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The factors impacting Critical Care Nurses' decision-making processes in continuous renal replacement therapy.

Smith, Neil David


Neil David Smith


Mary Laurenson

Judith Dyson


Continuous Renal Replacement Therapy (CRRT) is a common treatment intervention in critical care units worldwide. It provides supportive therapy for critically ill patients with severe kidney dysfunction. Efforts to optimise its clinical effectiveness through modifying treatment regimens over recent years have proved largely unsuccessful. However, studies have not explored the human element of critical care nurses delivering CRRT.
This study is designed to understand the influences on critical care nurses’ decision-making in the management of CRRT. In doing so, develop and highlight areas where modifications in practices can be adopted, in order to improve both the patient and organisational quality indicators associated with CRRT delivery.
This study used an adaptive Interpretive Description approach. The study was conducted across four linked United Kingdom critical care units. Twenty- one (n=21) registered critical care nurses undertook the California Critical Thinking Disposition Inventory (CCTDI) and of these, 10 nurses were interviewed face to face in semi-structured audio recorded interview, which were then transcribed and thematically analysed.
Four major themes influencing critical care nurses decision-making regarding CRRT were identified, with a further two contributing an overarching influence. These themes were the Individual; Organisational; Practice; Support, these themes were complex and intertwined and in themselves highlighted issues about Variability and Competing demands whilst delivering CRRT.
The themes in this study showed an alignment with some of the findings from other critical care decision-making studies, including the influence of the individual nurse, experience, and support. However, this work has also been able to introduce significant new knowledge on the perceptions and insights of critical care nurses. These findings generate new knowledge and contextualise these understandings of individuals, the organisations, the wider interactions, and relationships between colleagues, and the CRRT technology, and provide insights to enable a holistic approach to understanding the provision of CRRT and potentially enable improvements in treatment delivery. In understanding these aspects, it has elucidated avenues for improvements in practice, identifying areas that can be engineered to improve CRRT practice and characterises elements within individuals which contribute to CRRT delivery.
This study draws up a number of recommendations from the themes identified, these recommendations focus on the ‘Individual’ and the ‘Organisational’ themes. They include the introduction of a harmonised training, educational and competency programmes with integrated in situ hi-fidelity simulation provision, alongside bespoke high quality clinical supervision, to facilitate critical care nurses self-awareness.


Smith, N. D. (2022). The factors impacting Critical Care Nurses' decision-making processes in continuous renal replacement therapy. (Thesis). University of Hull. Retrieved from

Thesis Type Thesis
Deposit Date Nov 10, 2023
Publicly Available Date Nov 23, 2023
Keywords Health studies
Public URL
Additional Information Faculty of Health Sciences
University of Hull
Award Date Jul 5, 2023


Thesis (5.3 Mb)

Copyright Statement
© 2022 Neil David Smith. All rights reserved. No part of this publication may be reproduced without the written permission of the copyright holder.

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