Effects of promoting nurses’ adherence to nursing practice guideline to prevent acute kidney injury in septic shock patients
Keywords:
nurses’ adherence, septic shock, acute kidney injury, nursing practice guidelineAbstract
The purpose of this applied action research was to study the effect of promoting nurses' adherence to the use of nursing practice guideline to prevent acute kidney injury in patients with septic shock. The theory of change was employed as a conceptual framework for this study. The study participants were 20 registered nurses working in medical intensive care units 1 and 2 at Khon Kaen Hospital; and 20 patients diagnosed with septic shock, who were admitted at Khon Kaen Hospital between August and November 2022, which was an equal proportion to number of nurses participating in the study.
The research instruments consisted of the nurse’s adherence to the use of nursing practice guideline assessment form, clinical outcomes of acute kidney injury in patients with septic shock evaluation form, and the nurse satisfaction on nursing practice guideline adherence promotion questionnaire. These instruments yielded the content validity index of 1.0, 0.97, and 1.0, respectively. The interrater reliability between the researcher and the research assistants was 0.90. The comparison between guideline adherence scores before and after adherence promotion was analyzed using McNemar's test.
The findings of this study showed that the intervention improved nurses' adherence to 9 out of a total of 14 nursing practice guideline items. This could be the outcome of the theory of change application that altered nurses' behavior regarding adherence to recommendations. After the intervention, the overall nurse adherence score significantly improved (p<.001). In addition, number of patients with improved mean arterial pressure and urine output were significantly (p <.0143 and p<.0253, respectively) increased, demonstrating the better clinical outcomes of acute kidney injury.
Regarding renal function, the mean serum creatinine, the proportion of hyperkalemia, and the proportion of acidosis significantly decreased (p<.0001, p<.0082, and p<.0455, respectively). According to the study's findings, it can be concluded that promoting nurses’ adherence to nursing practice guideline can reduce acute kidney injury in patients with septic shock, by modifying the nurses' behavior according to the guideline. This contributed to improve outcomes in patients with septic shock, particularly the absence of acute kidney injury.
References
Singer M, Deutschman CS, Seymour C, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA 2016; 315(8): 3227-337.
Yende S, Austin S, Rhodes A, Finfer S, Opal S, Thompson T, et al. Long-term quality of life among survivors of severe sepsis: Analyses of two international trials. Crit Care Med 2016; 44(8):1461-7.
Bellomo R, Kellum JA, Ronco C. Acute kidney injury. Lancet 2012;380(9843):756-66. doi: 10.1016/S0140-6736(11)61454-2. Epub 2012 May 21. PMID: 22617274.
Neyra JA, Li X, Canepa-Escaro F, Adams-Huet B, Toto RD, Yee J, et al. Cumulative fluid balance and mortality in septic patients with or without acute kidney injury and chronic kidney disease. Crit Care Med 2016;44(10):1891-900.
Khon Kaen hospital. Data and statistics of acute kidney injury in 2020 [Internet]. Khon Kaen: Khon Kaen hospital; 2020 [cited 2021 Aug 6]. Available from: https://www.kkh.go.th/nurse_c ategory/data-static/
Nie S, Feng Z, Xia L, Bai J, Xiao F, Liu J, et al. Risk factors of prognosis after acute kidney injury in hospitalized patients. Frontiers of Medicine 2017;11(3):393-402.
Khon Kaen hospital. Data and statistics of patients admitted in the medical intensive care unit 1 and 2 years 2021 [Internet]. Khon Kaen: Khon Kaen hospital; 2021 [cited 2021 Aug 6]. Available from: https://www. kkh.go.th/ nurse_category/data-static/
Lewin K. Resolving social conflicts and field theory in social science. Resolving social conflicts and field theory in social science. Washington, DC: American Psychological Association; 2004.
Williamson K, Johanson G. Action research: Theory and practice. In: Williamson K, Johanson G, editor. Research methods: Information, systems, and contexts [Internet]. Cambridge, MA: Elsevier, Chandos Publishing, an imprint of Elsevier; 2018 [cited 2021 Aug 6]. Available from: https://doi.org/10.1016/B978-0-08-102220-7.00008-X
Suebkinorn O, Methakanjanasak N. Effects of clinical nursing practice guideline to prevent acute kidney injury among critically ill trauma patients in Khon Kaen hospital. Journal of Nursing and Health Care 2019;37(2):208-17. (in Thai)
Rawangdee A, Methakanjanasak N. Effects of fluid management clinical nursing practice guideline (CNPG) on selected outcomes in patients with sepsis at emergency department, Chum Phae hospital. Journal of Nursing and Health Care 2020;38(1):32-41. (in Thai)
Porter CJ, Juurlink I, Bisset LH, Bavakunji R, Mehta RL, Devonald MA. A real-time electronic alert to improve detection of acute kidney injury in a large teaching hospital. Nephrology Dialysis Transplantation 2014;29(10):1888-93.
Satee A. The development of clinical nursing practice guideline in patients with acute kidney injury at inpatient services Ban Fang hospital. Journal of Khon Kaen Provincial Health Office 2021;3(2):177-91. (in Thai)
Valiee S, Salehnejad G. Barriers to and facilitators of nurses’adherence to clinical practice guidelines: A qualitative study. Creative Nursing 2020;26(1):1-7.
Vijayan A, Faubel S, Askenazi DJ, Cerda J, Fissell WH, Heung M, et al. Clinical use of the urine biomarker [TIMP-2]×[IGFBP7] for acute kidney injury risk assessment. American Journal of Kidney Diseases 2016;68(1):19-28.
Srihomjun K, Jitpanya C, Oumtanee A. Antecedent variables of organizational commitment of professional nurses: A meta–analysis. Royal Thai Navy Medical Journal 2018;45(2):216-34. (in Thai)
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