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Effect of Sepsis Education on Sepsis Recognition among Nurses in Nigerian Hospitals

Abstract

Sepsis is a life-threatening condition arising from a dysregulated response to infection and can progress rapidly to organ dysfunction, shock, and death when not recognized and treated promptly. Nurses play a critical role in the early recognition of sepsis because they are frequently involved in continuous patient observation, vital-sign monitoring, clinical assessment, documentation, and communication with other healthcare professionals. Sepsis education provides nurses with knowledge and practical information relating to infection-related deterioration, sepsis risk factors, early warning signs, vital-sign abnormalities, changes in mental status, abnormal urine output, recognition of organ dysfunction, sepsis screening, escalation of care, timely communication, and appropriate emergency response. Sepsis recognition refers to nurses' ability to identify clinical features and patterns that may indicate sepsis, recognize patients at increased risk of deterioration, initiate appropriate escalation, and promptly communicate concerns for further clinical assessment. In Nigerian hospitals, inadequate access to regular sepsis education, high workloads, staff shortages, limited access to standardized screening tools, inconsistent clinical protocols, and inadequate monitoring resources may affect nurses' ability to recognize sepsis promptly. Effective sepsis education may improve nurses' knowledge, clinical recognition skills, confidence, and preparedness to identify patients with suspected sepsis. Against this background, this study investigates the effect of sepsis education on sepsis recognition among nurses in Nigerian hospitals. The study is anchored on Social Cognitive Theory, the Knowledge-Attitude-Practice framework, and Experiential Learning Theory. Social Cognitive Theory emphasizes the interaction between knowledge, self-efficacy, behavioural capabilities, social influences, and environmental conditions in shaping nurses' clinical responses to deteriorating patients. The Knowledge-Attitude-Practice framework provides a basis for examining how structured sepsis education may improve nurses' knowledge and recognition-related practices. Experiential Learning Theory emphasizes learning through practical experience, clinical scenarios, simulation, reflection, and application, making it particularly relevant to sepsis recognition education. Collectively, these theoretical perspectives provide a suitable framework for explaining how sepsis education may influence sepsis recognition among nurses in Nigerian hospitals. The study will adopt a quantitative quasi-experimental research design. Primary data will be collected from nurses providing clinical care in selected public and private hospitals in Nigeria using a structured self-administered questionnaire, sepsis knowledge assessment, and standardized sepsis recognition assessment based on clinical case scenarios. A multistage sampling technique will be employed to select states, local government areas, hospitals, clinical departments, and eligible nurses. Where feasible, selected hospitals or nurse groups will be assigned to intervention and comparison groups. Nurses in the intervention group will receive structured sepsis education covering infection-related deterioration, sepsis risk factors, early warning signs, vital-sign abnormalities, changes in mental status, abnormal urine output, recognition of organ dysfunction, sepsis screening, escalation of care, timely communication, and appropriate emergency response procedures. Sepsis recognition will be assessed using indicators such as identification of suspected infection, recognition of abnormal physiological parameters, identification of altered mental status, recognition of reduced urine output and other indicators of deterioration, identification of possible organ dysfunction, recognition of patients requiring urgent clinical review, and appropriate escalation decisions. Clinical case scenarios will be incorporated to assess nurses' ability to apply sepsis recognition knowledge to realistic patient situations. Descriptive statistics will be used to summarize nurses' sociodemographic and professional characteristics, previous sepsis training, exposure to sepsis education, and sepsis recognition scores. Inferential statistical techniques, including chi-square tests, paired-sample tests, independent-sample tests, and multiple regression analysis, will be used to determine the effect of sepsis education on sepsis recognition. Where appropriate, pre-intervention and post-intervention recognition scores will be compared. Diagnostic tests will also be conducted to assess the reliability of the research instruments, model assumptions, goodness of fit, and robustness of the findings. The study is expected to find that sepsis education has a significant positive effect on sepsis recognition among nurses in Nigerian hospitals. Nurses exposed to structured sepsis education are expected to demonstrate improved knowledge of sepsis risk factors, early warning signs, physiological abnormalities, clinical deterioration, and indicators of possible organ dysfunction. Education may improve nurses' ability to identify patients with suspected sepsis earlier, recognize patterns of deterioration, initiate timely escalation, and communicate concerns to physicians and other members of the healthcare team. Case-based and simulation-oriented education may further strengthen recognition skills by allowing nurses to apply sepsis concepts to realistic clinical situations. However, education alone may not guarantee timely recognition and management of sepsis because nurses may continue to face barriers such as inadequate staffing, high workloads, limited monitoring equipment, inconsistent access to laboratory investigations, absence of standardized screening protocols, and delays in clinical escalation. Consequently, sepsis education is expected to be most effective when supported by standardized sepsis screening procedures, appropriate monitoring equipment, clear escalation protocols, adequate staffing, regular clinical supervision, multidisciplinary teamwork, and functional emergency response systems. The study is expected to contribute to the literature on sepsis, sepsis recognition, emergency nursing, patient deterioration, healthcare worker education, patient safety, clinical assessment, emergency care, and public health in Nigeria by providing empirical evidence on the effect of sepsis education on sepsis recognition among nurses in Nigerian hospitals. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, state ministries of health, hospital management authorities, Nursing and Midwifery Council of Nigeria, nursing training institutions, professional nursing associations, hospital quality improvement committees, emergency care programmes, development partners, and policymakers regarding strategies for improving early recognition of sepsis. The study will also provide evidence-based recommendations for integrating sepsis education into nursing education and continuing professional development, strengthening standardized sepsis recognition and screening protocols, improving clinical monitoring systems, enhancing nurses' capacity to identify deterioration, strengthening escalation and referral pathways, and promoting timely recognition and response to sepsis in Nigerian hospitals.

Keywords: Sepsis education, sepsis recognition, nurses, Nigerian hospitals, sepsis, clinical deterioration, emergency nursing, patient safety, clinical assessment, emergency care, healthcare worker education, sepsis screening, public health, Nigeria.