Development of nursing practice guidelines for prevention acute limb ischemia among sepsis patients treated with norepinephrine

Abstract

Acute limb ischemia (ALI) is a serious complication resulting from the administration of norepinephrine. Clear nursing practice guidelines are necessary to prevent this condition. This action research aimed to study the current situation, develop, and evaluate the implementation of nursing practice guidelines to prevent this complication in patients with sepsis in the Medical Intensive Care Unit 3 of Mahasarakham Hospital by using the Kemmis and McTaggart’s framework. Participants included 12 registered nurses and 160 patients with sepsis. The research tools consisted of a focus group discussion guide, patient data and clinical outcome recording forms, a nurse knowledge assessment (KR-20 = 0.70), a nursing practice evaluation form (inter-rater reliability=0.83), and a satisfaction questionnaire (Cronbach's alpha = 0.83). Results showed that, after three cycles of action research, nursing practice guidelines were developed comprising four key activities: 1) Continuous monitoring, 2) Strictly slow drug administration, 3) Selection and care of intravenous access sites and management of ALI if it occurs, and 4) Treatment plan review and urine output documentation. Following implementation, the incidence of ALI was not found. Nurses demonstrated significantly increased knowledge in ALI prevention nursing care (p<.01), practiced with accuracy and comprehensiveness, and reported high satisfaction (\bar{x}=4.33, SD=0.45). Therefore, the developed nursing practice guidelines can be effectively applied to prevent ALI in patients receiving norepinephrine.