Nurses’ Performance on Intravenous Fluid Therapy and Associated Factors for Adult Medical-Surgical Patients in Kisumu County, Kenya

Abstract

Context: Adult inpatients need intravenous fluid therapy to prevent or correct fluid and electrolyte status. Global surveys on nurses' performance in intravenous fluid therapy revealed considerable gaps in knowledge and skills, highlighting an urgent need for education and awareness regarding intravenous fluids.

Aim: The study aims to determine nurses’ performance on intravenous fluid therapy and associated factors for adult patients in selected referral hospitals in Kisumu County, Kenya.

Methods: This study employed a cross-sectional analytical design. The study area was selected from hospitals in Kisumu County. The study population included nurses working in medical and surgical units. A total of 110 nurses were included in the study. The data were analyzed using SPSS version 28. The tools utilized were a structured interview questionnaire that collected data on respondents' demographics and knowledge of intravenous fluid, and an intravenous fluid administration checklist with 20 steps of intravenous fluid administration adopted from the Nursing Procedure Manual of the Nursing Council of Kenya.

Results: A total of 110 nurses participated in the study. Most respondents were aged between 31 and 40 years (55.4%); the majority, 62.7%, worked in surgical units. The majority of participants had a high level of knowledge, at 74 (67.0%). According to the checklist, 96.4% of nurses were able to review patients' records to verify intravenous fluid orders and medical histories, and 87.3% explained the procedure to patients. Preparation of the infusion bag which included verification of expiry date, placing bag on a flat surface, removing protective cap from the tubing, insertion of spike, hold port firmly with one hand then insert spike with other hand, priming tubing, calculation of drops and regulation of drops, inspect the IV site for complication, leaving patient comfortable and clears equipment was done by all the participant 110(100%), documentation of condition of IV site and any change of dressing (0.0%), and documentation of flow rate (0.0%) was poorly done 108(98.2%) did not label the infusion bag, 70.9% did not document patient's condition during and after infusion, 56.4% did not evaluate fluid intake and output charts, overall 59.1% had unsatisfactory performance. Only work experience (p=0.05) was significantly associated with the level of nurses’ performance.

Conclusion: The study concludes that nurses possess a high level of knowledge but a low level of practice in intravenous fluid therapy, with documentation being a particular area of concern, as evidenced by the respondents' inadequate documentation. The study recommends that nurses should be encouraged to participate in continuing professional development to stay updated on the latest knowledge and guidelines in intravenous fluid therapy. Additionally, the units should have an intravenous fluid mentor to provide guidance, aiming to improve performance.