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Nurses' Self‐Reported Practices and Prescribers' Expectations in Intravenous Fluid Therapy for Hospitalised Patients: A Survey Study and Clinical Documentation Review

ABSTRACT

Aims

To assess self-reported practices and knowledge of nurses and prescribers (i.e., physicians and nurse practitioners) on intravenous fluid therapy, and to evaluate how this is documented through a clinical documentation review.

Design

Multicentre cross-sectional study, between April 2022 and July 2022, across 13 wards from four Dutch hospitals.

Methods

A survey study was conducted to assess self-reported practices related to intravenous fluid therapy. A 12-item questionnaire evaluated knowledge. To gain insights into documentation practices, a retrospective chart review was performed. Data analysis involved descriptive statistics, with group differences analysed using the chi-squared test or Fisher's exact test, as appropriate.

Results

Three hundred and four healthcare professionals completed the questionnaire (92% nurses). The majority of prescribers (n = 20/25; 80%) expected that nurses would start, stop or change intravenous fluid therapy. Overall, the median number of correct answers to knowledge questions was eight (IQR 7–9, range 0–12); four participants (1%) answered all knowledge questions correctly. Knowledge about the composition of sodium chloride 0.9% solution was limited. Analysis of patient charts revealed that 54% (196/362) received intravenous fluids, most commonly 0.9% sodium chloride infusion (168/195; 86%), although the indication was described in 3% (6/196). Thirty-one percent (61/196) of patients received intravenous fluids to keep the vein open (< 30 mL/h).

Conclusion

The study identified shared responsibility, a knowledge gap, and limited documentation concerning intravenous fluids. Prescribers expect nurses to adjust intravenous fluids without consulting a prescriber, which aligns with what nurses do, although they are not legally authorised. Given the limited documentation of the indication for intravenous fluids, it is plausible that several patients received intravenous fluids unnecessarily.

Implications

The perceived shared responsibility presents an opportunity to develop a protocol engaging both prescribers and nurses, aiming to guide more targeted infusion therapy.

Impact

Reducing unnecessary infusions to keep-the-vein-open can help eliminate low-value care.

Reporting Method

CROSS guideline.

Patient or Public Contribution

No patient or public contribution.

Perceptions of Nurses, Patients, and Family Members on Rooming‐In in Adult Care: A Cross Sectional Survey Study

ABSTRACT

Aim

To better develop and understand the practice of rooming-in in adult care, this study aims to explore the perceptions of the three most important stakeholders: nurses, patients, and family members.

Design

A cross sectional survey study in a university medical centre in the Netherlands.

Methods

A convenience sample was drawn from nurses, adult patients, and family members across ten general wards. Data of patients and family members were collected through online questionnaires, developed and validated prior to the study. Their responses were summarised using descriptive statistics. For the nurses, data were obtained by analysing responses to an open-ended question from an existing questionnaire, using thematic analysis.

Results

The sample consisted of 364 nurses, 26 patients, and 35 family members. Thematic analysis of the nursing data revealed four themes: (1) reducing the workload of nurses, (2) optimising patient recovery, (3) unclear policy and inadequate facilities, and (4) complexities for nurses. Regarding the perceptions of patients and family members, more than 75% perceived that rooming-in enhanced patients' sense of safety. Additionally, 54.1% of family members indicated that rooming-in improved their understanding of medical information. For most patients (57.7%) and family members (62.9%), the rules and conditions for rooming-in were not clear. Moreover, 65.7% of family members reported experiencing physical burden. Both patients and family members rated rooming-in with a median of 8 out of 10.

Conclusion

According to nurses, patients, and family members, rooming-in may be beneficial in reducing nurses' workload, enhancing patient safety, and improving family understanding of medical information.

Implications for Clinical Practice

Given the ambiguity surrounding rooming-in policies in adult care, clear guidelines and their implementation are essential for ensuring their success.

Impact

Rooming-in can positively contribute to adult care by facilitating family involvement.

Reporting Method

STROBE statement.

Patient or Public Contribution

No patient or public contribution.

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