Assessment of knowledge and practices of staff nurses regarding care of peripheral intravenous line in child care areas of selected hospital, Ludhiana, Punjab.

 

Liji Mariam Abraham*

Lecturer, College of Nursing, Pondicherry Institute of Medical Sciences, Puducherry, Pin - 605014

 

ABSTRACT:

Introduction: - Peripheral vascular catheters are associated with complications like phlebitis, catheter related blood stream infection, extravasations, hemorrhage and infiltration. Children are more susceptible to peripheral intravascular infiltration and extravasation due to developmental and physiological factors such as poor communication skills, hyperactivity and fragile veins. Infiltration injuries have been reported to occur in as many as 78% of all paediatric peripheral intravascular catheters, and up to 43% of these events results in skin, muscle or nerve damage. Education and training of all health professionals to impart knowledge and skills are necessary to anticipate and prevent intravenous catheter related problems. Materials and Methods: An exploratory research study was designed to assess the knowledge and practices of staff nurses regarding care of peripheral intravenous line in child care areas of a selected hospital in North India. The sample included 60 staff nurses working in child care areas and willing to participate in the study, selected using purposive sampling technique. Purposive sampling technique was used to select sample. A structured questionnaire was used to assess the knowledge and an observation checklist was used to assess the practices of staff nurses regarding care of peripheral intravenous line among children. Results: The knowledge on care of peripheral intravenous line in children was excellent, good, average and below average for 5%, 65%, 25%, 5% respectively among nurses working in child care areas.  All the staff nurses had inadequate practices regarding care of peripheral intravenous line. No significant association was observed for knowledge and practice with sociodemographic variables like age, professional qualification, no. of years of experience and place of training, but there was a statistically significant association for knowledge and practice with place of work and in-service education attendance. There was a weak positive correlation between knowledge and practice of staff nurses related to care of peripheral intravenous line in children. Conclusion: It is necessary to educate and provide training periodically for nurses regarding care of peripheral intravenous line in children. Clinical guidelines were prepared with a view to improve staff nurses knowledge and practices regarding care of peripheral intravenous line in child care areas.

.

 

 

INTRODUCTION:

Venipuncture or peripheral venous cannula insertion is a technique in which a vein is punctured through the skin by a sharp rigid stylet. Common peripheral intravenous puncture sites include the hand and the arm. The use of the foot for an intravenous site is common with paediatric clients (Potter and Perry, 2009).  Nurses do various functions in their routine work in the clinical setting and one among them is Intravenous cannulation and it is a very common therapeutic procedure in patient care. Intravenous cannula is a little plastic tube that has been mounted on a needle for insertion into the client’s vein that requires frequent access to the blood stream.  The importance of asepsis in intravenous therapy has become an integral part  of modern patient care because the number of patients who require intravenous therapy has increased due to changes in prescribed patterns and the acute nature of today’s illness. Almost 60% or more patients admitted to a hospital require the insertion of an intravenous cannula. (Ingram P and Lavery I, 2007).  In a previous study it was estimated that complications related to intravenous line noted in 50- 75% of patients. A study conducted in Kerala reported that nurses have inadequate knowledge regarding peripheral intravenous line care. It shows that the protocol based nursing care outcomes of intravenous line cannula care are effective in terms of reduction in complications (Suja J, 2010).

 

OBJECTIVES:

1.      To assess the knowledge of staff nurses regarding care of peripheral Intravenous line.

2.      To assess the practices of staff nurses regarding care of peripheral intravenous line.

3.      To find out the relationship between knowledge and practices of staff nurses regarding care of peripheral intravenous line.

4.      To ascertain the relationship of knowledge and practices of staff nurses regarding care of peripheral Intravenous line with selected variables i.e. age (in years), professional qualification, professional experience (in years), working area, training institute and in-service education.

5.      To identify the deficits in areas of knowledge and practices of staff nurses regarding care of peripheral Intravenous line with a view to prepare guidelines on Care of Peripheral Intravenous Line in children.

 

MATERIALS AND METHODS:

·        Research design:

A non-experimental research design and quantitative research approach was considered appropriate

·        Independent variables:

Age (in years), Professional Qualification, Professional Experience (in years), Working Area, Training Institute, In-Service Education.

·        Dependent Variables:

Knowledge and practices of staff nurses regarding care of peripheral intravenous line in child care areas.

·        Research setting:

The study was conducted on staff nurses working in child care areas of Christian Medical College and Hospital, Ludhiana, Punjab.

·        Target population:-

All the staff nurses working in child care areas of Christian Medical College and Hospital, Ludhiana, Punjab.

