Year of Publication


Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Sheila Melander

Clinical Mentor

Dr. Brittany Bissell Turpin

Committee Member

Dr. Candice Harvey Falls


Background: Fluid overload in patients requiring intensive care leads to increased costs for hospitals and patients, increased length of intensive care unit (ICU) and total hospital stay, ventilator days, acute kidney injuries, and mortality rates. Multiple studies have indicated that aggressive de-resuscitation with diuretics can decrease length of stay, ventilator days, organ injury, and mortality rates. A nurse-driven diuresis protocol utilizing intravenous (IV) push furosemide was introduced to the University of Kentucky Medicine ICU, but patients are still commonly still over-resuscitated with no plan to diurese until organ damage has occurred. By educating bedside nurses, improving their knowledge and confidence regarding the diuresis protocol adherence to the protocol may be increased.

Purpose: The purpose of this DNP project was to examine the impact a web-based educational intervention has on bedside ICU nurses’ perceived knowledge, confidence, adherence, and attitudes on using protocolized diuresis. In addition, barriers towards using a protocolized diuresis will be identified.

Methods: This study used a one-group pre- and post-intervention survey design. Participants completed a 15-question survey prior to and after watching a web-based educational intervention. Unpaired t-tests and Spearman’s Correlation Coefficient via SPSS software were used to analyze the data and interpret its significance to clinical practice.

Results: There were no statistically significant changes in total knowledge over time, with a p value of 0.245. Nurses were significantly more comfortable in using the MICU Diuresis protocol in the post-intervention survey (p = 0.010). Additionally, nurses more strongly agreed that excessive fluid resuscitation increased length of ICU and total hospital stay, ventilator days, acute kidney injuries, and mortality rates (p = 0.017) in the post-intervention results. There were no statistically significant changes in barriers identified by nursing staff to utilizing the MICU Diuresis Protocol.

Conclusion: Results of this study indicated that MICU bedside nursing staff, while familiar with the signs of over-resuscitation, were uncomfortable using the nurse-driven Diuresis Protocol for a variety of reasons. While there was no statistical significance in the study, notably there was clinical significance, as nurses felt much more comfortable using the diuresis protocol. The study also showed that utilization of a web-based training intervention can be effective at significantly improving knowledge, comfort, and attitudes towards and determining barriers of using the MICU Diuresis Protocol. Future research should focus on assessing the knowledge, confidence, and attitudes of other MICU healthcare providers to understand the barriers surrounding multidisciplinary use of the Diuresis Protocol.