Perioperative fluid management and associated complications in children receiving kidney transplants in the UK.

BACKGROUND: Intravenous fluid administration is an essential part of perioperative care for children receiving a kidney transplant. There is a paucity of evidence to guide optimal perioperative fluid management. This study aimed to identify the volume of perioperative fluids administered across 5 UK paediatric kidney transplant centres and explore associations between fluid volume administered, graft function, and fluid-related adverse events. METHODS: Data were collected from five UK paediatric kidney transplant centres on perioperative fluid volumes administered, and incidence of pulmonary oedema, systemic hypertension, and requirement for intensive care support. Children < 18 years of age who received a kidney-only transplant between 1st January 2020 and 31st December 2021 were included. RESULTS: Complete data from 102 children were analysed. The median total volume of fluid administered in 72 h was 377 ml/kg (IQR 149 ml/kg) with a high degree of variability. A negative relationship between total fluid volume administered and day 7 eGFR was noted (p < 0.001). Association between urine volume post-transplant and day 7 eGFR was also negative (p < 0.001). Adverse events were frequent but no significant difference was found in the fluid volume administered to those who developed an adverse event, vs those who did not. CONCLUSIONS: This study describes a high degree of variability in perioperative fluid volumes administered to children receiving kidney transplants. Both fluid volume and urine output were negatively associated with short-term graft function. These data contrast traditional interpretation of high urine output as a marker of graft health, and highlight the need for prospective clinical trials to optimise perioperative fluid administration for this group. A higher resolution version of the Graphical abstract is available as Supplementary information.

A case study of frontline nurse leadership informed by complex responsive processes of relating.

AIMS AND OBJECTIVES: To understand the social construction of frontline nurse leadership and how power operates at this level. BACKGROUND: It is argued that frontline nurse leaders are central to the negotiation of care. Evidence suggests they feel ill-equipped to lead and lack confidence in their ability to do so. Disempowerment has been proposed as a barrier to effective ward leadership. There is a lack of studies about daily frontline leadership practice. DESIGN: Single instrumental case study with embedded cases. METHODS: A purposive sample of one acute National Health Service Trust, with a convenience sample of embedded cases, was selected. Multiple methods of data collection were used including semi-structured interviews, nonparticipant observations, field notes and documentary evidence. Thematic analysis using constant comparison and categorisation of data within, between and across cases was used to generate a theory of ward leadership in its organisational context. COREQ Checklist compliant. RESULTS: These findings suggest the frontline nurse leaders' power is a dynamic and situation-dependent phenomenon that shapes and is shaped by ongoing interactions between stakeholders in the NHS. In these interactions, power ebbs and flows. These leaders, like all actors involved, were paradoxically both powerful and powerless at the same time. CONCLUSION: This study offers a new contribution to the discussion about the power of ward leaders and problematises the theoretical assumptions that perpetuate calls for increased power. RELEVANCE TO PRACTICE: In their efforts to resolve the spontaneous dilemmas that arise in practice, frontline nurse leaders would benefit from regularly participating in communities of reflexive practice.

Becoming fall-safe: a framework for reducing inpatient falls.

This article describes a 10-year programme of work that has reduced inpatient falls rate by 46% and how this improvement has been sustained. The methodology applied in this initiative has forced one Trust to challenge expectations about the inevitability of patient falls in hospital. This initiative has resulted in approximately 568 fewer falls each year. Based on costings from NHS Improvement, the estimated 5108 fewer falls between 2011 and 2019 have saved the Trust £13.3 million.

Performing the art of nursing.

Visiting Professor at Kingston University and St George's, University of London, Karen Norman recounts Performing the Art of Nursing, a lively showcase celebrating International Nurses Day 2016.

Karen Norman.

What gets you out of bed in the morning? Usually the noise from the bars across the road from where we live! Gibraltarians know how to party loud - and late!

Building an engaged and certified nursing workforce.

Professional certification has been linked to positive patient, system, and nurse outcomes. However, certification rates among nurses remain low. Using tenets from employee engagement theory, we designed strategies to fully engage nurses within our nursing division to pursue certification. After 1 year, certification rates more than doubled in our cardiac departments.