Emergency nurses’ experiences of the implementation of early goal-directed fluid resuscitation therapy in the management of sepsis

Mrs Gladis Kabil1,2,3, Dr Stephen McNally2, Professor Deborah Hatcher2, Dr Evan Alexanadrou2

1Australian Catholic University, North Sydney, Australia, 2Western Sydney University, Parramatta, Australia, 3Emergency Department Westmead Hospital, Westmead, Australia

Background: Severe sepsis can lead to multiple organ failure and death if intravenous fluids are not commenced within the first hour. The time critical nature of the initiation of intravenous fluids is not always given its deserved priority. Whilst a large number of studies have analysed administration of first dose antibiotics, studies have not explored factors inhibiting timely intravenous fluids and the experience of emergency nurses related to the initiation of early goal-directed fluid resuscitation (EGDFR).

Aim: To explore the experiences of emergency nurses related to the initiation of EGDFR in the care of patients with sepsis

Methods: A qualitative exploratory approach, encompassing face to face semi-structured interviews was used for data collection. Ten registered nurses currently practicing in emergency settings across NSW were interviewed. Braun and Clarke’s (2006) thematic analysis framework guided the data analysis.

Results: Three main themes with subthemes were identified: 1. Nurses’ perceptions and experiences regarding IVF administration in sepsis: a) Controversies regarding the importance of IV fluids in sepsis; b) Patients become more unwell; c) How much IVF should we give?; d) Unforgettable patient stories; e) Department’s compliance with protocols; f) We actually initiate fluids anyway. 2. Challenges related to initiating fluids: a) Undiagnosed sepsis; b) Ever busy, over-crowded , under-staffed ED; c) Complex patient ; d) There’s an “I’m a doctor, you’re a nurse”; e) Nursing skill level and expertise; f) My hands are tied- limited scope of practice. 3. Strategies to improve compliance with EGDFR: a) Nurse-initiated IV fluids, b) A simpler and clearer sepsis pathway; c) More personnel and technical resources; d) Education and training; e) Advanced skill training.

Conclusion: The outcomes of this research will provide an impetus for re-evaluating current protocol guidelines and provide a positive impact on the scope of emergency nurse practice empowering them to initiate EGDFR.


Gladis is an emergency nurse working at Westmead Hospital, Western Sydney. She has worked clinically across several settings predominantly in the emergency department. She works as a Lecturer in Nursing at Australian Catholic University, North Sydney and is the Lecturer-in-charge for final year acute nursing care unit.  She completed her Master in Nursing at Western Sydney University in 2016. She is currently in the final stages of her Master in Research at Western Sydney University. Her clinical experience with controversies around fluid management in sepsis patients has prompted the current study exploring emergency nurses’ experiences of fluid resuscitation in the management of sepsis.