A DESCRIPTIVE STUDY TO ASSESS COMPETENCIES OF STAFF NURSES RELATED TO FLUID AND ELECTROLYTE IMBALANCES.

assess Three of and The collected from 120 selected probability purposive using and The study revealed that maximum staff below average level of knowledge and in terms of interpretation, 44.17% staff nurses had below average level of interpretation. A moderate positive correlation (0.47) was found between knowledge and interpretation. Professional qualification had significant relationship with interpretation (at p< 0.05). Maximum deficit in terms of knowledge and interpretation was in risk for developing hypernatremia (87.5%) and nursing intervention for hyponatremia (89.17%) respectively. It was concluded that maximum deficit was in the areas of electrolyte imbalances. Therefore, an In-Service Education was conducted for the staff nurses of the selected hospital.


Body fluids and electrolytes play an important role in homeostasis.
Homeostasis is the state of equilibrium in the internal environment of the body. Disturbances in fluid and electrolytes are among the most common clinical problems encountered in the intensive care units. A descriptive study was conducted to assess competencies of staff nurses (in terms of knowledge and interpretation) related to fluid and electrolyte imbalances in a selected hospital, Ludhiana, Punjab. A qualitative research approach and non-experimental descriptive design was adopted for the study. Conceptual framework was based on Three Phase Learning Theory by Fitts and Posner, 1967. Data was collected by using a Competency Assessment Tool of Fluid and Electrolyte Imbalances (CATFEI) which was found reliable (r=0.77). The collected data from 120 staff nurses selected by non-probability purposive sampling technique was analyzed using descriptive and inferential statistics. The study revealed that maximum staff nurses (41.67%) had average level of competency. In terms of knowledge, 35.83% staff nurses had below average level of knowledge and in terms of interpretation, 44.17% staff nurses had below average level of interpretation. A moderate positive correlation (0.47) was found between knowledge and interpretation. Professional qualification had significant relationship with interpretation (at p< 0.05). Maximum deficit in terms of knowledge and interpretation was in risk for developing hypernatremia (87.5%) and nursing intervention for hyponatremia (89.17%) respectively. It was concluded that maximum deficit was in the areas of electrolyte imbalances. Therefore, an In-Service Education was conducted for the staff nurses of the selected hospital.

…………………………………………………………………………………………………….... Introduction:-
"Water is essential for life, and maintaining the correct balance of fluid in the body is crucial to health" [1]. Fluid balance is a term used to describe the balance of the input and output of fluids in the body to allow metabolic processes to function correctly [2]. Some fluid and electrolyte imbalances are directly caused by illness or disease (e.g. burns, heart failure). At times, therapeutic measures (e.g. IV fluid replacement, diuretics) cause or contribute to fluid and electrolyte imbalances ISSN: 2320-5407 Int. J. Adv. Res. 6(6), 376-382 377 [3]. It is the responsibility of the nurse caring for a patient to ensure observations and fluid balance are recorded in a timely manner, with any abnormal findings documented and reported to the nurse in charge [4].
Recent studies have reported that fluid and electrolyte imbalances are associated with increased morbidity and mortality among critically ill patients. To provide optimal care, health care providers should be familiar with the principles and practice of fluid and electrolyte physiology and pathophysiology [5].
Competency is defined as "The ability to demonstrate the application of knowledge, understanding, practical and thinking skills to achieve effective performance in a professional role. This involves problem solving and being sufficiently flexible to meet changing demands." [6].

Need of the study:-
It is the responsibility of the nurse caring for a patient to ensure observations and fluid balance are recorded in a timely manner, with any abnormal findings documented and reported to the nurse in charge [7]. Recent studies have reported that fluid and electrolyte imbalances are associated with increased morbidity and mortality among critically ill patients. To provide optimal care, health care providers should be familiar with the principles and practice of fluid and electrolyte physiology and pathophysiology. [8] Competencies are an important part of a continual process to ensure that the organization provides a high-quality care to its customers and patients. Since many diseases and their treatments have the ability to affect fluid and electrolyte balance. It is important for the nurses to anticipate the potential for alterations in fluid and electrolyte balance associated with certain disorders and medical therapies, to recognize the signs and symptoms of imbalances, and to intervene with the appropriate action. Hence the investigator felt the need for assessing and improving competencies of staff nurses in identifying and dealing patients with fluid and electrolyte imbalances.

