Nurse Practitioners vs. Physician Assistants during Sepsis Treatment

This paper is devoted to the analysis and contrast of the work efficacy of nurses and physician assistants in the process of sepsis treatment aimed at achieving the best patient outcomes. The problem of sepsis is one of the gravest in medicine because of the high risk of patient mortality, which is why hospitals and clinics require work of qualified health care providers. Nurses and physician assistants represent a similar middle level of care and can substitute each other when treating sepsis. However, the study presumes that one category of health care providers may achieve better outcomes. Therefore, the research answers the question, “In patients with sepsis diagnosis (P) would assistance of nurses (I) decrease the patients’ mortality risk and increase recovery time (O) in comparison with interventions provided by physician assistants (C) within a week after the patients’ admission (T)?” In order to test the hypotheses, a quasi-experimental research framework is designed. In case the statistic information reveals that one group of medical practitioners has more relevant knowledge and practice required for achieving better patient outcomes in sepsis treatment, medical institutions would obtain an instrument for a positive systemic change. Therefore, the proposed project is valid and capable of improving the well-being of the community by means of solving the problem of increased mortality risk in patients with sepsis.

Introduction

Sepsis treatment belongs to the issues that require opting for the timely interventions of nursing practitioners or physician assistants in order to achieve better outcomes. Although both categories of health care professionals share some clinical responsibilities, yet it is unknown whether the skills and knowledge regarding sepsis treatment are better in nurses or physician assistants. Therefore, this research proposes a methodological framework on the basis of problem analysis and literature review, which would allow solving the issue of selecting the most competent health care provider required for sepsis treatment. In case of successful application of the proposed methodology, hospitals and clinics would obtain the possibility for improvement of the efficacy of sepsis treatment interventions by means of selecting the most relevant type of providers.

Research Problem

Although nurses and physician assistants often share similar workplaces and duties, their training and qualification differ. As a result, one type of a health care provider may be superior to her/his counterparts of a different type in case his/her knowledge corresponds to the situational requirements in the best way. However, the selection of a practitioner of one type over another without any research may decrease the efficacy of care and treatment due to the fact that both categories belong to the similar midlevel of care and treatment (Solomon, 2014), which is why the practical relevance of their interventions is hard to estimate. For instance, the benefit of a nurse may be an increased accent on a patient’s outcomes including care, health, status, functional status, the number of previous hospital visits and hospitalization, family disease history, etc. (Stanik-Hutt et al., 2013). In contrast, physician assistants may outperform nurses by ensuring better continuity of care, detection of subtle changes in patients’ conditions, better communication with other practitioners and patient family, and clinical research (Kannampallil, Jones, Patel, Buchman, & Franklin, 2014). However, the problem is that modern hospitals and clinics lack statistical knowledge that would allow them making a relevant choice in sepsis treatment.

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Practice Issue

Sepsis belongs to the type of complex diseases associated with the increased number of complications and adverse side effects of a patient with slow recovery. The reason for this is the nature of the disease, which involves complication of a severe infection that leads to the systemic inflammatory response with 25-30% risk of mortality for severe sepsis and 40-70% for septic shock (Gauer, 2013). Therefore, in order to eradicate a patient’s mortality and complication risks, timely and relevant interventions are required among which is stabilization of the patient’s airway and breathing followed by restoration of perfusion to the peripheral tissues and administration of antibiotics (Schmidt & Mandel, 2017). In addition, experts admit that, in order to avoid septic shock and admission of the patient to the intensive care unit, a healthcare provider should start adequate antibiotic therapy. The term “adequate” means that the nurse or physician should select proper dosage and spectrum of an active agent (Kalil, 2016). Therefore, selection of a more relevantly trained health care practitioner may drastically change the patient’s outcomes, thus avoiding the risk of mortality and gravity of complications.

