Sepsis Debriefing Questions

Sepsis
Debriefing/Guided Reflection Questions for This Simulation (Remember to identify

important concepts or curricular threads that are specific to your program)
1. How did you feel throughout the simulation experience?

Initially, I felt anxious throughout the simulation as the patient was visibly unwell and
was going to get discharged home. From previous experience within my unit, sepsis has
been difficult to recognize and treat. It is concerning that the patient’s temperature has
been elevated for a prolonged period. Overall, I think the nurse’s response was
appropriate as he advocated for Mr. Daniels and provided appropriate care. He used his
critical thinking to comprehend that an elevated heart rate, decreased blood pressure, an
elevated temperature, and fatigue are all symptoms of sepsis (Lewis, Bucher,
Heitkemper, Harding, Barry, Lok, & Goldsworthy, 2019).
2. Describe the objectives you were able to achieve.

Objectives I was able to achieve include accurately noting the steps to diagnose sepsis.
From Lewis et al. (2019), I could recognize and predetermine the interventions that the
nursing team performed, such as measuring lactate levels, ensuring that blood cultures
were performed prior to administration of any antibiotics, reassessing vital signs, and
providing a bolus to hydrate the patient and increase blood pressure. The 1-hour bundle
associated with a sepsis diagnosis aids decision making and narrows interventions that
are time sensitive and specific to proper care (Chen, Simpson, & Pallin, 2019). The
utilization of the 1-hour bundle within this simulation improved patient outcomes and
assured the patient received proper care and resources (Chen et al., 2019). I anticipated
that treatment would begin immediately as the diagnosis was prevailing, as early sepsis
treatment results in a larger chance of survival (Chen et al., 2019).
3. Which ones were you unable to achieve (if any)?

An objective I was unable to achieve included anticipating the accuracy of
documentation. Within my practice, it is not common to chart during care unless a patient
is coding. This patient required timely, critical care, however, teaching me that having a
documenter during emergency situations is beneficial and necessary. The accuracy of this
nursing teams’ documentation will be an indicator of quality care being provided and it is
a method of communication, due to readback on orders from nurse practitioners and/or
physicians (Alkouri, AlKhatib, & Kawafhah, 2016). This team’s charting was specific,
clear, consistent, and comprehensive (Alkouri et al., 2016). Through accurate charting,
advances can continue to be made in sepsis diagnosis and care.
4. Did you have the knowledge and skills to meet objectives?

I did have the knowledge and skills to meet objectives. I can recognize that sepsis is not
always diagnosed based off a patient’s physical appearance, but much is seen in vital
signs and bloodwork results. This patient, specifically, did appear unwell while white
blood cells (WBC’s) were within normal range. Working on a surgical floor, when
patients are critically ill or have had an extensive surgery and have multiple morbidities,
sepsis is a complication that fear nurses and physicians have and aim to avoid. Sepsis on
the surgical units is highly susceptible because it is widespread and aggressive (Rhee &
Klompas, 2020). Post operative patients are susceptible to sepsis as they are
immunocompromised and often have open wounds. To meet these objectives more
accurately as a registered nurse, I will further familiarize myself with the 1-hour bundle
and shadow registered nurses as they aid in diagnosis and treatment of patients with
sepsis. I have learned that reliable biomarkers for postoperative identification of sepsis
includes an elevated IL-8 and IL-6 serum levels, as they produced a low prognosis in
patients with postoperative organ failure (Siloşi, Siloşi, Pădureanu, Bogdan, Mogoantă,
Ciurea, Cojocaru, Boldeanu, Avramescu, Boldeanu, & Popa, 2018). I can recognise that
sepsis occurs in response with an infection becoming generalized and is present in organ
dysfunction, requiring use of broad-spectrum antibiotics to be initiated (Silosi et al.,
2018). On my unit, I commonly assess blood work; therefore, I could comprehend the
requests of blood work from the nurse practitioner to the group of nurses caring for Mr.
Daniels.
5. Were you satisfied with your ability to work through the simulation?
I was satisfied with my ability to work through the simulation as I demonstrated critical
thinking and time- sensitive care. I recognized that lactate levels are a priority as they
identify the severity of the condition and allow a patient’s health care team to provide
appropriate interventions (Silosi et al., 2018). I understand that blood cultures are
retrieved prior to antibiotic therapy because it improves the chances of identifying the
microorganism invading a patient’s system. Antibiotic use may delay results, and
inappropriate antibiotic use may prolong treatment or worsen sepsis. I am aware that
broad-spectrum antibiotics are first-line medications in sepsis and can affect infections
quickly, covering a wide range of microorganisms. Lastly, I commonly use boluses at
work to raise patient’s blood pressure’s post operatively. As a registered nurse, I will aid
registered nurses as they treat acute septic patients. I will continue to use critical thinking
to quickly apply nursing interventions to both prevent and treat sepsis.
6. To Observer: Could the nurses have handled any aspects of the simulation differently?
I believe the nurses could have approached the nurse practitioner in a different manor.
The nurse immediately indicated that something may be wrong with the patient and
demanded that the patient stay and not be discharged. The nurse openly questioned the
nurse practitioner’s orders. Although the nurse is advocating for the patient, the nurse
should have approached her in a calmer manor and recommended doing bloodwork or
having her assess the patient again. The nurse needed to recognize his boundaries and his
approach towards interprofessional care. Also, I think the nurse could have provided an
ISBAR report to the nurse practitioner, as he vaguely stated facts about the patient before
requesting that the patient stay in hospital. This way, the nurse practitioner may have re-
evaluated these symptoms herself.
7. If you were able to do this again, how could you have handled the situation differently?
If I was able to do this again, I would have handled the situation differently by not
leaving the patient’s side until his was stable enough to ambulate independently or until I
was positive about leaving the patient alone. The nurse indicates that the patient was
quite ill to the nurse practitioner. The nurse should have suggested to the patient that he
wait to ambulate until the nurse was in the room or use the call bell to notify the nurse
that he was feeling lightheaded and weak. The patient had a time sensitive illness, despite
the lack of diagnosis, and required immediate care to ensure healing.
8. What did the group do well?

