Wei Ling Chua

Aims: To synthesize evidence on the characteristics, implementation and effects of nurse‐driven sepsis protocols on process‐of‐care indicators and clinical outcomes. Design: Systematic review without meta‐analysis. Methods: Studies were included if they described and evaluated nurse‐driven sepsis protocols in hospitals. Two reviewers independently screened titles, abstracts and full texts for eligibility. The Johns Hopkins Nursing Evidence‐Based Practice model was used to appraise included studies. Data were extracted and narratively synthesized. Data Sources: Eight databases were searched from database inception to 30 June 2025. Results: Fifteen studies were included, most using before‐and‐after designs and conducted in the emergency departments ( n = 7) and hospital‐wide settings ( n = 4). Protocols commonly used systemic inflammatory response syndrome criteria for screening ( n = 12) and incorporated key Surviving Sepsis Campaign recommendations ( n = 14). Most studies reported improved or comparable outcomes to baseline in overall sepsis bundle compliance and key process‐of‐care indicators, including timely antibiotic administration, blood culture collection, lactate measurement and fluid administration. All 11 studies evaluating mortality reported reductions, although only four were statistically significant. Findings for hospital length of stay were inconsistent. Common implementation strategies included nurse education and training, coupled with audit and feedback. Conclusions: Nurse‐driven sepsis protocols may improve adherence to and timeliness of key sepsis care processes. Effects on clinical outcomes are less certain, given the predominance of before‐and‐after designs and inconsistent findings for hospital length of stay. The review identifies implementation strategies that can guide future sepsis quality improvement initiatives. Implications for the Profession and/or Patient Care: Nurse‐driven protocols may support nurses in initiating timely sepsis care and strengthening adherence to recommended care processes. Further high‐quality studies are needed to establish effects on clinical outcomes and broader impacts, including healthcare costs, intensive care resource utilization, patient and nurse satisfaction, and safety outcomes. Patient or Public Contribution: No patient or public contribution.

To identify and characterize instruments used to assess post-sepsis syndrome and health-related quality of life (HRQoL) in adult sepsis survivors and/or caregivers, and to map a conceptual HRQoL framework for post-sepsis recovery. A mapping review was conducted. Eight electronic databases were searched from inception to 19 May 2025 to identify peer-reviewed studies using at least one instrument to assess HRQoL among adult sepsis survivors. Two reviewers independently screened titles, abstracts, and full texts for eligibility. Data were extracted and summarized using tabular and narrative forms. Visual mapping techniques were used to map domain coverage and identify gaps in sepsis-specific instrument validation. Seventy-three studies were included, most originating from the United States (n = 20, 27.8%), Germany (n = 18, 24.7%), and Japan (n = 5, 6.9%). A total of 101 instruments were identified. The most frequently used measures were the 36-Item Short Form Survey (SF-36) (n = 17, 23.3%), WHO/Zubrod score (n = 8, 11.0%) and Posttraumatic Stress Scale (PTSS-10) (n = 8, 11.0%). Nearly all instruments (98.0%) were validated in non-sepsis populations; only the SF-36 and Reintegration to Normal Living Index (RNLI) had undergone validation in sepsis survivors. Cognitive and psychological domains were most commonly assessed, whereas pain, sleep, and fatigue were underrepresented. Considerable variability exists in post-sepsis HRQoL measurement, with limited sepsis-specific validation. A preliminary framework, derived from this review, highlights the multidimensional nature of post-sepsis recovery and provides a hypothesis-generating foundation for the development of sepsis-relevant patient-reported outcome measures to support survivorship care.

Objectives: : Real-time automated alert and trigger systems that notify clinical staff beyond the patient’s assigned bedside nurse are increasingly used to improve the recognition and response to clinical deterioration in hospital wards. This review evaluated their effects on clinical outcomes in adult general ward patients. Data Sources: : Seven electronic databases were searched from inception to April 1, 2024, supplemented with citation tracking. Study Selection: : Two sets of reviewers independently screened for comparative studies assessing automated clinical deterioration alert and trigger systems vs. conventional manual escalation processes. Data Extraction: : Two sets of reviewers extracted data. Primary outcomes were hospital mortality and in-hospital cardiac arrest. Secondary outcomes included unplanned ICU transfers, and hospital and ICU length of stay. Data were pooled using random-effects meta-analysis. Data Synthesis: : Eighteen studies ( n = 349,818) were included: two randomized controlled trials (RCTs), 15 before-and-after designs, and one quasi-experimental study. All studies had at least moderate risk of bias. The main meta-analysis included nine studies ( n = 58,632) involving alert-eligible cohorts (i.e., patients meeting alert thresholds). Based on two before-and-after studies, automated alert and trigger systems were associated with a significant reduction in-hospital cardiac arrests (risk ratio [RR], 0.60; 95% CI, 0.43–0.85; p = 0.004). No significant reduction in hospital mortality was observed (RR, 0.80; 95% CI, 0.62–1.05; p = 0.09), based on pooled data from RCTs and before-and-after studies. ICU length of stay was also significantly reduced, based on one RCT and one before-and-after study. No significant effects were found for hospital length of stay or unplanned ICU transfers in either alert-eligible or all-admission cohorts. Conclusions: : Real-time clinical deterioration automated alert and trigger systems are associated with reduced in-hospital cardiac arrests and may offer mortality benefits when integrated into structured escalation pathways. Further high-quality trials are needed to confirm these findings and optimize system design.