·        Sample and Sampling technique:-

The investigator selected a sample of 60 staff nurses for the present study by using purposive sampling technique.

·        Inclusion criteria:

o  Registered staff nurses who are working in child care areas of CMC Hospital, Ludhiana, Punjab.

o  Nurses who are willing to participate in the study.

·        Exclusion criteria:

à      Care of central venous line and peripherally inserted central catheters are excluded.

à      Nurses who are not willing to participate in the study are excluded.

à      ANMs are excluded from the study.

·        Selection and Development of tool:

A structured questionnaire was used to assess the knowledge of staff nurses and an observation checklist was used to assess the practices of staff nurses regarding care of peripheral intravenous line in child care areas.

 

Description of tool:

Tool used in the study was divided in to three parts:

 

Part I: Sample characteristics:

This part of data is for obtaining personal information i.e. age (in years), professional qualification, professional experience (in years), working area, training institute and in-service education.

 

Part II: Multiple choice structured knowledge questionnaire:

This part is comprised of knowledge related questions on care of peripheral intravenous line.

 

This self structured questionnaire consists of 24 multiple choice items, each item consists of one correct answer among the four choices and each correct answer carries one mark.

 

The questions were related to following aspects-

Table  No:- 1

Area	Number of Items
Hand washing	3
Equipments used for IV infusion	3
Preparation and administration of IV fluid	4
IV dressing	3
Removal of IV catheter	3
Complications	8

 

Criterion Measure:

The criterion measure used in this study is knowledge score on the care of peripheral IV line. The knowledge score refers to the total score on knowledge items in structured multiple choice questionnaire by staff nurses.

Table  No:- 2

 

Part III:

Structured Practices (Observation) Checklist was used to assess the practices of staff nurses regarding care of peripheral intravenous line.

 

This part consists of observational checklist, which had30 items to assess the practices of staff nurses regarding care of peripheral intravenous line. Each item carries one mark. Items were scored as yes/no. Yes will be scored as 1and no scored as zero.

 

Table  No:- 3

Area	Number of items
Preparation of self and articles	10
Preparation of IV line	5
Administration of IV fluid	9
Care of IV line and IV catheter	4
Replacing the articles	2

Criterion measure

 

Table  No:- 4

 

·        Validity of tool:

Validity of tool was determined by expert opinions and on the relevance of items.  Tool was given to experts in the field of Medical Surgical nursing, Child Health Nursing, Psychiatric nursing, Obstetric and gynecological nursing and community health nursing. The opinion of experts was taken regarding relevance of items and according to their valuable suggestions modifications were made. The structured questionnaire for assessing knowledge was finalized with 24 questions and structured checklist for assessing practices with 30 items.

 

·        Reliability of tool:

Reliability of the knowledge tool was computed by Spilt half method using Karl Pearson’s Co-Efficient of Co-Relation and Spearman Brown Prophecy Formula. Reliability of knowledge questionnaire came out to be 0.88 The reliability of practice checklist was computed using the interrator reliability by observing the procedure simultaneously and independently by two different observers. The reliability of practice checklist was found to be 0.87

Hence the tools were reliable.

 

·        Data collection process:

The investigator first introduced herself to the subject and explained the purpose of gathering information. Consent was taken from subjects for filling the structured questionnaire and was assured that their confidentiality will be maintained. The investigator collected data from staff nurses working in Child care areas of CMC and Hospital Ludhiana. The respondents took 10-20 minutes to fill the structured questionnaire used to assess the knowledge regarding care of peripheral intravenous line. To assess the practices the researcher used checklist on care of peripheral intravenous line. Structured Practice Checklist filled by the researcher without informing the study subjects through participatory observation. Observation was done twice for each staff nurse. The data collected was then organized for analysis.

 

RESULTS:

Findings related to knowledge of staff nurses related to care of peripheral intravenous line.

 

Level of Knowledge

Figure 1. Percentage Distribution of Staff Nurses according to Level of Knowledge regarding Care of Peripheral Intravenous line

 

-        Staff nurses had maximum knowledge score in the area of preparation and administration of IV fluid (rank1) and the least knowledge scores in the area of complications (rank 6).

-        According to sample characteristics  age(in years), professional qualification, professional experience (in years), training institute had no impact on the knowledge of staff nurses related to care of peripheral intravenous line, while working area and in-service education had significant impact on knowledge of staff nurse.

 

Findings related to practices of staff nurses related to care of peripheral intravenous line.

