The Grey Area of Fluid Balance: Nurses’ Knowledge of Insensible Water Loss and Usability of a Digital Decision-Support App

This project investigates nurses’ knowledge regarding fluid balance and insensible water loss (perspiratio insensibilis) and evaluates the usability of a researcher-developed digital decision-support prototype (CareBalance-N). Fluid balance assessment is a central component of nursing practice in nephrology and high-complexity care settings. While measurable inputs and outputs are routinely documented, insensible water loss remains inconsistently estimated and rarely standardized in clinical reasoning. The absence of structured tools for integrating this physiological component into daily assessment may contribute to variability in practice. To address this gap, the research team developed CareBalance-N, a digital mockup designed to support nursing reasoning by integrating measurable fluid balance parameters with an estimated component of insensible water loss and optional clinical modifiers. The application is currently evaluated in a simulated format and is not implemented in clinical care. This observational cross-sectional study will assess baseline nursing knowledge and examine the perceived usability and quality of the digital prototype using the Italian validated version of the User Version of the Mobile App Rating Scale (uMARS). The study includes nurses from dialysis units, internal medicine wards, and intensive care units. The project aims to provide preliminary evidence to inform future educational interventions and digital innovation in nephrology nursing practice.