Best evidence for fluid resuscitation nursing in hypovolemic shock patients in emergency care based on GRADE system

Background Hypovolemic shock is a life-threatening condition frequently encountered in emergency care, resulting from significant blood or fluid loss that impairs oxygen delivery to vital organs. Common causes include trauma, surgery, gastrointestinal bleeding, and ruptured ectopic pregnancy. Prompt fluid resuscitation is critical, with nurses playing a central role in early recognition, timely intervention, and continuous monitoring. Objective To synthesise the best evidence for fluid resuscitation practices in hypovolemic shock and assess nursing knowledge and practice in emergency settings. Methods This systematic review was conducted using preferred reporting items for systematic reviews and metaanalyses (PRISMA) guidelines and evaluated through the grading of recommendations assessment, development, and evaluation (GRADE) system. Databases including PubMed, EMBASE, and Cochrane Library were searched for studies published between 2015 and 2024. Results The isotonic crystalloids are the preferred first-line therapy, with early goal-directed fluid administration and close patient monitoring improving outcomes. Nurse-led assessment and reassessment were key to guiding resuscitation and reducing complications. However, gaps in protocol adherence, documentation, and practice variation were identified. Knowledge deficits among nurses were also evident, highlighting the need for targeted training. Conclusions This review supports the development of a structured nursing guideline for managing hypovolemic shock, emphasising evidence-based fluid strategies and continuous clinical evaluation. Strengthening nursing competencies through education and standardised protocols can enhance emergency care delivery and patient survival.