 

Level of Practices

Figure 2. Percentage Distribution of Staff Nurses according to Level of Practices regarding Care of Peripheral Intravenous Line in Child Care Areas

-        Majority of staff nurses had maximum practice score in the area of replacing articles and least in the area of care of IV line and IV catheter.

-        According to sample characteristics age (in years), professional qualification, professional experience (in years) and training institute had no significant impact on the skill of staff nurses related to care of peripheral intravenous line, while working area and in-service education had significant impact on practice of staff nurses.

 

Findings related to relationship between Knowledge and practices:

There was a weak positive correlation between knowledge and practices of staff nurses related to care of peripheral intravenous therapy.

 

DISCUSSION:

The analysis of data revealed that maximum number of staff nurses (65%) had good knowledge, regarding care of peripheral intravenous line in child care areas. These findings were supported by Karadeniz G, Kutlu N, Tatlisumak E and Ozbakkaloglu (2003), that the nurses were found to have high knowledge levels about using intravenous catheter and intravenous fluid treatment and the symptoms and treatment procedure foe phlebitis.

 

It was further supported by Arbee IFand Mohd Ghazali AN (2012) who studied knowledge and practice towards peripheral intravenous cannulation among nurses. Results shown that nurses had knowledge score in using transparent dressing to recognize infection (100%) and hand hygiene before IV insertion (100%). The research finding contradicted the finding of present study was that nurses also had highest knowledge score in the area of identification of complications of peripheral venous cannula.

 

The findings of the study revealed that the practices of all staffs (100%) who participated in the present study were unsatisfactory. This finding was supported in study done by Karadeniz G, Kutlu N, Tatlisumak E and Ozbakkaloglu (2003), that the nurses found to have high knowledge levels, but practices were not suitable to their knowledge levels.

 

In the present study the relationship between knowledge and practices of staff nurses regarding care of peripheral intravenous line in child care areas showed a weak positive relationship (0.26). This finding was supported by Arbaee IF, Mohd Ghazali AN (2012) that shows 75.9% of nurses had the knowledge in caring and maintaining IV cannula and 83.7% followed the correct practice of care and maintenance of IV cannula.

 

 

RECOMMENDATIONS:

-        The study findings showed unsatisfactory practices among staff nurses regarding care of peripheral intravenous line in child care areas and highlight the need for continuous reinforcement of nurses regarding the procedure and practice related to IV line care.

-        The findings of this study may contribute to filling the gaps in nursing knowledge, for improving protocols for care of peripheral intravenous line, and may also assist nurse managers to create a supportive practice environment.

-        The findings show need for conducting regular in-service education for staff nurses to improve knowledge and practices regarding IV line care in child care areas.

-        Nursing students and staffs must be encouraged to carry out researches on different aspects of management and complications of peripheral intravenous line so as to develop checklist and performa that can be utilized for regular evaluation.

-        A clear instructional policy should be available to nurses to improve their practice and skill regarding management of IV line.

 

REFERENCES:

1.     Potter, Perry.  Fundamentals of Nursing. 7^th edition. Philadelphia: Mosby, 2009.

2.     Ingram P, Lavery I. Peripheral intravenous cannulation: safe insertion and removal. Nursing Standard 2007; 22(1):44-48.

3.     Suja J. Protocol Based Nursing Care of Patients with Intravenous Line Cannula. Nightingale Nursing Times 2010; 6(2): 52-54.

4.     Arbee IF, Mohd Ghazali AN. Nurses knowledge and practice towards care and maintenance of peripheral intravenous cannulation. 2012.

5.     Karadeniz G, Kutlu N, Tatlisumak E, Ozbakkaloglu B. Nurses’ knowledge regarding patients with intravenous catheters and phlebitis interventions. Journal of Vascular Nursing June2003;21(2):44-47.

6.     Lopez V, Molassiotis A, Chan WK, Ng F, Wong E. An intervention study to evaluate nursing management of peripheral intravascular devices. Journal of Infusion Nursing Sep 2004; 27(5):322-331.

7.     Cicolini G, Simonetti V, Blot S, Pelusi G, Di Giovanni P, Labeau S. Nurses’ knowledge of evidence-based guidelines on the prevention of peripheral venous catheter related infections: a multicentre survey. Journal of Clinical Nursing Dec2013;20.

8.     George K, Muninarayanappa B. Effectiveness of structured teaching programme on knowledge and practices of staff nurses on prevention of intravenous cannulae complications. Archives of medicine and health sciences 2013;1:115-119.

 

Received on 18.07.2017       Modified on 18.09.2017

Accepted on 09.10.2017       ©A&V Publications All right reserved