Background and Significance of the Problem

The significance of the research problem is based on the possibility of improving the systemic processes of care and treatment of sepsis. The major critical goal achieved after the validation of the proposed research method is the ability to provide timely and efficient treatment of sepsis. The researchers of the problem of sepsis treatment state that every hour of delay in administration of appropriate antimicrobials substantially increases the risk of patient mortality (Zilberberg & Shorr, 2015). In addition, in case the antimicrobial agent is selected timely but irrelevantly, the patient is endangered by the perspective of getting severe sepsis or septic shock (Vazquez-Guillamet et al., 2014). Consequently, when selecting more skilled personnel, clinics and hospitals would ensure timely and relevant treatment of sepsis of diverse gravity. Another issue associated with this solution is the increase of patient safety because of systemic inflammation and upregulation of coagulation caused by acute sepsis that requires administration of relevant anticoagulants (Zarychanski et al., 2015). Thus, safety issues might be significantly improved in case of providing a timely sepsis de-escalation therapy (Garnacho-Montero et al., 2013). Among the other positive changes are an increase of patients’ recovery process and a decrease of the risk of septic shock development. Therefore, diverse medical institutions would benefit from the outcomes of this research that allow bypassing the problem of the speed and quality of sepsis treatment.

The relevance of the research is increased due to the recent changes in the healthcare system of the US that aim at reducing staff shortage and increasing the quality of care and treatment. For example, diverse institutions increase entry barriers for obtaining qualified nurses and physician assistants with high levels of education (Gadbois, Miller, Tyler, & Intrator, 2015). Moreover, in case one group of medical practitioners is responsible for sepsis treatment, another would obtain the other responsibilities leading to the improvement of the organizational performance of the facility.

Problem Statement

According to the research design, its problem is to define whether one category of healthcare providers is more efficient when treating patients with sepsis. The answer to this problem would allow increasing the relevance of care by means of assigning more competent practitioners to departments responsible for treating sepsis.

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Hypotheses

The objective of the research is to define which of the two hypotheses regarding the efficacy of health care practitioners for treating sepsis is correct. The research work performed during hypothesis testing would incorporate planning, implementation, and achievement of the result, therefore, undertaking the research work (Kumar, 2016). The list of the hypotheses includes:

1) The assistance of the nursing staff to patients with sepsis is more efficient when compared to the one of physician assistants and allows reducing the risk of sepsis shock development and resultant mortality, and therefore achieving better health outcomes.

2) The assistance of physician assistants to patients with sepsis is more efficient when compared to the one of nurses and reduces the risks of sepsis shock development and resultant mortality, and therefore achieving better health outcomes.

Aim of the Project/Outcomes to Achieve

The aim of the project is to obtain empirical knowledge that allows estimating the efficacy of nurses’ actions in the treatment of sepsis as compared to that of physician assistants. The expected results would allow hospitals and clinics to reorganize the staffing policy, thus leaving the most efficient health care providers in sepsis treatment in departments that receive patients with sepsis. The outcomes of such change would promote health and well-being of the community and reduce mortality risks caused by acute sepsis and septic shock.

PICOT Question

In order to increase the validity of the research framework and obtained results, the investigation seeks the answer to the PICOT question. Such question format is beneficial for medical investigations because it fosters the formation of the research framework, assists in interpreting the results, and transforms the research findings into practice (Riva, Malik, Burnie, Endicott, & Busse, 2012). The question is, “In patients with sepsis diagnosis (P) would assistance of nurses (I) decrease the patients’ mortality risk and increase recovery time (O) in comparison with interventions provided by physician assistants (C) within a week after the patients’ admission (T)?”

Literature Review

The performed literature review demonstrates that, although diverse investigations analyzed factors that allow improving the efficacy of treatment of sepsis, no one of them addressed the need for staff competency analysis. For example, a study by Prescott, Calfee, Thompson, Angus, and Liu (2016) reveals that different health care practitioners characterize sepsis in different ways, which directly impact the speed and the quality of their further actions. Besides, scholars recognize that the competence of nurses and physician assistants directly impacts their choices of elements of antimicrobial therapy for patients with severe sepsis and septic shock (Yokota, 2014). The other research projects direct their focus towards systemic improvements associated with the enhancement of the toolkit available for those who treat sepsis. Among such projects is the one by Damiani et al. (2015) who propose improving patients’ outcomes by means of supplying sepsis bundles that allow reducing patient mortality rates. At the same time, the predominant part of these initiatives focuses on treatment substances failing to recognize a possible positive perspective of enhancing sepsis treatment process by means of assigning the most efficient practitioners. The adverse effect of such approach is that, although the offered treatment agents programs such as empiric antibiotic treatment offered by Ferrer et al. (2014) are efficient, their efficacy may reduce in the case they are implemented by less competent practitioners. Last, although some initiatives assess the efficacy of the impact of nurse practitioners and physician assistants’ competencies on the outcomes of their clinical domain, they evaluate factors that are irrelevant for this research. For instance, despite the fact that the research by Kahn et al. (2015) evaluates the relevance of work of both categories of health care providers, it does not contrast the outcomes of their interventions. Moreover, the investigation focuses on the aspect of surgical critical care, which is irrelevant to the problem of sepsis and septic shock. Therefore, the absence of evidence that analyzes and contrasts the efficacy of ways of sepsis treatment implemented by nurse practitioners and physician assistants validate the need for this project.

