Date of Award


Document Type


Degree Name

Doctor of Philosophy (PhD)


Nursing Science

Research Advisor

Ann K. Cashion, Ph.D.


Xueyuan Cao, Ph.D.; Lacretia Carroll, Ph.D.; Joyce C. Graff, Ph.D.; Csaba P. Kovesdy, M.D.


Acute Kidney Injury; Causes of delayed sepsis treatment; Early sepsis recognition; Early sepsis treatment; Nursing perspectives; Sepsis


Purpose. Each year at least 1.7 million adults in America develop sepsis. Sepsis can lead to life threatening organ dysfunction, severe hypotension, and death when severe sepsis or septic shock is involved. Sepsis is responsible for 50% of acute kidney injury (AKI), which is the most common form of organ dysfunction seen in critical care. Sepsis associated AKI results in loss of, or decreased renal function, is associated with adverse long-term outcomes, and carries a higher mortality rate than non-septic AKI, sepsis without AKI, or septic shock without AKI. Surviving sepsis guidelines suggests a 1-hour window from the time of sepsis diagnosis to initiating critical treatments. Nurses are vital in identifying early signs and symptoms of sepsis. Early sepsis treatment is essential to hinder preventable sepsis deaths. The purpose of this study was to gauge how critical care nurses who work in ED and ICU perceive factors that might affect early or delayed sepsis treatment. Methods. An exploratory sequential mixed methods approach was performed to describe the study findings. Qualitative data was collected and analyzed from 14 nurses, whereby themes were extracted and explained using a phenomenological method. Descriptive statistics were used to analyze the results of a self-completed survey for the quantitative portion of the study. Surveys were given out to and collected from 100 nurses. The quantitative data was utilized to strengthen the themes of the qualitative themes. Results. Themes from the quantitative study corroborated qualitative findings. Study participants ranked poor communication and coordination of care, knowledge deficit regarding appropriate management, and lab delays as the 1st, 2nd, and 3rd greatest cause of delays in sepsis treatment, respectively. Although self-knowledge of sepsis identification was high among participants, sepsis management was more difficult. Conclusion. Sepsis bundles assist nurses in facilitating early sepsis treatment. Edu- cation programs dedicated to ED and ICU nurses are needed. Yearly continuing education programs focusing on sepsis management should be implemented to keep nurses well informed on sepsis identification and management.

Declaration of Authorship

Declaration of Authorship is included in the supplemental files.




2022-019-Harris-DOA.pdf (131 kB)
Declaration of Authorship

Supplemental Chart of Survey .xlsx (26 kB)
Supplemental Chart of Survey