Application of a Nursing Care Protocol Based on King's Theory of Goal Attainment: a Pre-Experimental Study

Objective: Peripheral Intravenous catheterization is a common clinical procedure that demands a high level of nursing competency. This study intends to assess the effect of nursing care protocol for peripheral intravenous therapy on knowledge and practice of registered nurses and the association between pretest knowledge scores and selected socio-demographic variables using King’s conceptual framework and Goal Attainment Theory. Methodology: One group- pretest-posttest design, was used with self - reports and observation methods to collect knowledge and practice data from 30 registered nurses selected by simple random sampling (lottery method). Structured questionnaire and checklist based on personal, interpersonal, and social system of king’s conceptual system was used to assess the knowledge and practice of registered nurses, respectively. Results: Even though 30% of the nurses had attended previous continuing education on peripheral intravenous therapy, only 3.3% had very good knowledge. There was a significant difference in the knowledge and practice after implementation of the nursing care protocol. The pre-test knowledge scores have association with attendance in previous continuing nursing education. Conclusion: Study findings reveals the advantages of protocol development and improved knowledge and practice of nurses, which in turn obviously increase the health status of the patients and quality index of the hospital. Recommendation: The novice nurses can be educated on the protocol as a hospital policy enhancing the effectiveness of nursing care. Its implication can be evaluated using nursing audit at periodic intervals. Keywords: King’s conceptual framework, Goal Attainment Theory, nursing care protocol, peripheral intravenous therapy, knowledge, and practice.

Differences in the Characteristics of Ischemic and Haemorrhage Stroke Patients with Mechanical Phlebitis

Introduction: One of the complications of stroke patients receiving intravenous therapy is mechanical phlebitis. The purpose of this study was to analyze the differences characteristic of stroke patients who experienced mechanical phlebitisMethods: This study was used a comparative descriptive method with a documentation study design. The subjects of this study were stroke patients who experienced mechanical phlebitis from January 2018 until September 2020. The sampling method used total sampling with 92 samples. Data analysis using Chi-squared test.Results: Gender (p = 0.020) had a significant difference with the incidence of mechanical phlebitis in stroke patients. Characteristics of age (p=0.511), history of hypertension (p=0.058), diabetes mellitus (p=0.503), pneumonia (p=0.164), and stroke (p= 0.160) did not have a significant difference with the incidence of mechanical phlebitis in stroke patients.Conclusion: There are differences in gender characteristics in stroke patients who experience mechanical phlebitis.

Training, management, and quality of nursing care of vascular access in adult patients: The INCATIV project

Background: More than one billion of peripheral venous catheters are inserted into hospitalized patients every year. This study sought to identify the status of nursing care in vascular accesses in different hospitals and to evaluate the impact of a series of informative and formative interventions aimed at their care. Methods: Quasi-experimental, multicenter study. A total of 54 nursing professionals of 19 hospitals participated. The intervention consisted of informative talk and three training sessions related to the care and maintenance of vascular accesses and intravenous therapy in the hospital-admitted adult population. This was delivered in four years, with eight periodic cross-sectional assessments conducted before and after each intervention. To assess quality of nursing care in vascular accesses and intravenous therapy, a quality indicator called Standard Variable (VES), was developed and validated with the Delphi methodology. Results: A total of 21,108 patients, aged 64.0 years (SD 18.3), were assessed, of which 78.3% (16,516) had some type of vascular access inserted. An average of 22.1% (95% CI: 21.4–22.7) were classified as optimal. In total, 3218 nursing care professionals took part in the training activities. The VES indicator grew steadily throughout the study, raising from 7.8% to 37.6%. Changes were statistically significant between those time points in which one of the described interventions was delivered; however, there were no significant changes between time points with no intervention. Conclusions: This study supports that continuous training interventions can produce improvements in the quality of nursing care and reduce complications in patients with vascular accesses. In addition, the VES indicator was a useful and simple tool to measure quality, but the experience with its use suggests continuous research in the search for standardized indicators that objectify the evaluation and evolution of care.

