Sepsis Knowledge Gaps Shape How ICU Nurses Make Critical Decisions

Sepsis remains one of the most feared and fastest-moving conditions in modern medicine, and in the intensive care unit it is the nurses who stand at the front line of recognition. A new cross-sectional study from Türkiye, published in BMC Nursing, offers a detailed portrait of how much intensive care nurses actually know about sepsis, and how that knowledge connects to the way they make clinical decisions and exercise professional autonomy. The findings are both encouraging and sobering: trained nurses know more, exposure to septic patients matters enormously, and yet significant gaps persist in exactly the areas where minutes can mean the difference between recovery and organ failure.

The research team, led by Betülay Kılıç of the University of Health Sciences’ Gülhane Faculty of Nursing in Ankara, together with colleagues from Gazi University and Başkent University, set out to answer a question that has been surprisingly underexplored. While nurses’ knowledge is widely acknowledged as fundamental to early sepsis recognition and timely management, its relationship with nursing decision-making styles and professional autonomy had not been systematically quantified. The team surveyed 125 of 143 eligible intensive care nurses working at a university hospital, achieving a response rate of 87.4 percent through a total population sampling approach, and reported the work in accordance with the STROBE guidelines for observational studies.

The participants were a relatively young cohort, with a mean age of 30.06 years and a standard deviation of 5.6, suggesting a workforce with substantial career years ahead but potentially limited accumulated clinical experience. Each nurse completed three validated instruments: the Sepsis Knowledge Questionnaire, which probes understanding of sepsis definitions, recognition criteria, and management principles; the Nursing Decision-Making Instrument, which distinguishes between intuitive and analytical decision-making tendencies; and the Attitude Toward Professional Autonomy Scale, which measures how independently nurses view their own clinical role. The data were analyzed using descriptive statistics, non-parametric group comparisons, Spearman’s rank correlation, and multiple linear regression.

The headline number from the study is a mean sepsis knowledge score of 20.24 out of a possible 30, with a standard deviation of 4.21. On its face, that suggests a workforce with a reasonable working grasp of sepsis, but the aggregate figure conceals what the researchers describe as notable knowledge gaps across several recognition and management items. In sepsis care, such gaps are not academic. The condition progresses from infection to systemic inflammation, tissue hypoperfusion, and multi-organ dysfunction along a timeline measured in hours, and international survival campaigns have repeatedly emphasized that every hour of delayed recognition and treatment increases mortality. A nurse who misidentifies early warning signs, or who misunderstands fluid resuscitation targets or the significance of falling mean arterial pressure, may inadvertently contribute to that delay.

One of the most intriguing findings concerns the relationship between knowledge and decision-making style. Sepsis knowledge showed a weak but statistically significant positive correlation with the total score on the Nursing Decision-Making Instrument, with a Spearman’s rank correlation coefficient of 0.239 and a p-value of 0.007. The direction of that instrument matters: higher scores indicate a greater tendency toward intuitive rather than analytical decision-making. In other words, nurses with stronger sepsis knowledge in this sample leaned more heavily on intuition, a pattern the authors’ data link to expertise, since intuitive judgment in clinical settings is generally understood to be built on a foundation of accumulated knowledge and pattern recognition rather than on guesswork.

The study also found a weak positive correlation between sepsis knowledge and work-related independence, one of the dimensions of professional autonomy, with a coefficient of 0.220 and a p-value of 0.013. Critically, both of these associations survived the researchers’ correction for false discovery rate, with adjusted p-values of 0.034 for each. This statistical rigor matters in a field where small correlation coefficients can easily evaporate under multiple-comparison corrections. The persistence of these relationships suggests, cautiously, that knowledge, confident judgment, and a sense of professional independence travel together in the intensive care setting, forming a cluster of attributes that may reinforce one another in daily practice.

The multivariable regression analysis sharpened the picture of what actually drives sepsis knowledge. After adjusting for other factors, previous sepsis training was independently associated with higher knowledge scores, adding 1.799 points on the 30-point scale with a p-value of 0.025. Even more striking was the effect of clinical exposure: nurses who had never cared for patients with sepsis scored 3.473 points lower than those who cared for septic patients frequently, a difference with a p-value of 0.037. The magnitude of that exposure effect, nearly double that of formal training, underscores a point that educators and hospital administrators would do well to internalize. Classroom instruction builds knowledge, but the bedside encounter with a deteriorating septic patient appears to cement it.

These results arrive at a moment when sepsis continues to burden health systems worldwide. The World Health Organization has identified sepsis as a global health priority, and the condition’s dependence on rapid, coordinated frontline response makes nursing staff pivotal to any improvement strategy. In the intensive care unit, nurses continuously monitor vital signs, interpret trends in systolic blood pressure and mean arterial pressure, administer antibiotics and fluids, and escalate concerns to physicians. When their knowledge base is solid, they function as an early warning system; when it is not, the safety net develops holes precisely where patients are most vulnerable.

The authors are careful about the limits of their work, and those limits deserve emphasis. The study was conducted at a single university hospital, which means the findings may not generalize to community hospitals, rural facilities, or different national health systems. The cross-sectional design captures a single moment in time, so it can demonstrate association but not causation: the data cannot tell us whether sepsis training causes higher knowledge, whether more knowledgeable nurses seek out training, or whether unmeasured factors such as motivation drive both. The modest correlation coefficients, while statistically robust, also indicate that knowledge explains only a small share of the variation in decision-making style and autonomy. The researchers explicitly recommend interpreting the findings in light of these design constraints.

Even with those caveats, the practical implications are clear and actionable. The independent associations between structured sepsis education and higher knowledge, and between clinical exposure and higher knowledge, point toward a two-pronged strategy: evidence-based sepsis training programs paired with practice-oriented learning opportunities that guarantee nurses genuine exposure to septic patients, whether through rotations, simulation, or deliberate case-based education. For a condition in which the first hours decide outcomes, investing in the knowledge, judgment, and autonomy of the nurses who watch over critically ill patients around the clock may be among the most cost-effective interventions available. The study, published open access with a permanent DOI, invites hospital leaders and nursing educators alike to look hard at their own units and ask whether their frontline staff are being given both the training and the bedside experience that sepsis care demands.

Subject of Research: Sepsis knowledge, clinical decision-making, and professional autonomy among intensive care nurses

Article Title: Factors associated with sepsis knowledge and its relationship with clinical decision-making and professional autonomy among intensive care nurses: a cross-sectional study

Article References: Kılıç, B., Tosun, M. H., Yardımcı Gürel, T., & Candan Yamak, Z. (2026). Factors associated with sepsis knowledge and its relationship with clinical decision-making and professional autonomy among intensive care nurses: a cross-sectional study. BMC Nursing. https://doi.org/10.1186/s12912-026-05384-3

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05384-3

Keywords: sepsis, intensive care nursing, clinical decision-making, professional autonomy, nursing education, cross-sectional study, critical care, knowledge gaps, Sepsis Knowledge Questionnaire, early recognition, BMC Nursing, STROBE