Abstract A Hospital is health care institution providing patient treatment with specialized medical and nursing staff and medical equipments. Intravenous cannulisation is the method of insertion of a flexible plastic device with a stylet available, inserted to the vein to administer medications, fluids and blood transfusions. The research work entitled A Study to assess the knowledge and practice of intravenous cannulation among staff nurses in selected hospital at Moradabad was carried out with the prime objectives as To assess the knowledge regarding intravenous cannulation and its complication among staff nurses.
To assess level of practice regarding intravenous cannulation and its complication among staff nurses. To determine the relationship between knowledge score and practice score regarding regarding intravenous cannulation and its complication among staff nurses. To determine the association between level of knowledge and selected demographic variable. To determine the association between level of practice and selected demographic variable. This study based on descriptive quantitative approach. Sample and sampling technique purposive sampling technique was used to obtain a sample of 93 staff nurses.
Structured knowledge questionnaire was used to check knowledge level of staff nurses and practice observation checklist was prepared to collect data which contained part i demographic data ,part ii is structured knowledge questionnaire ,part iii practice observation checklist of intravenous cannulation. Results Level of knowledge scores showed that majority i.e.68 (73.1%)had average knowledg 22(23.7%) had good knowledge and 3(3.2%) had poor knowledge. Level of practice scores showed that majority were 58 (62.4%) staff nurses had good practice 34 (36.6%) had average practice and 1 (1.1%) had poor practice. Conclusion The main conclusion drawn from present study is that majority of nurses were having adequate knowledge and knowledge on practice regarding peripheral intravenous infusion but still there is need to improve the knowledge by regular learning. For better
results in relation to practice of intravenous cannulation and reduction in complications, regular supervision of practice should be conducted. Keywords: Intravenous therapy , Complications , Knowledge, Practice, Nurses.
CHAPTER I INTRODUCTION Background of the study Intravenous cannula is one of the most frequently used medical devices in the world. Intravenous cannulation (IV) with drugs, nutrients and blood components is necessary in todays health care. Intravenous cannulation is a procedure in which the patients skin is punctured with a needle to allow insertion of a temporary plastic tube into a vein (Jackson, 2003). The IV cannula is usually inserted into a metacarpal vein on the back of the hand or a vein in the lower arm, either the cephalic or basilic vein (Dougherty, 2008). Femoral veins should be avoided because of the higher density of skin flora in this area, which would put the patient at increased risk of infection (Parker, 2002). It is estimated that approximately 60% of hospital inpatients annually undergo Intravenous cannulation in order to receive therapeutic IV medication (Wilson, 2006). Since the procedure involves breaching the skin and leaving a foreign body in the vein, patients are exposed to a number of risks, one of which is infection (Dougherty, 2008). Thrombophlebitis and infection are common complications of IV cannula and their use should be discontinued because of occlusion or leakage. Insertion, monitoring and assessing IV cannula site is a common nursing activity. The guidelines recommend that IV cannula should be removed or replaced every 12-72 hours to avoid complication such as thrombophlebitis. Furthermore the smallest necessary intravenous cannulation should be well documented with date, time, size and location in the patients chart. A primary goal of IV cannulation is to maintain patent, comfortable IV access that can be used to administer the prescribed therapy reliably and safely. The Nosocomial Infection National
Surveillance Service (NINSS, 2002) postulates that 6.2% of hospital-acquired bacteraemias may be directly attributable to IV cannulation. Some might argue that this is a small percentage, but for the patient who develops a bacteraemia any percentage is going to be significant. Infection may be localized or systemic; however, intravenous cannulations are more commonly associated with localized than systemic infection. Nevertheless, because of the high number of IV cannula inserted annually, serious infections have resulted in significant annual morbidity (OGrady et al, 2002). The majority of patients who undergo IVcannulation will not experience serious ill effects. However, individuals who do develop complications, the temporary / longterm loss or use of a limb may affect an individuals choice of occupation causing economic impact. Loss of working days increased nursing time and the costs of treating IV cannulation complications will contribute to the economic burden felt by both the patient and the healthcare organization (Abbas et al, 2007). Despite the known of complications of intravenous cannulation, there are nurses still not practicing the correct way of insertion, removing as well as maintenance of it. Factors identified as such could lead to practice modification through education, equipment or procedure changes. Need of the study Intravenous Cannula is commonly used in hospitals to deliver intravenous medications. They are associated with a range of complications that can be damaging to patients health and increase healthcare costs, incidence and prevalance of IV Cannulation. In order to minimize the risk of these complications, thorough patient assessment and careful intravenous cannulation management are essential. Intravenous cannulation is one of the most common invasive procedures that nurses perform and it carries with it a high risk of complication. For example, phlebitis rates reported for patients receiving intravenous
