NURS3055 Evidence Based Nursing Practice Report Sample

NURS3055 Evidence Based Nursing Practice

Course objectives being assessed:

CO4. Critically evaluate the skills required to incorporate research findings into nursing practice.

CO5. Apply critical thinking skills and enquiry strategies to search databases and locate credible, clinically relevant research literature.

CO6. Critique research literature using appropriate frameworks and tools.

Format

• 3000 words (+/- 10%) not including tables, figures, reference list and appendices.

• Submission must be in word format using the template provided (see instruction 3).

• Reference list and in-text references must comply with APA 7 Referencing Style. Failure to show competency to the referencing method will result in mark deduction (per the marking rubric).

• Do not include a table of contents for this assessment.

Instructions (1-3)

1. Chose one (1) of the following research questions.

2. What are the risk factors for difficult peripheral intravenous cannulation in adults?

3. Refer to the 3 articles that we have selected for you relevant to the chosen research question.

4. literatures provided

5.Complete the template provided for your chosen research question and submit it under the assignment 2 link.

Marking and Feedback

• Refer to the marking rubric (you do not need to submit this with your literature review). Remember to proof your work and do a self-assessment using the rubric provided.

• Assessments will be marked based on the criteria provided.

• Assessments will be returned through Gradebook no later than 10-15 days after the due date.

• Late or extended submissions will be returned through Gradebook no later than 10- 15 days after the date of submission.

Solution

What are the risk factors for difficult peripheral intravenous cannulation in adults?

One of the obstacles present in the management of peripheral intravenous (IV) is a chronic problem encountered among healthcare providers, predominantly in adult patients. This particular technique engages a very fine catheter introduced into a peripheral vein. Later it can be used for infusion of fluids, drugs or blood substitutes. In particular, though, some components can cause this process problematic, including abandonment of introduction, unnecessary patient sufferings, and off-track launching of the treatment (Bahl et al., 2024). The thorough comprehension of independent variables involving difficult peripheral IV infusion can be highly beneficial for healthcare providers where they are able to predict and pre-empt difficulty as a way of improving patients' results and experiences.

The clinical significance for MBA assignment expert of studying the factors of hard peripheral IV cannulation arises from its wide impact on healthcare services in many medical facilities e.g. hospitals, clinics, and emergency departments. Venous accessing, which is a big component of a patient's care, is frequently the first link in therapy, so this makes it a critical step. But on the other side, not only leads to a long time-elapsed for the delivery of treatment but also high cost prices of the healthcare services as well as patients continuation of encountering dissatisfaction.

The goals of this literature review are to scan and analyse the existing research to find the leading risk factors involved in the personable IV cannulation in adults (dos Santos et al., 2024). Synthesizing evidence from several studies, this review seeks to clarify factors like patient's conditions (e.g ages, bodies mass index, the medical history), bodily organs (bodies are visible, depths where veins are situated), and procedural factors (level of expertise of the healthcare provider and the utilization of ultrasonography) that can either make or break the success of cannulation.

Develop the PICO or PICo (delete which table does not apply to the chosen research question).

List the key concepts, similar concepts, synonyms, and different forms.

Key concepts:

• Non-responders of peripheral intravenous cannulation (DIVA) could have a similar extent of risk.
• The possible cause of failed peripheral intravenous cannulation may be determined by peripheral intravenous cannulation problems.

Similar concepts:

• Peripheral intravenous access difficulties
• Challenging with kitchen cannulation of peripheral veins (Xu et al., 2024).
• Pervious highly challenging to get the support of the venous system on the peripheral.

Synonyms:

• Difficulties in PIVC
• Challenges in IV cannulation

Different forms:

• Difficult peripheral IV cannulation
• Not easy to insert the cannulas into the central or main veins.

Present your advanced search using AND and OR (delete what does not apply). Include Boolean truncation.

Article 1

Title: Prevalence of difficult venous access and associated risk factors in highly complex hospitalised patients

Aim: To identify the risk variables that is linked to problematic venous access and to quantify its incidence in complicated patients with multimorbidity.

