Understanding Nursing Staff Perspectives on Fluid Balance Charting: A Nordic Focus Group Study

Evidence has established that the quality of fluid balance charting is often low, and quality improvement initiatives have had varying success. However, knowledge of the issue from a nursing staff perspective is lacking and has not previously been explored within a Nordic context. This study aimed to explore nursing staff's experiences with fluid balance charting in Denmark and Sweden.

In this descriptive, qualitative study, data were collected through semi-structured focus group interviews with nurses and healthcare assistants from various clinical departments in Denmark and Sweden. The interviews were analysed using a phenomenological-hermeneutic approach inspired by Paul Ricoeur.

We included 25 nurses and healthcare assistants in eight focus group interviews. We found a notable discrepancy between the perceived importance and accuracy of fluid balance charting. Nursing staff perceived fluid balance charting as a fundamental nursing task and recognized that the quality of charting could directly impact patient outcomes. However, the involvement of multiple persons and high patient-nurse ratios caused nursing staff to experience the charting procedures as beyond their control and consider the results inaccurate. Quality may potentially be enhanced by following routines and responsibilities being clearly established. Digital technologies were suggested as a means of easing workflows.

Although fluid balance charting is perceived as an essential nursing task potentially reducing mortality and morbidity, nursing staff lacked control over charting, which was frequently inaccurate. Enhanced charting procedures may be achieved through consensus on responsibilities, well-established routines and the support of digital technologies.