cannulation have been as high as 80% with the rates in most hospitals. Patients also experience unnecessary discomfort or pain. Nurses performing the procedure should be well trained as many complications can arise from intravenous cannulation. Inserting monitoring and maintaining peripheral venous access is an integral component of nursing practice. Intravenous cannulation result from appropriate training of personnel which understanding of techniques and the associated risk involved .planning and expert management of this powerful technique are necessary to minimize the risks presented. Investigator felt the need to know how much knowledge and skills staff nurses possess regarding IV cannulation so complication related to iv cannula can be prevented in present scenario. Hence investigator planning to conduct study to assess knowledge and practice regarding IV cannulation and its complication among staff nurses in selected hospital. STATEMENT OF THE PROBLEM A study to assess the knowledge and practice regarding intravenous cannulation and its complications among staff nurse in selected hospital at Moradabad. PURPOSE OF THE STUDY The purpose of this study is to assess the nurses knowledge and practice regarding intravenous cannulation and its complication among staff nurses while caring hospitalised patients. OBJECTIVES OF THE STUDY 1 To assess the knowledge and practice regarding intravenous cannulation and its complication among staff nurse. .
2 To determine the relationship between knowledge and practice regarding intravenous cannulation and its complication among staff nurse. 3 To determine the association between level of knowledg with selected demographic variables. 4 To dertermine the association between level of practice with selected demographic variables. HYPOTHESIS H1: There is a significant correlation between knowledge score and level of practice score regarding intravenous cannulation and its complication among staff nurses. H2: There is a significant association between level of knowledge and selected demographic variables. H3: There is a significant association between level of practice and selected demographic variable. ASSUMPTION ? IV Cannulation is painful and clean procedure. ? Nursing staff is educated on the proper securement and sites of peripheral intravenous catheter placement, this will result in an increase in the longevity of the peripheral intravenous catheter. VARIABLES Research variables Knowledge and practice regarding intravenous cannulation and its complications
Demographic variables Age, professional qualification , clinical experience ,gender , in-service education attended on intravenous cannulation , number of cannulation performed daily. OPERATIONAL DEFINITION Staff Nurse : In this study it refers to an individual who qualified after diploma or degree in nursing programme and registered as a nurse in state nursing council. Knowledge : In this study knowledge refers to the understanding by the staff nurse about the method of insertion of intravenous cannula in the forearm of a patient and its complication through structured knowledge questionnaire. Practice : In this study it refers to a set of organised skills adopted by staff nurses during intravenous cannulation using a practice observation checklist . Intravenous cannulation: in this study it refers to a common invasive procedure performed in hospital. Intravenous cannulation is a technique involves insertion of a needle into the peripheral veins for different reasons. DELIMITATIONS ? The study is delimited to the Teerthanker Mahaveer Hospital in Moradabad. CONCEPTUAL FRAMEWORK The conceptual framework for the study is based on health belief model. Health beliefs are ideas and knowledge about intravenous cannulation and its complications.They may be based on factual information or wrong information. The health behaviours usually result from the health beliefs. Rosenstocks (1974) and Beckers (1975) health belief model addresses relationship between the way of understanding and predicting how people will behave in
relation to their health and how they will care. Use of model is based on persons perception of susceptibility to diseases. This model will help to understand the various attitudes and beliefs in order to plan the effective care. This model describes about three factors. Individual perception Perception of staff nurse regarding intravenous cannulation and its complications and perceived threats like unclean procedure, improper techmique of intravenous cannulation, improper size intravenous cannula. Modifying factors It includes demographic variables of the subjects like age, gender, marital status, working experience, income in rupees, area of residence, type of family. Likelihood of taking actions This part includes maintaining proper precautions, inservice education regarding proper technique of intravenous cannulation and management of complications.