The group worked as an interprofessional team well. The primary nurse delegated tasks
to ensure the patient was being cared for appropriately. The team verbalized their tasks
and results prior to moving onto the next task. The documenter verbalized every task and
order to clarify, minimizing mistakes. The team recognized the 1-hour bundle and
initiated it immediately. The care team recognized abnormal values and verbalized them.
The primary nurse also explained all interventions and their rationale to the patient. The
nurse practitioner immediately apologized to the primary nurse for disregarding his
concerns.
9. What did the team feel was the primary nursing diagnosis?
The team felt that the primary nursing diagnosis was fluid volume deficiency related to
sepsis as evidence by hypotension, tachycardia, fever, and orthostatic dizziness
(Carpenito, 2017). This is relevant as the team immediately begun a bolus of normal
saline. Sepsis causes fluid to shift out of the intravascular space, causing a shift in vital
signs (Lewis et al., 2019). The team immediately acted on this priority diagnosis.
10. How were physical and mental health aspects interrelated in this case?
Physical and mental health aspects were interrelated in this case through showing
exhaustion within the nurse practitioner and the affect it had on her quality of care until
she physically saw how acutely ill the patient was. She verbally apologized to the
primary nurse and attended to the patient with care and compassion. As the audience, we
were unable to physically see that she was tired or mentally drained. Additionally, the
audience could visualize how scared the patient was of their illness. Physical aspects that
were interrelated include Mr. Daniels’ illness. The simulation showed his point of view
by creating a dizzy, unstable environment from his perspective and showing him as pale
and diaphoretic with unstable vital signs. The physical illness was undiagnosed by the
doctor until physical signs began prevailing, which usually occurs with mental illness
issues instead.
11. What were the key assessments and interventions?

The key assessments and interventions included vital signs, laboratory tests including
CBC, lactate, Chem 7, ABGs, and blood cultures, intravenous initiation for a normal
saline bolus, administration of broad-spectrum antibiotics, and tele initiation. Frequent
blood pressures were taken, and vital signs were verbalized if abnormal. A respiratory
assessment was performed to exclude crackles, wheezing, and diminished or absent
sounds. The team ensured they worked together to provide quality care.
Vitals, full blood work up of CBC, UA/C&S,

lactate, blood cultures, CMP to make sure no
signs of dehydration due to patient running a
temp for the past week, oral mucosa
assessment, skin turgor, and body
assessment to look for open areas, start and
IV line on patient for possible IV fluids and IV
ABT if patient labs come back positive for
infection
References
Alkouri, O. A., AlKhatib, A. J., & Kawafhah, M. (2016). Importance and implementation of
nursing documentation: review study. European Scientific Journal, 12(3).
Carpenito, L. (2017). Handbook of nursing diagnosis (15th ed.). Philadelphia: Wolters Kluwer.
Chen, A. X., Simpson, S. Q., & Pallin, D. J. (2019). Sepsis guidelines. N Engl J Med, 380(14),
1369-1371.
Lewis, S., Bucher, L., Heitkemper, M.M., Harding, M., Barry, M., Lok, J., & Goldsworthy, S.
(2019). Medical-surgical nursing in Canada. (4th ed.). Elsevier: Canada.
Rhee, C., & Klompas, M. (2020). Sepsis trends: increasing incidence and decreasing mortality,
or changing denominator?. Journal of Thoracic Disease, 12(Suppl 1), S89.
Siloşi, C. A., Siloşi, I., Pădureanu, V. L. A. D., Bogdan, M., Mogoantă, S. Ş., Ciurea, M. E.,
Cojocaru, M., Boldeanu, L., Avramescu, C. S., Boldeanu, M. V., & Popa, D. G. (2018).
Sepsis and identification of reliable biomarkers for postoperative period prognosis. Rom
J Morphol Embryol, 59(1), 77-91.

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Sepsis

Debriefing/Guided Reflection Questions for This Simulation (Remember to identify

1. How did you feel throughout the simulation experience?

2. Describe the objectives you were able to achieve.

3. Which ones were you unable to achieve (if any)?

4. Did you have the knowledge and skills to meet objectives?

8. What did the group do well?

11. What were the key assessments and interventions?

Vitals, full blood work up of CBC, UA/C&S,

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