Date of Award


Degree Name

Master of Philosophy (School of Nursing)

Schools and Centres

Nursing and Midwifery

First Supervisor

Doctor Steven Hardman

Second Supervisor

Doctor Benjamin Hay


Introduction: Diabetic ketoacidosis (DKA) is an acute complication of diabetes. Registered nurses (RNs) knowledge with regard to DKA has never been investigated in any depth, nor has their decision making ever been examined in this specific context.

Research Significance: Nursing research literature acknowledges that nurses have an important role in the management of patient with DKA. However, there is very little empirical evidence available to support this claim. The purpose of this study is to provide evidence of the level of knowledge, the decision-making processes and the factors that influence nurses’ decision making whilst managing patients with DKA.

Methodology: A sequential mixed methods design in four phases was used. An online survey was developed and tested for clarity, internal consistency, content validity and reliability. The survey was administered to nurses who were likely to have been involved in the care of patients with DKA in their clinical practice and the data analysed using descriptive statistics. Semi-structured interviews were then conducted based on the results of the survey. Finally, both data sets were amalgamated in a mixed methods analysis to develop recommendations for future research and clinical practice.

Results: The survey results indicate that RNs had varying levels of knowledge in relation to DKA and strengths and weaknesses at different stages of their decision-making process. Some of the knowledge deficits related to policy, pharmacology and psychosocial issues. Four themes emerged from the qualitative data relating to the factors that influence RNs decision making whilst managing patients with DKA including policy, staffing, patients and confidence. The mixed methods analysis resulted in a number of recommendations for xix organisational and education strategies to enables RNs to provide holistic and evidence-based care to patients with DKA.

Conclusion: This study found that RNs were generally able to demonstrate adequate levels of knowledge to manage patients with DKA and utilised all the stages of the Clinical Judgment Model when making decisions. It was found that the most significant knowledge gaps related to information directly out of the hospital policy, which nurses found served as both an enabler and a barrier to their decision making. There were a number of limitations in this study, many relating to the COVID-19 pandemic. The participants requested a flow chart be developed to aid their knowledge application and decision-making practices whilst managing these acutely unwell and complex patients.

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Included in

Nursing Commons