Examining intensive care nurses' clinical decision-making associated with acute kidney injury and continuous renal replacement therapy (Conference Abstract)

Introduction: Acute kidney injury (AKI) is a complex disorder which impacts upon patient morbidity and mortality, especially among critically ill adults. The increasing numbers of AKI patients in intensive care unit (ICU) settings and the complex treatment creates a greater need for nurses to make timely and safe clinical decisions. To date there have been no studies examining ICU nurses’ clinical decision-making when providing continuous renal replacement therapy (CRRT). Study objectives: To understand how ICU nurses make clinical decisions that inform their actions when managing AKI patients and CRRT. Method: A single explanatory case-study design was used. Over a six month period, 29 nurses working in ICU were observed while caring for patients who were receiving CRRT. Observations were followed by individual semi-structured interviews. Data were analysed thematically. Results: One of the four themes identified involved complexity of performance with CRRT technology. This theme showed how ICU nurses make clinical decisions, and take action, in answer to AKI patient deterioration and CRRT issues. Two sub-themes emerged: recognising and responding to critically ill AKI patient conditions and CRRT problems. ICU nurses’ performance varied between working rapidly, slowly and incompetently to identify and act on CRRT problems. Conclusion: A high level of professional competence is crucial for ICU nurses to manage the complexity of critically ill AKI patients and CRRT technology. This study suggests that there is a need for ongoing education, competency development and training evaluations with CRRT technology and the deteriorating AKI patient