Timing of Intravenous Therapy, Venepuncture and Cannulation Education for Nurses

<p>Internationally it is becoming more acceptable for nurses to carry out intravenous (IV) therapy, venepuncture and cannulation. There does not appear to be consensus about when nurses should undergo this education either nationally or internationally. The aim of this research project was to try and identify when IV therapy, venepuncture and cannulation education should take place and also to identify what different District Health Boards (DHBs) and nursing schools in New Zealand consider should be included in undergraduate nursing curricula related to IV therapy, venepuncture and cannulation. An email survey method was employed, which returned 36 responses. Descriptive statistics were used to analyse these responses. This research project has utilised an exploratory descriptive approach to examine perceptions of registered nurses, who are employed in hospitals and schools of nursing, about whether nurses in New Zealand should be prepared to administer intravenous therapy, undertake venepuncture and cannulation prior to, or following, registration. Participants were asked to share their personal beliefs, thoughts and understanding about the topic. Benner's framework of Novice to Expert was used as a theoretical framework for this study. The major findings that emerged from this study were that IV therapy should be a core component of undergraduate study and that there should be a national education and training programme. There was however, no agreement about the timing of venepuncture and cannulation education and training. The findings of this study indicated that education and competency are an issue which needs to be addressed by the different health providers and associated educators. This would lead to the development of a nationally agreed framework, with agreed standards.</p>

Timing of Intravenous Therapy, Venepuncture and Cannulation Education for Nurses

<p>Internationally it is becoming more acceptable for nurses to carry out intravenous (IV) therapy, venepuncture and cannulation. There does not appear to be consensus about when nurses should undergo this education either nationally or internationally. The aim of this research project was to try and identify when IV therapy, venepuncture and cannulation education should take place and also to identify what different District Health Boards (DHBs) and nursing schools in New Zealand consider should be included in undergraduate nursing curricula related to IV therapy, venepuncture and cannulation. An email survey method was employed, which returned 36 responses. Descriptive statistics were used to analyse these responses. This research project has utilised an exploratory descriptive approach to examine perceptions of registered nurses, who are employed in hospitals and schools of nursing, about whether nurses in New Zealand should be prepared to administer intravenous therapy, undertake venepuncture and cannulation prior to, or following, registration. Participants were asked to share their personal beliefs, thoughts and understanding about the topic. Benner's framework of Novice to Expert was used as a theoretical framework for this study. The major findings that emerged from this study were that IV therapy should be a core component of undergraduate study and that there should be a national education and training programme. There was however, no agreement about the timing of venepuncture and cannulation education and training. The findings of this study indicated that education and competency are an issue which needs to be addressed by the different health providers and associated educators. This would lead to the development of a nationally agreed framework, with agreed standards.</p>

Intravenous or oral antibiotic treatment in adults and children with cystic fibrosis and Pseudomonas aeruginosa infection: the TORPEDO-CF RCT

