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 Table of Contents  
ORIGINAL ARTICLE
Year : 2013  |  Volume : 1  |  Issue : 2  |  Page : 115-119

Effectiveness of structured teaching program on knowledge and practices of staff nurses on prevention of intravenous cannulae complications


1 Department of Medical Surgical Nursing, Yenepoya Nursing College, Yenepoya University, Deralakatte, Mangalore, Karnataka, India
2 Professor, Government College, Bangalore, Karnataka, India

Date of Web Publication13-Dec-2013

Correspondence Address:
Kanishka George
Department of Medical Surgical Nursing, Yenepoya Nursing College, Yenepoya University, Deralakatte, Mangalore - 575 018, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2321-4848.123020

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  Abstract 

Infectious rates and peripheral intravenous cannulae-associated complications are very common in patients with intravenous therapy. This study was aimed to assess the incidence of intravenous cannulae complications among patients after 72 hours in situ and to examine the impact of structured teaching program on knowledge and practices of staff nurses. In this study, researcher used descriptive and quasi-experimental approach; a non-probability convenient sampling technique was adopted to select 80 staff nurses, each 40 in experimental and 40 in control group. 67.79% of patients developed peripheral intravenous cannulae-related complications with grade 1 (33.05%) and grade 2 (34.74%) complications. Result revealed that it was highly significant at 0.05 level (t = 9.978; P < 0.05) for knowledge and not significant (t = 0.974; P > 0.05) for practice. The post-test knowledge found to be highly significant at 0.05 level (t = 3.909; P < 0.05), whereas practice score was not significant (t = 0.426; P > 0.05). It could be inferred that there is no significant difference between the pre-test and post-test practice score of staff nurses who attended the structured teaching program regarding prevention of intravenous cannulae complications.

Keywords: Effectiveness, intravenous cannulae complications, knowledge, nurses, practice, prevention, teaching program


How to cite this article:
George K, Muninarayanappa B. Effectiveness of structured teaching program on knowledge and practices of staff nurses on prevention of intravenous cannulae complications. Arch Med Health Sci 2013;1:115-9

How to cite this URL:
George K, Muninarayanappa B. Effectiveness of structured teaching program on knowledge and practices of staff nurses on prevention of intravenous cannulae complications. Arch Med Health Sci [serial online] 2013 [cited 2017 Mar 29];1:115-9. Available from: http://www.amhsjournal.org/text.asp?2013/1/2/115/123020


  Introduction Top


As many as 80% of the patients receive infusion therapy during their hospital stay. [1] Catheter-related infections such as bloodstream infections (BSI) are linked to increased morbidity, death, and prolonged hospitalization. In the United States alone, catheter-related bloodstream infections (CR-BSI) occur at an average rate of 5 per 1,000 days in ICUs, resulting in 80,000 episodes of CR-BSI each year. Intravascular devices are now the most important cause of health care-associated BSI, with an estimated 250,000-500,000 cases occurring each year in the United States. [2] Knowledge of how to plan, insert, care for, and handle the peripheral intravenous infusion line has been a part of basic nursing education since the 1950s in Sweden. [3] Today, the insertion and care of peripheral cannulae is a routine task for nurses of all kinds of care. [4] As cannulation is a practical skill, the nurse must ensure that he or she is the most appropriate person to undertake the procedure and understands his or her accountability to ensure that the patient receives the highest standard of care and has a positive experience of cannulation. It also requires the health-care practitioner to possess the knowledge and rationale for the guiding principles that underpin this clinical skill. [1] To make the nurses aware about the incidence and peripheral intravenous cannulae complications, an educational effort is necessary. Studies showed that education measure is effective in reducing the incidence of complication and for handling peripheral intravenous catheters, so the researcher felt that a systematic education regarding intravenous cannulation will help the staff nurses to practice safe and accountable care and thereby prevent the complication.

Objectives

  1. To assess the incidence of intravenous cannulae complications among patients.
  2. To compare the knowledge of staff nurses regarding prevention of intravenous cannulae complications, before and after structured teaching program.
  3. To compare the practices of staff nurses regarding prevention of intravenous cannulae complications, before and after structured teaching program.
  4. To determine the correlation between staff nurses' knowledge and practices regarding prevention of intravenous cannulae complications.
  5. To find the association of level of knowledge and practices of staff nurses regarding prevention of intravenous cannulae complications with their selected personal variables.


Conceptual/theoretical frame work

The present study was focused on assessing effectiveness of STP on knowledge and practices regarding prevention of intravenous cannulae complications among staff nurses. The study is based on System theory by Von Bertlanffy.


