Nursing Research: Sepsis Survivors Express Need for Follow-Up Support

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Research led by a faculty member from the University of Tennessee Health Science Center College of Nursing shows that survivors of sepsis feel a need for advocacy and support after discharge from the hospital. And these results have inspired further research into this vulnerable population.

“Care during this period is fragmented, without systematic support for patients after their ICU discharge, said Reba Umberger, PhD, RN, CCRN-K, who is lead author of the study published recently in Dimensions of Critical Care Nursing. “My team’s next study will target this high-risk period to better understand physical, psychological, cognitive, and immune function recovery, and how peer support may benefit survivors of sepsis and their caregivers,”

Sepsis is a life-threatening response to an infection that can lead to conditions such as septic shock, acute kidney injury or organ failure. It is a medical emergency that requires prompt recognition and treatment.

Reba Umberger, PhD, RN

“Sepsis is a devastating and life-threatening illness with serious long-term consequences,” Dr. Umberger said. Currently an assistant professor in UTHSC’s College of Nursing, Dr. Umberger was previously an assistant professor at UT Knoxville, where the study was conducted. Sandra Thomas, PhD, chair of the UT Knoxville College of Nursing’s PhD program, is co-author of the study.

“Sepsis mortality rates in hospitals have decreased over the past decade, increasing the number of survivors who may experience long-term consequences,” Dr. Umberger said. “Our study aims to identify how participants perceive their illness and its aftermath.”

Researchers conducted interviews with survivors nearly two years after their admission to an intensive care unit with sepsis. UT Knoxville’s Transdisciplinary Phenomenology Research Group, led by Dr. Thomas, assisted in analyzing interview transcripts to identify common themes.

The study identified five major themes among survivors: how they survived, blurring of time and counting time by events, helpful versus unhelpful assistance, feeling powerless and striving for control, and survival without full recovery.

“Participants were younger than expected, possibly indicating that those we could not reach were too ill to respond. We knew that survivors can develop post-intensive care syndrome (PICS), as well as increased risk for new infections,” said Dr. Umberger. “Recovery after sepsis is very individual, and our method of interviewing participants allowed them to direct what stood out as important, so we did not probe about symptoms unless they shared them.”

Many participants did report some psychological, physical, and cognitive symptoms associated with PICS, and interviews reflected chronic illness. Most participants were interviewed nearly two years after sepsis, and the majority still expressed the need for a caregiver. Only one participant had returned to work.

“Our findings should be viewed in context with other work in the field,” Dr. Umberger said. “Rigorous qualitative studies are typically small. Our study was small so we cannot make inferences about factors such as returning to work; however, we know that this is an important issue based on larger published studies. We are beginning to see many more qualitative studies in the medical literature. These types of studies add context and value to our understanding of patient experiences. In addition, there are specific types of qualitative methods or traditions that impact how interviews are conducted and analyzed.

“Because of the unique qualitative nature of the in-depth interviews, this study revealed the meaning of the sepsis experience to the participants, which was previously not well understood,” she added.

Recovery after sepsis varies: some patients may fully recover, but some may need prolonged support. After ICU there is not a systematic process of follow-up care for patients who have had sepsis. There are currently a very limited but growing number of post-critical care clinics in the U.S., and only one in Tennessee.

“Our recent analysis of the 2015 Nationwide Readmission Database shows that about 18 percent of patients admitted with sepsis experienced at least one readmission with sepsis within three months,” Dr. Umberger said. “It is unknown how many readmissions might be preventable. Patients would benefit from better follow-up support after sepsis to prevent readmissions and mitigate PICS. The first step is to create awareness.”

The study was funded by the Physicians’ Medical Education and Research Foundation in Knoxville.

To learn more about improving recovery after sepsis, watch Life after Sepsis, a video created by the Society of Critical Care Medicine and the Sepsis Alliance.

Hannah Browning, Office of Communications and Marketing, The University of Tennessee, Knoxville, contributed to this article.