Background People with cystic fibrosis are susceptible to pulmonary infection with Pseudomonas aeruginosa. This may become chronic and lead to increased mortality and morbidity. If treatment is commenced promptly, infection may be eradicated through prolonged antibiotic treatment. Objective To compare the clinical effectiveness, cost-effectiveness and safety of two eradication regimens. Design This was a Phase IV, multicentre, parallel-group, randomised controlled trial. Setting Seventy UK and two Italian cystic fibrosis centres. Participants Participants were individuals with cystic fibrosis aged > 28 days old who had never had a P. aeruginosa infection or who had been infection free for 1 year. Interventions Fourteen days of intravenous ceftazidime and tobramycin or 3 months of oral ciprofloxacin. Inhaled colistimethate sodium was included in both regimens over 3 months. Consenting patients were randomly allocated to either treatment arm in a 1 : 1 ratio using simple block randomisation with random variable block length. Main outcome measures The primary outcome was eradication of P. aeruginosa at 3 months and remaining free of infection to 15 months. Secondary outcomes included time to reoccurrence, spirometry, anthropometrics, pulmonary exacerbations and hospitalisations. Primary analysis used intention to treat (powered for superiority). Safety analysis included patients who had received at least one dose of any of the study drugs. Cost-effectiveness analysis explored the cost per successful eradication and the cost per quality-adjusted life-year. Results Between 5 October 2010 and 27 January 2017, 286 patients were randomised: 137 patients to intravenous antibiotics and 149 patients to oral antibiotics. The numbers of participants achieving the primary outcome were 55 out of 125 (44%) in the intravenous group and 68 out of 130 (52%) in the oral group. Participants randomised to the intravenous group were less likely to achieve the primary outcome; although the difference between groups was not statistically significant, the clinically important difference that the trial aimed to detect was not contained within the confidence interval (relative risk 0.84, 95% confidence interval 0.65 to 1.09; p = 0.184). Significantly fewer patients in the intravenous group (40/129, 31%) than in the oral group (61/136, 44.9%) were hospitalised in the 12 months following eradication treatment (relative risk 0.69, 95% confidence interval 0.5 to 0.95; p = 0.02). There were no clinically important differences in other secondary outcomes. There were 32 serious adverse events in 24 participants [intravenous: 10/126 (7.9%); oral: 14/146 (9.6%)]. Oral therapy led to reductions in costs compared with intravenous therapy (–£5938.50, 95% confidence interval –£7190.30 to –£4686.70). Intravenous therapy usually necessitated hospital admission, which accounted for a large part of this cost. Limitations Only 15 out of the 286 participants recruited were adults – partly because of the smaller number of adult centres participating in the trial. The possibility that the trial participants may be different from the rest of the cystic fibrosis population and may have had a better clinical status, and so be more likely to agree to the uncertainty of trial participation, cannot be ruled out. Conclusions Intravenous antibiotics did not achieve sustained eradication of P. aeruginosa in a greater proportion of cystic fibrosis patients. Although there were fewer hospitalisations in the intravenous group during follow-up, this confers no advantage over the oral therapy group, as intravenous eradication frequently requires hospitalisation. These results do not support the use of intravenous antibiotics to eradicate P. aeruginosa in cystic fibrosis. Future work Future research studies should combine long-term follow-up with regimens to reduce reoccurrence after eradication. Trial registration Current Controlled Trials ISRCTN02734162 and EudraCT 2009-012575-10. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 65. See the NIHR Journals Library website for further project information.

Providing community intravenous therapy during the COVID-19 pandemic

Community intravenous therapy is well-established in most regions of the UK. Although there are national good practice recommendations detailing the service provision of outpatient parenteral antibiotic therapy (OPAT), examples of extended service delivery of other therapies are limited. This article describes the development of a community IV therapy service through integration with acute and primary care teams. IV therapies delivered in addition to antimicrobials safely outside of the hospital setting are also discussed with scope for future areas of development explored. The benefits of care closer to home for patients during the global COVID-19 pandemic are examined, as well as the potential for widening the whole gamut of practice for already established NHS community services through the development of integrated working in a local care organisation.

Evaluation of unmodifiable and potentially modifiable factors affecting peripheral intravenous device-related complications in neonates: a retrospective observational study

ObjectivesInfants in neonatal units benefit from dependable peripheral intravenous access. However, peripheral intravenous access exposes infants to high rates of clinically minor and serious complications. Despite this, little is known about the interplay of risk factors. The aim of this study was to assess the incidence and evaluate the interactions of risk factors on the occurrence of peripheral intravenous complications in a neonatal population.DesignThis was a retrospective observational study.SettingThe study was performed on the neonatal intensive care unit of the Women’s Wellness and Research Center, Hamad Medical Corporation, Qatar, as a single-site study.ParticipantsThis study included 12 978 neonates who required intravenous therapy.Outcome measurementsThe main outcome was the occurrence of any peripheral intravenous cannulation failure, leading to unplanned removal of the device before completion of the intended intravenous therapy.ResultsA mean dwell time of 36±28 hours was recorded in participants with no complications, whereas the mean dwell time was 31±23 hours in participants with an indication for premature removal of the peripheral intravenous catheter (PIVC) (p<0.001, t=11.35). Unplanned removal occurred in 59% of cases; the overall complication rate was 18 per 1000 catheter days. Unmodifiable factors affecting PIVC dwell time include lower birth (HR=0.23, 0.20 to 0.28, p<0.001) and current body weight (HR=1.06, 1.03 to 1.10, p=0.018). Cannulation site (HR=1.23, 1.16 to 1.30, p<0.001), the inserted device (HR=0.89, 0.84 to 0.94, p<0.001) and the indication for intravenous treatment (HR=0.76, 0.73 to 0.79, p<0.001) were modifiable factors.ConclusionMost infants experienced a vascular access-related complication. Given the high complication rate, PIVCs should be used judiciously and thought given prior to their use as to whether alternate means of intravenous access might be more appropriate.