  Materials and Methods Top


A descriptive approach (Phase I) as well as quasi-experimental non-equivalent control group before and after design (Phase II) was used for the study. The samples in phase I were patients on intravenous cannulae for more than 72 hours during the first week of data collection, and phase II comprises of Eighty (80) staff nurses of selected hospitals, Mysore, with forty (40) samples each in experimental group and control group. Non-probability convenient sampling technique was used to select the samples. [11]

Data collection instruments

  1. Observation scale (modified combination of Maddox scale and Baxter scale). This scale is a standardized scale, which is borrowed from reviews related to peripheral intravenous cannulation and practices was used to check the incidence of intravenous cannulae in the present study. [5]
  2. Structured knowledge questionnaire: Forty-eight questions were included in the present study, and total knowledge scores ranged from 0-48. The score is further divided arbitrarily as follows; Poor knowledge (0-16), Average knowledge (17-32), Good knowledge (33-48).
  3. Structured practice questionnaire: A modified Likert-type practice scale with 24 statements regarding the practices towards intravenous cannulation was prepared.


  • Inclusion criteria

    Patients who were on intravenous cannulae for at least 72 hours.

    Staff nurses who were willing to participate in the study and present at the time of data collection.
  • Exclusion Criteria

    Patients who were on intravenous cannulae for less than 72 hours.



  Data Collection Procedure Top


After obtaining ethical clearance and formal permission from the concerned authority, the purpose of the study was explained to the subjects and informed consent obtained. Data were collected from 80 staff nurses from 24-08-2010 to 17-09-2010. Phase I (The observation of the incidence of intravenous cannulae complications) was performed for one week in the whole hospital through surveying. Phase II was conducted to 80 staff nurses who fulfilled the inclusion criteria (40 staff nurses in experimental group and 40 staff nurses in control group).

Data analysis

Frequency and percentage were computed for analyzing sample characteristics. Mean and standard deviation were computed for describing the individual scores of staff nurses regarding knowledge and practice. Paired 't' test computed to determine the effectiveness of the structured teaching program. Independent 't' test computed to determine the effectiveness of the structured teaching program. Chi-square test computed to determine significance of association between knowledge and practice of staff nurses regarding prevention of intravenous cannulae complication and their selected personal variables viz. age, gender, educational qualification, area of work, years of experience, and exposure to any related in-service education program.


  Results Top


Section 1

Description of incidence of intravenous cannulae complications

Among 326 patients who were on intravenous cannulae, 118 patients had intravenous cannulae for more than 72 hours and they were selected for determining the incidence of intravenous cannulae complications. Among them, 38 patients (32.20%) were in grade 0 i.e., no pain at intravenous site, no erythema, no induration, no palpable venous cord; 39 patients (33.05%) were in grade I i.e., painful intravenous site or erythema, no swelling, no induration, no palpable venous cord; 41 patients (34.74%) were in grade 2 i.e., painful intravenous site with erythema or some degree of swelling or both, no induration, no palpable venous cord. Hence, the total numbers of patients with intravenous cannulae complications among the samples of 118 were 80 (67.79%).

Section 2

Description of selected personal variables

  1. Frequency and percentage distribution of staff nurses in experimental and control group according to their Selected Personal Variables is presented in [Table 1], [Figure 1].
  2. In order to find out the significance of difference between means of pre-test and post-test knowledge and practice scores within groups, paired 't' value was computed and is represented in [Table 2] and [Table 3].
  3. To find the significance of difference between post-test mean knowledge and practice scores of experimental group and control group, independent 't' value was computed. The result showed that the mean difference in the post-test knowledge scores between experimental and control groups was 4.8. This indicates an increase in knowledge scores in experimental group after undergoing structured teaching program. The independent 't' test value was t (78) = 3.909 and is found to be significant at 0.05 level of significance. The independent 't' test value was computed for practice scores and the obtained value was t (78) = 0.426 in post-test and is found to be not significant at 0.05 level of significance.
Figure 1: Frequency and percentage distribution of staff nurses according to their area of work

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Table 1: Frequency and percentage distribution of staff nurses according to their personal variables


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Table 2: Mean, mean difference, SD difference, SEMD, and paired 't' test of pretest and post-test knowledge scores of staff nurses regarding prevention of intravenous cannulae complications in experimental group and control group


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Table 3: Mean, mean difference, SD difference, SEMD, and paired 't' test between pre-test and post-test practice scores of staff nurses on prevention of intravenous cannulae complications in experimental group and control group N = 40


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Section 3

Findings related to relationship between knowledge and practices

In order to find out the correlation of pre-test knowledge and practice scores of staff nurses among experimental and control group for prevention of intravenous cannulae complications, a correlation coefficient was computed by using Karl Pearson's coefficient of correlation and the data are presented in [Table 4].
Table 4: Correlation coefficient of pre-test knowledge and practice scores of staff nurses in experimental group and control group


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Section 4

Findings related to association of level of knowledge and practice scores of staff nurses with their selected personal variables

To find out the association of the pre-test level of knowledge and practice with selected personal variables, chi-square was computed. Chi-square values for association between pre-test level of knowledge and practices of staff nurses regarding prevention of intravenous cannulae complications and their selected personal variables are not found to be statistically significant.