CONCEPTUAL FRAMEWORK BASED ON HEALTH BELIEF MODEL INDIVIDUAL PERCEPTION MODIFYING FACTORS LIKELIHOOD ACTIONS Perception of staff nurse regarding intravenous cannulation and its complications Demographic variable Age, gender, educational status and working experience of staff nurses. Preventive actions Inservice education regarding proper technique of IV caanulation and management of complications. Perceived threat Unclean procedure improper technique of intravenous cannulation ,improper size IV cannula can cause various complications to patients. Cues of action Current update of knowledge ,well practice skill Perceived benifits Improve techniques of intravenous cannulation, educate regarding proper care of procedure
SUMMARY This chapter deals with the background of study, problem statement, purpose of the study ,objectives, hypotheses, assumption, and variables, definition of terms and conceptual framework.
CHAPTER II REVIEW OF LITERATURE Review of literature is a key step in research project which help to familiarize with the existing knowledge base and it will provides the researcher with a background for understanding what has been already on the topic. It familiarizes the researcher with relevant theory, research strategy, specific procedures, and instruments that might be productive in publishing the problem. (Polit & Beck, 2004) The literature was reviewed from published journals, unpublished thesis, textbooks, SCIENCE DIRECT, Pub Med- Medline EBSCO, to widen the understanding of research problem and methodology for the study. Liji Mariam Abraham (2017) conducted a study among 60 staff nurses working in child care areas regarding assessment of knowledge and practice in Ludhiana , Punjab. Descriptive study design and questionnaire is used in this study .Results shows staff nurses had maximum knowledge score in the area of preparation and administration of intravenous fluid and the least knowledge score in the area of complication. Majority of nurses had maximum practice in the area of care of intravenous line and intravenous catheter. They recommended that it is required for conducting in service education for staff nurse to improve knowledge and practice regarding intravenous line care. Zonobia Qamar , Muhammad Afzal, Robina Kausar, All Waqas, Dr.Syed Amir Gilani (2017) conducted a study among 240 staff nurses regarding assessment of knowledge and practice in Lahore, Pakistan. Descriptive study design was used. Results shows that nurses have good knowledge regarding intravenous cannula protocols. The nurses are not practicing appropriately , practices are not according to standard protocol. It is concluded that
health care providers are accountable for safe and quality care delivery to the patients ,so they should well resourced and enough trained nursing staff. Jyoti Kapoor (2017) conducted a descriptive study among 30 staff nurse regarding assessment of knowledge and practice regarding intravenous cannulation in bakshi nagar Jammu . Descriptive research approach and non experimental research design is used, Results shows 21(70%)were having adequate knowledge , 9(30%) were having moderately adequate knowledge and regarding practice 19(63%) were had knowledge on practice and few 11(36.7%)were had moderately adequate knowledge on practice .The conclusion drawn from the study is that there is need to improve knowledge by regular learning. For better results in relation to practice regular supervision of practice should be conducted. Ayse Kacarolu Vicdan (2014) conducted a study among 193 staff nurses in order to determine the level of knowledge of nurse descriptive intravenous fluid therapy practices in Aksehir, Konya, by using a questionnaire . Results revealed that 88.8% nurses did not receive in service training regarding intravenous fluid treatment after their graduation. 77.1% nurses did not have enough information about the electrolytes in the body fluids . 57.9% nurses did not know the properties of the solutions that they frequently used in treatment. It is concluded that nurses who had in service training after graduation had higher average scores of knowledge. Cynthia Chernecky ,Lindsey Casella, Erin Jarvis, Denies Macklin, Marlene Rosenkoetter (2010) conducted a study among 100 staff nurses regarding nurses knowledge on intravenous connectors in USA by using a questionnaire. Survey research design and simple random sampling was used .Results revealed that 78% nurses were uninformed about different connectors type and their different care and 43% could not name two complications of connectors. NO significant relationship was found between education (r=0.121,p