Research Question

The research question is, “Are nursing practitioners capable of providing timely, safe and more relevant treatment of sepsis when compared to the interventions of physician assistants?”

Methodology and Research Design

The selected PICOT question suggests that the research would take a quasi-experimental framework using qualitative-quantitative research method. The reason for selecting a qualitative part of methodology is that it seeks to understand the reasons (Ingham-Broomfield, 2014) that would allow enhancing the quality of sepsis treatment and reducing patient mortality ratios. The quantitative tools, such as number and statistical analysis, would enhance the use of the qualitative ones, such as surveys and interviews, thus narrowing the amount of the critical data. The dependent variable is patients’ mortality and recovery ratios whereas the independent variable is the efficacy of the two separately measured groups of practitioners. The project includes a comparison group and an intervention group as well as baseline characteristics, but lacks random assignment whereas its conditions are assigned by means of self-selection (White & Sabarwal, 2014). The aim of the research in this context is to reveal the statistic of a propensity score that would demonstrate the amount of positive/negative patient outcomes achieved by the representatives of the two participating groups. This framework allows avoiding any biased results (White & Sabarwal, 2014), which increases the relevance of the results of the research. Therefore, by selecting the quasi-experimental design of the study the research is expected to obtain valid rigor for further practical validation of experimental results.

Setting

The setting of the research is complex as it combines the results of work of specialists engaged in sepsis treatment in all facilities of the state. The statistic sample would be formulated on the basis of actions and outcomes of the two groups of practitioners acting independently.

Confidentiality

The results of the research would be strictly confidential and available only to the administration of hospitals and participating health care providers. At the same time, the patients participating in the research would be obliged to sign an informed consent letter.

Procedure/Intervention

The research framework estimates that the major practical interventions of the study used for obtaining statistic results would be surveys and interviews. The experiment would take three months and at the beginning of each month the participants should undergo an interviewing and surveying process. Their aim is to obtain information for tracking the research progress. Afterwards, the data will be collected and analyzed, and the results of the project should impact the staffing policy of the participating medical facilities.

Aligning Stakeholders

The project expects that the minimum number of practitioners engaged in treatment initiatives in both groups should be 40-50 individuals. Similarly, the number of the treated patients and their conditions should be aligned to have a quantity difference of less than 10%. These measures would allow revealing the objective results of the experiment.

Instruments/Scales and Measurement of Outcomes

The outcome measurement would be calculated on the basis of statistical results associated with the number of cases of patient recovery, development of acute sepsis, and morbidity. Thus, the calculations expect that the result of the research would be reflected through average propensity scores associated with each type of the patients’ state.

Data Collection and Data Analysis

As indicated above, data collection tools would include surveys and interviews that would enumerate stakeholders’ actions and patients’ outcomes. In order to increase the understanding of the staff efficacy and competence, the surveys would use yes/no questions, Likert scale, and open-ended questions. The obtained data would be analyzed using computer calculations and visually presented in forms of grids, graphs, and diagrams. The use of the visual analysis would allow exposing the most critical outcomes of the experiment.

Assumptions and Limitations

The project presumes that there would be no limitations for its implementation except for the barriers of distance between groups and the need for technical assistance for the calculation and analysis of the results. Therefore, in order to breach these barriers, a format of distant control should be used. It suggests using telephone conversations, video conferencing, and digital mailing systems to reach the participants and engage them in the research.

Conclusion

The proposed project is designed for boosting the level of hospital care and treatment of patients with sepsis. The performed literature review demonstrated that, although different scholars attempt to improve patient outcomes associated with sepsis, no research has focused on the aspects of human resource evaluation. This is why, the idea of this research is valid and has a potential for improving patient safety outcomes and reducing mortality risk associated with sepsis. Therefore, in case the performed project is successful, hospitals and clinics would obtain a useful recommendation that would enhance the quality of treatment of patients with sepsis.