  Discussion Top


This study was aimed to assess the incidence of intravenous cannula complications among patients and to determine the effectiveness of structured teaching program on its prevention, among staff nurses in selected hospitals at Mysore. In the present study, surveying of the patients with intravenous cannulae for more than 72 hours showed that 80% of the samples were suffering from intravenous cannulae complications. The pre-test findings showed that most of the staff nurses had average knowledge and good practices regarding prevention of intravenous cannulae complications. It was also evident from the findings that pre-test level of knowledge and practice was independent of their personal variables viz. age, gender, educational qualification, area of work, years of experience, and exposure to any related in-service education program. The findings of the present study concluded that structured teaching program regarding prevention of intravenous cannulae complications was very effective in increasing the knowledge level of staff nurses as well as the practice level, and the level of knowledge is significant at 0.05. Hence, the study gave the evidence that the education and in-service program on peripheral intravenous cannulation can improve the knowledge of staff nurses, which they will be able to apply in their clinical setting to improve their standards of patient care.

Limitations

The limitations of the present study were:

  1. As the information regarding the practices of intravenous therapy was based on the nurses' response, there could be a possibility of some biased responses regarding their practices, which limits the generalization of the results outside the study sample.
  2. This study adopted non-probability convenience sampling; hence, the generalization of the findings outside the study sample is limited.
  3. The sample size is only 80 staff nurses; hence, this limits the generalization of findings beyond the study samples.


Recommendations

  1. A large scale study can be conducted to generalize the findings.
  2. A similar study can be conducted by adopting true experimental approach.
  3. A study can be conducted to find the effectiveness of various teaching strategies on prevention of intravenous cannulae complications (example-video, computer-assisted teaching program.)
  4. A comparative study can be conducted on knowledge and practice regarding prevention of intravenous cannulae complications at general hospital and super specialty hospitals.
  5. A study can be conducted to determine the impact of staff nurses' knowledge and practice on the rate of occurrence of intravenous cannulae complications.


 
  References Top

1.Tracey B. Peripheral cannulation: A practical guide. Br J Cardiac Nurs 2010;5(3):124-31.  Back to cited text no. 1
    
2.The Joanna Briggs institute. Management of peripheral intravascular devices Best Practice. 2008;12(5):1-4.  Back to cited text no. 2
    
3.Black JM, Hawks JH. Medical surgical nursing: Clinical management for positive outcomes. 8 th ed. St. Louis: Westline Industrial Drive; 2009.  Back to cited text no. 3
    
4.Waitt C, Waitt P, Pirmohamed M. Intravenous therapy. Postgrad Med J 2004;80:1-6.  Back to cited text no. 4
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5.Dalakas MC. Intravenous Immune Globulin therapy for neurologic diseases. Ann Intern Med 1997;126:721-30.  Back to cited text no. 5
[PUBMED]    
6.Lundgren A, Jorfeldt L, Christina A. The care and handling of peripheral intravenous cannulae on 60 surgery and internal medicine patients: An observational study. J Adv Nurs 1993;18:963-71.  Back to cited text no. 6
    
7.Grune F, Schrappe M, Basten J, Wenchel HM, Tual E, Stuzer H. Phlebitis rate and time kinetics of short peripheral intravenous catheters. J Infect 2004;32:30-2.  Back to cited text no. 7
    
8.Tripathi S, Kaushik V, Singh V. Peripheral IVs: Factors affecting complications and patency - A randomized controlled trial. J Infus Nurs 2008;31:182-8.  Back to cited text no. 8
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9.Cicolini G, Bonghi AP, Labio LD, Mascio RD. Position of peripheral venous cannulae and the incidence of thrombophlebitis: An observational study. J Adv Nurs 2009;65:1268-73.  Back to cited text no. 9
    
10.Bivins BA, Rapp RP, DeLuca PP, McKean H, Griffen WO Jr. Final inline filteration: A means of decreasing the incidence of infusion phlebitis. Surgery 1979;85:388-94.  Back to cited text no. 10
[PUBMED]    
11.Gareth SK. Department of anesthesiology: Intravenous catheter complications. Available from: https://www.netwellness.org/healthtopics/anesthesiology/ivcomplications.cfm. Net wellness: Consumer health information. [Last cited on 2007 Jun 18].  Back to cited text no. 11
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]


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