Nursing Patterns of Knowing in Assessment of Newborn Sepsis

Abstract

Sepsis is a devastating, life-threatening disease and a major problem for many newborns; it develops rapidly and requires expertise to identify the early, subtle signs to prevent death or disability. Evidence from nursing practice and philosophic inquiry indicates that nurses use diverse ways of knowing in their assessments. The purpose of this research was to address research questions concerning two areas: 1) Neonatal Intensive Care Unit (NICU) nurses’ patterns of knowing in the assessment of infants with sepsis as related to dimensions of nursing practice; and 2) Test the psychometric properties of the Newborn Scale of Sepsis (SOS) as a diagnostic or assessment tool. The theoretical framework incorporated the epistemological theories of nurses Carper and Benner and philosopher of science Nagel. This study employed a prospective, correlational design with a convenience sample of 119 NICU nurses. Twenty-eight of these nurses also completed the Newborn SOS to document their assessments of 62 newborns for sepsis. Two instruments were used: 1) The 16-item norm-referenced Nursing Patterns of Knowing (POK) scale (ɑ = .82 and item-scale correlations ≥ 0.33), and 2) The 13-item Newborn Scale of Sepsis (SOS), developed to assist the novice nurse to assess for signs of sepsis (ɑ = .65 and interrater reliability of 96.3%). Descriptive, psychometric, and correlational analyses were applied to the research questions. Results indicated that the more clinically experienced NICU nurses used a more integrated pattern of knowing when assessing newborns for signs of sepsis. The more experienced and competent nurses incorporated empirical, aesthetic and personal knowing in their assessments. More experienced nurses also used less authority-based knowing. More diversity in work experiences was negatively correlated with the sociopolitical pattern of knowing. Psychometric properties of the Newborn SOS indicated that, while its sensitivity was very good, its low specificity limited its usefulness as a diagnostic tool. It was concluded that the Newborn SOS can be used to assist novice nurses in developing pattern recognition of newborn sepsis. The Nursing POK has strong potential for use in a wide variety of studies examining nursing patterns of knowing in assessment of critical health conditions.