwald DP, et al. Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children. Pediatr Crit Care Med J Soc Crit Care Med World Fed Pediatr Intensive Crit Care Soc. 2020 Feb;21(2):e52–106. https://pubmed.ncbi.nlm.nih.gov/32032273/
Glomb NW, Shah MI, Cruz AT. Prioritising minimum standards of emergency care for children in resource-limited settings. Paediatr Int Child Health. 2017 May;37(2):116–20. https://pubmed.ncbi.nlm.nih.gov/27679955/
Duke T, Cheema B. Paediatric emergency and acute care in resource poor settings. J Paediatr Child Health. 2016 Feb;52(2):221–6. https://pubmed.ncbi.nlm.nih.gov/27062627/
Brierley J, Carcillo JA, Choong K, Cornell T, DeCaen A, Deymann A, et al. Clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock: 2007 update from the American College of Critical Care Medicine. Crit Care Med. 2009 Feb;37(2):666–88. https://pubmed.ncbi.nlm.nih.gov/19325359/
Paul R, Melendez E, Stack A, Capraro A, Monuteaux M, Neuman MI. Improving Adherence to PALS Septic Shock Guidelines. Pediatrics. 2014 May 1;133(5):e1358–66. https://pubmed.ncbi.nlm.nih.gov/24709937/
Sahoo T, Aradhya AS, Gulla KM. International Guidelines 2020 for the Management of Septic Shock in Children. Indian Pediatr. 2020 Jul 15;57(7):671–5. https://pubmed.ncbi.nlm.nih.gov/32727943/
Sepsis in children: Definitions, clinical manifestations, and diagnosis - UpToDate [Internet]. [cited 2025 May 14]. Available from: https://www.uptodate.com/contents/sepsis-in-children-definitions-clinical-manifestations-and-diagnosis
Wendy J Pomerantz,. Children with sepsis in resource-abundant settings: Rapid recognition and initial resuscitation (first hour) - UpToDate [Internet]. [cited 2025 May 14]. Available from: https://www.uptodate.com/contents/children-with-sepsis-in-resource-abundant-settings-rapid-recognition-and-initial-resuscitation-first-hour?sectionName=Institutional%20guidelines%20and%20protocols&topicRef=6395&anchor=H2060049524&source=see_link#H2060049524
Weiss SL, Fitzgerald JC. Pediatric Sepsis Diagnosis, Management, and Sub-phenotypes. Pediatrics. 2023 Dec 12;153(1):e2023062967. https://pubmed.ncbi.nlm.nih.gov/38084084/
Shock in children in resource-limited settings: Initial management - UpToDate [Internet]. [cited 2025 May 14]. Available from: https://www.uptodate.com/contents/shock-in-children-in-resource-limited-settings-initial-management?topicRef=85767&source=see_link
Mariana Miranda. Pediatric Sepsis: a Summary of Current Definitions and Management Recommendations | Current Pediatrics Reports [Internet]. [cited 2025 May 14]. Available from: https://link.springer.com/article/10.1007/s40124-023-00286-3
Dr Erica Dibb-Fuller, Dr Timothy Liversedge. Management Of Paediatric Sepsis [Internet]. WFSA Resource Library. 2013 [cited 2025 May 14]. Available from: https://resources.wfsahq.org/atotw/management-of-paediatric-sepsis-anaesthesia-tutorial-of-the-week-278/
Dr Ella Dzora, Dr Anne Rawnsley. Guideline for the Recognition and Treatment of Sepsis and Septic Shock. Sheff Child NHS Found Trust [Internet]. 2021 Sep; Available from: https://www.sheffieldchildrens.nhs.uk/download/285/sepsis/22963/recognition-and-treatment-of-sepsis.pdf
Sample Size Calculator [Internet]. [cited 2025 May 14]. Available from: https://www.calculator.net/sample-size-calculator.html?type=2&cl2=95&ss2=38&pc2=50&ps2=&x=Calculate#findci
Jeffery AD, Mutsch KS, Knapp L. Knowledge and Recognition of SIRS And Sepsis among Pediatric Nurses. Pediatr Nurs. 2014 Dec;40(6):271–8. https://pubmed.ncbi.nlm.nih.gov/25929121/
Jankhuang P, Tangpukdee J. Knowledge for Assessments and Management in the Early Stage of Sepsis in Critical Care Pediatric Patients among Pediatric Nurses at the Tertiary Care Level Hospital, Northeastern of Thailand. 2(5). https://ijmrap.com/wp-content/uploads/2019/10/IJMRAP-V2N4P42Y19.pdf
Yue J, Zhao H, Li J, Wu J, Zheng R. Knowledge, attitudes and practices towards the diagnosis and management of paediatric sepsis among paediatric physicians and nurses: a cross-sectional study of 21 hospitals in Hubei Province, China. BMJ Open. 2024 Feb 27;14(2):e079411. https://pubmed.ncbi.nlm.nih.gov/38417965/
Chua WL, Teh CS, Basri MABA, Ong ST, Phang NQQ, Goh EL. Nurses’ knowledge and confidence in recognizing and managing patients with sepsis: A multi-site cross-sectional study. J Adv Nurs. 2023 Feb;79(2):616–29. https://pubmed.ncbi.nlm.nih.gov/36069994/
Choy CL, Liaw SY, Goh EL, See KC, Chua WL. Impact of sepsis education for healthcare professionals and students on learning and patient outcomes: a systematic review. J Hosp Infect. 2022 Apr 1;122:84–95. https://pubmed.ncbi.nlm.nih.gov/35045340/
Qian J, Wang Y, Zhang Y, Zhu X, Rong Q, Wei H. A Survey of the First-Hour Basic Care Tasks of Severe Sepsis and Septic Shock in Pediatric Patients and an Evaluation of Medical Simulation on Improving the Compliance of the Tasks. J Emerg Med. 2016 Feb;50(2):239–45.
https://pubmed.ncbi.nlm.nih.gov/26275743/
Woods JM, Scott HF, Mullan PC, Badolato G, Sestokas J, Sarnacki R, et al. Using an eLearning Module to Facilitate Sepsis Knowledge Acquisition Across Multiple Institutions and Learner Disciplines. Pediatr Emerg Care. 2021 Dec;37(12):e1070. https://pubmed.ncbi.nlm.nih.gov/31464879/
James EJG, Vyasam S, Venkatachalam S, Sanseau E, Cassidy K, Ramachandra G, et al. Low-Cost “Telesimulation” Training Improves Real Patient Pediatric Shock Outcomes in India. Front Pediatr. 2022 Jul 26;10:904846. https://pmc.ncbi.nlm.nih.gov/articles/PMC9364444/
Denny V, Wolfe H, Adabie Appiah J, Nadkarni V, Amisah J, Nettey G, et al. 1581: The Acceptability And Feasibility Of Telesimulation Septic Shock Training In Low-Resourced Settings. Crit Care Med [Internet]. 2025 Jan [cited 2025 May 15];53(1). Available from: https://journals.lww.com/ccmjournal/fulltext/2025/01001/1581__the_acceptability_and_feasibility_of.1534.aspx
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
This is an open access article under the CC BY-NC-ND license Creative Commons Attribution-Noncommercial 4.0 International (CC BY-NC 4.0).
