A Survey of Nurses' Knowledge, Attitudes and Beliefs about a Hospital-Wide Pragmatic Trial Evaluating FLUID Administration
CCCF ePoster library. McArdle T. 11/12/19; 283393; EP60
Tracy McArdle
Tracy McArdle
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Topic: Survey or Interview (quantitative or qualitative)

McArdle, Tracy1; McDonald, Ellen15; Weijer, Charles10; Taljaard, Monica1,3, Brehault, Jamie1; Schweitzer, Irwin1, Cook, Deborah J9; English, Shane W1,2; Fergusson, Dean1,3; Forster, Alan1; Fox-Robichaud, Alison4; Graham, Ian D1; Hawken, Steven1,3; Iyengar, Akshai11, Martin, Claudio5; Marshall, John6; Maybee, Alies12; Menon, Kusum7; McCartney, Colin14; Muscedere, John8; Saginur, Raphael11; Seely, Andrew JE1,14; Thavorn, Kednapa1,3; McIntyre, Lauralyn1,2,3,

1. Department of Epidemiology, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
2. Department of Medicine, Division of Critical Care, University of Ottawa, Ottawa, Ontario, Canada
3. School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
4. Department of Medicine, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
5. Division of Critical Care Medicine, London Health Sciences Centre, Western University, London Ontario, Canada
6. Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
7. Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
8. Department of Critical Care Medicine, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
9. Department of Medicine, Clinical Epidemiology and Biostatistics, St. Joseph's Healthcare Hamilton, McMaster University, Hamilton, Ontario, Canada
10. Rotman Institute of Philosophy, Western University, London, Ontario, Canada
11. Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
12. Patient Engagement Advisory Board, Bruyere Research Institute, Ottawa, Ontario, Canada
13. Department of Anesthesiology, The Ottawa, Hospital, Ottawa, Ontario, Canada
14. Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
15. McMaster University, Hamilton, Ontario, Canada

Background: FLUID is a hospital-wide pragmatic cluster cross-over randomized trial evaluating whether Ringer's lactate reduces death and re-admission to hospital compared to Normal Saline. The FLUID pilot trial included 4 centres and demonstrated feasibility of our design and execution.
Objectives: Due to FLUID's pragmatic and novel design (hospital-wide intervention, waiver of consent, requirement for nurses to implement an automatic fluid substitution), we surveyed clinical nurses at FLUID pilot centres to understand the effectiveness of FLUID communication strategies, as well as knowledge, attitudes and beliefs about FLUID's pragmatic trial design.
Methods: A web-based survey was developed targeting nurses who provided direct patient care at FLUID pilot centres by using hospital email distribution lists upon completion of the trial and was followed by 2 reminder emails. The survey was developed by the FLUID scientific team and piloted for clinical sensibility and readability with six nurses. The 5-minute survey included the following domains: nurse demographics, FLUID communication strategies and knowledge and attitudes and beliefs about FLUID's pragmatic design. Completion was voluntary. Data were anonymized, collected using a web-based survey platform. Communication effectiveness and knowledge, attitudes and belief questions about FLUID were answered using a 5-point Likert scale. Responses were described with counts and proportions and with mean and standard deviations or medians and interquartile ranges as appropriate. Posthoc, Likert scale responses were collapsed into 3 categories to enhance clarity of the results.
Results: A total of 500 nurses responded. 90% (451/500) of the respondents were Registered Nurses and 52% (258/500) were in practice for more than 10 years. The two most common reported nursing specialties were surgical 26% (128/500) and intensive care 18% (93/500). 73% (367/500) reported they were aware of the FLUID trial prior to study launch. The top four reported communication strategies were posters, word of mouth, email and nurse educators (very effective/effective: 82% (411/500), 78% (389/500), 73% (364/500), and 72% (362/500) respectively). The majority of nurses reported being comfortable performing the automatic substitution order (agreed/strongly agreed 88% (440/500)). 63% (314/500) of nurses agreed/strongly agreed they were prepared to answer questions from patients/families about the FLUID trial. Although 72% (362/500) agreed or strongly agreed that waiver of consent was appropriate, 8% (41/500) disagreed or strongly disagreed. Over the course of the two study periods, 98% (489/500) of nurses reported either never receiving resistance (72%) or receiving resistance from ≤ 5 different physicians (26%) when performing the automatic substitution. Furthermore, 72.0% (360/500) of nurses reported never/rarely encountering Do Not Substitute Orders from the treating physicians.
Conclusions: Registered Nurses at participating FLUID pilot centres reported a high level of FLUID awareness and knowledge as well as overall comfort performing study related tasks such as automatic fluid substitution. Communication to enhance pre-study implementation awareness can be improved for the larger trial. A future qualitative study to gain further perspective from this key stakeholder group on FLUID's design (including waiver of consent) and its implementation may further inform the design and execution of future similar trials.

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