A survey of the knowledge and practices of nursing students of Mbarara University of Science and Technology around Monitoring Fluid Requirements for burns patients on surgical ward at Mbarara Regional Referral Hospital

Burns present a serious public health threat causing an estimated 180,000 deaths annually with majority of these occurring in low- and middle-income countries [1]. In 2018, nearly 11 million people were burned severely enough to require medical attention [2]. According to a scoping review by Mukagaju and colleagues, between 1993 and 2019, 44,369 patients with burns were reported in East Africa [3]. Mortality of burns has declined in the past decades but people living in the middle- and low-income countries still face a challenge [4]. Despite the high incidence of burns in sub-Saharan Africa, health care providers skilled in burns care are rare, and there is a need to scale up proper training to manage such patients [5]. Management of burns patients involves both immediate care and long-term care. The initial management requires prioritization of the airway, breathing, and circulation, with the goals of long-term care including closure of the wound, management of the hypermetabolic response, and prevention of infection and multiple organ dysfunction [1]. It is widely accepted that fluid loss is one of the major problems faced following major burns. Appropriate fluid management directly improves the prognosis and outcome of burns patients [6]. According to the American Burn Association guidelines, adult and paediatrics patients with burns of greater than 20% total body surface area (TBSA), should receive fluid resuscitation based on their weight and surface area burnt [7, 8].

However, little is known about the knowledge and understanding of nursing students towards appropriate fluid resuscitation monitoring. A recent experimental study found a health education program to improve nurses’ knowledge surrounding fluid and electrolyte replacement [9].

Inaccurate monitoring of fluid balance, especially in burns patients, may worsen the patients’ condition. This study aimed to examine the knowledge and practices of clinical nursing students at MUST around the monitoring of adult burns’ patients in the surgical ward of Mbarara regional referral hospital (MRRH).

Overall, we received 37 responses (64.9% response rate). Most students were aged 20 -24 years and more than half of the students were female (21, 56.7%) and pursuing BNC (19, 51.4%). 64.9% of the students surveyed were single. The majority of the students (23, 53.2%) had spent more than one semester on a surgical ward (See Table 1).

This study was designed to assess the knowledge and practices of MUST nursing students around fluid monitoring in hospitalised burns patients on the surgical ward at MRRH. We generally found that nursing students had insufficient knowledge and poor practices. This is the first study looking at the knowledge and practices of nursing students regarding monitoring of fluid requirements for adult burns patients in Uganda. The findings of our study are consistent with pre-intervention findings of prior similar studies [9, 10]. These found poor knowledge regarding monitoring of fluid replacement for burns patients among nurses prior to enrollment in interventional educational program.

Three quarters of the students managed to pass each of the two out of ten knowledge questions concerning monitoring fluid replacement of burns patient. Only 13.51% of the participants knew the basic steps in the fluid replacement process. Given that knowledge of fluid balance is very important in guiding nurses when caring for critically ill patients [11], our identified knowledge gap, warrants further study as students with insufficient knowledge may cause greater harm than benefit to patients.

When looking at fluid administration our study produced results that corroborate previous studies. These found nurses have difficulty in using formulae for fluid replacement [9, 12]. Parkland’s formula is a commonly used method to estimate the amount of fluid required to adequately resuscitate burns patients in the first 24 hours of acute burn injury basing on their burnt estimated total body surface [13]. 16.2% of our study participants were able to correctly state Parklands’ formula, while 48.7% of the students were able to select the right fluid requirement in a set scenario using the Parkland formula. Some students may have correctly guessed an answer to the scenario presented to them, producing contradicting results. Interventional studies might address this knowledge gap.

In our study, we could not completely confirm this but we think lack of prior training around fluid and electrolyte replacement for burns patients and the limited number of semesters rotated on surgical ward, one semester (14, 37.8%) and 2 semesters (11, 29.7%), may be the cause of lack of sufficient knowledge amongst surveyed students. Further research will be needed to confirm or disapprove this.

In contrast, Kanakalakshmi [14], found more than one third of the working nurses followed safe practices regarding fluid and electrolyte replacement therapy. Our study found a significant proportion of students displaying safe practices regarding fluid replacement for burns patients. More than three quarters of students reported having performed each of six out of the eleven safe practices. There is a need to observe these students and assess to see if these practices were performed correctly.

However, with a small sample size, caution must be taken. Our findings may not be transferable to nursing students at Mbarara University and in Uganda generally.

We were unable to clearly determine the degree of burns which our participants had taken care of.

The aim of this study was to determine the knowledge and practices of nursing students around fluid monitoring in burns patients. Despite its descriptive nature, our investigation has shown that nursing students have poor knowledge and fair practices regarding fluid replacement in this patient cohort. Teaching institutions should have periodic surveys of their students’ clinical skills to ensure that they are following appropriate guidelines. In-order to improve the survival rates of burn patients, appropriate fluid management of major burns is crucial.

The aim of this study was to assess the level of knowledge and the practices of nursing students around fluid replacement in burns patients. Despite its descriptive nature, our investigation has shown that nursing students surveyed at MUST have poor knowledge and fair practices regarding fluid replacement in this patient cohort.

There is need for supplementary fluid balance monitoring and replacement educational trainings designed to help hone the clinical skills of nursing students that responded to our survey.

We recommend that more teaching institutions in Uganda to survey clinical skills of their nursing students in order to confirm or refute findings of our survey.