Research Problem:-
A Descriptive Study to Assess Competencies of Staff Nurses related to Fluid and Electrolyte Imbalances in a Selected Hospital, Ludhiana, Punjab. Reliability of the tool:-Reliability of the tool was computed by applying split half (odd-even) method and was calculated by Karl Pearson's co-efficient correlation and Spearman Brown Prophecy formula and was found r'=0.77.

Results:-
The analysis was done using descriptive and inferential statistics.
Finding related to sample characteristics:-Maximum staff nurses were in the age group of 26-30 years (49.17%), 74.17% were females, 68.33% did GNM, 42.5% had a total of >5 years of total professional experience, 69.17% were working in Intensive Care Units and 39.17% got information related to fluid and electrolyte imbalances through textbooks/classroom teachings (Table  1).

Findings related to competencies in terms of knowledge and interpretation of staff nurses related to fluid and electrolyte imbalances:-
Maximum staff nurses 41.67% were found to have average level of competency (Fig 1). In terms of knowledge, maximum staff nurses 35.83% had below average level of knowledge. In terms of interpretation, maximum staff nurses 44.17% had below average level of interpretation.

Findings related to correlation of knowledge and interpretation:-
The mean of knowledge score was 10.73 and mean of competency score was 9.87. A moderate positive correlation (0.47) between knowledge and interpretation was found.
Findings related to relation of competencies of staff nurses related to fluid and electrolyte imbalances with various personal and professional factors:-Highest mean interpretation score (11.86) was found among staff nurses who did Post Basic B.Sc. Nursing. Analysis was done with analysis of variance. It was statistically significant at p<0.05 level which shows that professional qualification had an impact on interpretation score of staff nurses related to fluid and electrolyte imbalances.

Findings related to Deficits in Competencies of Staff Nurses related to Fluid and Electrolyte Imbalances:-
It was found that staff nurses had maximum competency score in interpretation of fluid imbalances and were least competent to interpret electrolyte imbalances ( Table 2 & Fig. 2) In terms of knowledge, risk for developing hypernatremia in electrolyte imbalances has maximum deficit (87.5%) ( Table 3) whereas in terms of interpretation, nursing intervention for hyponatremia in electrolyte imbalances has maximum deficit (89.2%) ( Table 4). Hence, from the above findings, it was concluded that maximum deficit was in the areas of electrolyte imbalances.    Conclusion:-Disturbances in fluid and electrolytes are among the most common clinical problems encountered in the intensive care unit (ICU). To provide optimal care, health care providers should be familiar with the principles and practice of fluid and electrolyte physiology and pathophysiology. The study concluded that most of the staff nurses had an average level of competency related to fluid and electrolyte imbalances. Staff nurses were least competent to interpret electrolyte imbalances. Implementation & evaluation of ongoing in-service education on competencies regarding fluid and electrolyte imbalances for staff nurses posted in critical care areas and general wards was 382 recommended to improve their competencies regarding fluid and electrolyte imbalances. This will ensure immediate identification and management of such imbalances and quality assurance in health.

Discussion:-
The analysis of the data revealed that maximum staff nurses had average (41.67%) and low (40.83%) levels of competencies related to Fluid and Electrolyte Imbalances. In terms of knowledge, maximum staff nurses 35.83% had below average level of knowledge and in terms of interpretation, maximum staff nurses 44.17% had below average level of interpretation. These findings were supported by Van De Vreede et al (2008) 9 who states that nurses could make medication errors because they do not have sufficient knowledge and practice about intravenous potassium administration and medication safety. These errors may cause fatalities and incidents. The findings were also supported by Mogileeswari P, Ruth Grace M. (2016) [10] who states that 15 staff nurses (15%) had adequate knowledge, 62(62%) had moderately adequate knowledge and 23(23%) had inadequate knowledge. The study also showed practice regarding fluid and electrolyte replacement therapy for patient with burns among nurses. 37(37%) had safe practice, 42(42%) had moderately safe practice and 21(21%) had unsafe practice.
The relationship between knowledge and interpretation was found to be moderate positive (0.47) for the present study. This was supported by Alex J (2010) [11] who revealed that there exist a positive correlation between knowledge and practices of staff nurses regarding anticoagulant drugs. This was also supported by Wynne N, Brand S & Smith R (1997) [12] who suggests that scientific knowledge gives nurses greater potential in understanding and performing nursing care.