Nursing Students' Understanding of Neonatal Sepsis Early Warning Signs in Clinical Settings, Lahore

Abstract

Neonatal sepsis remains a leading and largely preventable cause of neonatal mortality in low- and middle-income countries, and the early recognition of its warning signs is a core nursing competency upon which newborn survival frequently depends. This study examined nursing students' understanding of neonatal sepsis early warning signs in clinical settings in Lahore, Pakistan, and the pathways through which knowledge and observational competence translate into clinical action. Grounded in a positivist, quantitative paradigm and informed by Benner's Novice to Expert model, Kolb's Experiential Learning Theory, and Bandura's Social Cognitive Theory, a cross-sectional survey was conducted among 352 Post-RN and BSN nursing students undertaking clinical rotations at Jinnah Hospital and Gulab Devi Hospital. Data were collected using a structured, five-point Likert questionnaire measuring four constructs: Neonatal Sepsis Knowledge (NSK), Clinical Observation Skills (COS), Early Warning Recognition (EWR), and Clinical Response Behavior (CRB). Data were analysed in SPSS version 25 using descriptive statistics, Cronbach's alpha reliability analysis, Pearson correlation, linear regression, and mediation analysis using Hayes' PROCESS macro (Model 4) with 5,000 bootstrap samples. All scales demonstrated strong internal consistency (α = 0.879–0.934). Participants reported moderate-to-high scores across the four constructs, and all study variables were significantly and positively correlated. Regression analyses supported all direct hypotheses, while mediation analyses confirmed that Early Warning Recognition partially mediated both the NSK→CRB and COS→CRB pathways. The findings indicate that theoretical knowledge and observational skill are necessary but insufficient for competent clinical response unless operationalised through accurate recognition of sepsis warning signs. The study recommends the integration of dedicated neonatal sepsis modules, structured early warning scoring systems, and simulation-based experiential learning into nursing curricula in Lahore.