Aim: To examine temporary registered nurses' job satisfaction, motivation, intent to stay and work experiences of gig or locum nursing roles.Design: A two‐phase mixed methods study.Methods: Participants were temporary registered nurses who engaged in gig or locum roles. In Phase I, a cross‐sectional quantitative study was carried out to examine temporary nurses' job satisfaction, motivation and intent‐to‐stay. In Phase II, a descriptive qualitative study was conducted to provide a more nuanced understanding of the factors that influenced temporary nurses' work experiences. The participants took part in a one‐time, individual, semi‐structured audio‐ and video‐recorded interview via Zoom. The interviews were transcribed verbatim and subjected to thematic analyses.Results: A total of 111 temporary nurses were included in this study. The temporary nurses scored higher for the subscale on intrinsic job satisfaction than on extrinsic job satisfaction, with the lowest item score for career advancement. They scored highest for extrinsic motivation, with the highest item score on compensation. They also reported low intention to stay in their current roles. A purposive sampling of 20 nurses participated in the interviews. Four themes emerged from the qualitative findings on their work experience: flexible schedule for work‐life balance, attractive yet unstable compensation, job autonomy and impeding clinical and professional growth.Conclusion: Temporary nurses are attracted to gig or locum nursing work due to compensation, work flexibility and job autonomy. Further research to examine the perspectives of patients, permanent staff and nursing managers is needed to provide more insights for healthcare policymakers and administrators.Impact: Healthcare organisation could consider incorporating flexible work schedule and job rotation to make permanent staffing models more attractive for them. The digital platform could be adopted to promote long‐term engagement in specific work setting and foster career development, ensuring the safe practice of temporary nurses.Patient or Public Contribution: No patient or public contribution.

Background: Nurse worry is a criterion often included in early warning systems tools and used to escalate care when other clinical markers do not indicate deterioration. What it means to worry, however, is not always clear. Aims: To generate a concept analysis of nurse worry in relation to clinical deterioration. Design: Rodgers's evolutionary method was used. Method: A review was first conducted in April 2024, searching the Cumulative Index for Nursing and Allied Health Literature, Pubmed, EmCare, and Embase databases. A total of 22 articles were subjected to analysis of the antecedents, attributes, and consequences of nurse worry in the context of clinical deterioration. The processes of nurse worry were subsequently mapped and conceptualised, leading to a descriptive statement of nurse worry. Results: Worry captures a nurse's sense of knowing the patient and is embodied via assessing, sensing, recognising, and processing information, cues, and patterns. Conclusion: Nurse worry is a complex process, impacted by external and internal factors. Implications for the profession or patient care: Assured practice, driven by validation of a nurse's worry, leads to proactive care of the deteriorating patient, whereas apprehensive practice, driven by fear and trepidation, leads to reactive care of the deteriorating patient. Impact: Nurse worry is a criterion often included in early warning systems tools and used to escalate care when other clinical markers do not indicate clinical deterioration. What it means to worry, however, is not always clear. From the concept analysis, a descriptive statement of nurse worry emerged. Worry captures a nurse's sense of knowing the patient and is embodied via assessing, sensing, recognising, and processing information, cues, and patterns. Implications for the Profession or Patient Care: This research has implications for nurses, policymakers, and organisations, as nurse worry is an important element in detecting clinical deterioration. Nurse worry must be organisationally supported. Reporting Methods: PRISMA Extension for Scoping Reviews (PRISMA‐SCR). Patient or Public Contribution: No Patient or Public Contribution.

Aim: The early warning scores (EWS), quick Sequential Organ Failure Assessment (qSOFA) and systemic inflammatory response syndrome (SIRS) criteria have been proposed as sepsis screening tools. This review aims to summarise and compare the performance of EWS with the qSOFA and SIRS criteria for predicting sepsis diagnosis and in‐hospital mortality in patients with sepsis.Design: A systematic review with meta‐analysis.Review Methods: Seven databases were searched from January 1, 2016 until March 10, 2022. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Sensitivity, specificity, likelihood ratios and diagnostic odd ratios were pooled by using the bivariate random effects model. Overall performance was summarised by using the hierarchical summary receiver–operating characteristics curve. This paper adhered to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses of Diagnostic Test Accuracy Studies (PRISMA‐DTA) guidelines.Results: Ten studies involving 52,474 subjects were included in the review. For predicting sepsis diagnosis, the pooled sensitivity of EWS (65%, 95% CI: 55, 75) was similar to SIRS ≥2 (70%, 95% CI: 49, 85) and higher than qSOFA ≥2 (37%, 95% CI: 20, 59). The pooled specificity of EWS (77%, 95% CI: 64, 86) was higher than SIRS ≥2 (62%, 95% CI: 41, 80) but lower than qSOFA ≥2 (94%, 95% CI: 86, 98). Results were similar for the secondary outcome of in‐hospital mortality.Conclusions: Although no one scoring system had both high sensitivity and specificity, the EWS had at least equivalent values in most measures of diagnostic accuracy compared with SIRS or qSOFA.Implications for the profession: Healthcare systems in which EWS is already in place should consider whether there is any clinical benefit in adopting qSOFA or SIRS.No patient or public contribution: This systematic review did not directly involve patient or public contribution to the manuscript.