Design and methods: A cross-sectional study was carried out using the data from April 2013 to November 2013. ‘Complex’ (n = 135) patients were selected from COVID-19 affected population. The main study variable was the prevalence of difficult venous access, assessed using one of the following criteria: (1) From chronological difficulties establishing venous access, which includes more than two valiant attemps to install an IV line, and (2) nothing is visible or palpableones veins (Armenteros‐Yeguas et al., 2017). Besides issues related to difficult access which were also included in the risk measurements (age, gender and chronic disorders), other model factors were also considered.

Results/findings: Although the hard vascular access was 596%, there is always a chance that the patient will experience pain when getting an IV inserted. On the basis of the univariate logistic regression analysis it can be concluded that gender, a higher risk of vascular access complication and a tendency for osteoarticular disease are directly associated with the difficulties while blood access (Piredda et al., 2017). Through multivariable logistic regression, it was found that only gender was the most important independent predictor of cardiac disease; the odds ratios was 285.

Together with a team of researchers, we chose a group of 135 patients as participants in our study. This group consisted of nearly 60% of women. The average age for the patients was 78.4 years old and the patients ranged between 49 to 99 years old. In most of the patients cardiovascular diseases was the diagnose (94.8%) additionally to respiratory condition (67.4%). The difficulty of venous access which was up to 59 %, was mainly encountered by those patients who had a history of troubles using intravenous therapy. Baseline characteristics such as sex, history of comorbidities associated with intravenous therapy, and bones/joints disease were found to be generally access problems in univariate analysis evaluation.

Critical Appraisal tool used: The following are the descriptive statistics. The frequencies and the percentage were calculated for the qualitative variables. For the continuous data sets, we used both mean and standard deviation or median, interquartile range, and minimum-maximum depending on the normal distribution of the variable.

Distributions were compared using Student’s T-test, and ratios were compared using the nonparametric Mann–Whitney U test.

Binary mean regression in univariate analysis was applied to investigate the link between individual risk factors and problematic venous access. It was decided to use the nonparametric Mann-Whitney U-test, which is always used where the normality tests ended up not being satisfactory. The significance level p < 02 in this univariate analysis are pooled together and selected for the multivariable logistic regression model. The odds ratios were used to show the likelihood of the risk of challenging venous access in patients. All statistical tests employed the conventional level of significance which was set at 0.5. Data were analyzed with SPSS version 21.0 (IBM Corporation Windows version).

Critical Appraisal summary: The research was based on a cross-sectional design, which took place from the period of April 2013 to November 2013, concentrating on a sample of 135 "complex" patients referred from Covid-19 affected population. The main one is considered to be a hard venous access that is stipulated by a criteria such as: first to establish corresponding veins and duration of the process as well as visibility and palpability of veins. Univariate analysis was used to conduct individual risk factor investigation setting p << 0.2 as a criterion and, further to this, the significant cases were probed using multivariate logistic regression estimating the likelihood of occurrence. The study has several strengths such as examining a significant health care problem, thorough data analysis which involved descriptive and regression analysis, and the employment of a method analytical tool to assess the methodological integrity. Furthermore, the study used a non-parametric test, the Mann–Whitney U test and logistic regression, as some of the data demonstrated non-parametric characteristics.

Nonetheless, we also need to realize the limitations here. The claimed study doesn't have the causality statement between variables, because it is only based on cross-sectional design. Other than that, the research perhaps relied on retrospective information, which could lead to biases or errors. Though p < 0.2 may be contemplated as a lenient standard of the choice of the accountability level, this standard may also affect the results of the investigation. Finally, the program SPSS version 21.0, which in the current standards might be contemporary, adds the difficulties to replicate the research using more recent software.

Article 2

Title: Factors affecting difficult peripheral intravenous cannulation in adults: a prospective observational study
Aim: The purpose of this study was to determine the risk factors for problematic IV cannulation in adult patients utilising radiology services in relation to patient, healthcare provider, and equipment characteristics.

Design and methods: The study aims to demonstrate the observational design in radiology service at the University Italian hospital from Jan to August 2013; hence, an observational prospective study was conducted. The thirteen nurses got involved in the placing of intravenous lines in the 763 patients (mostly women, 53%, the mean age for such patients was 63 years and 65% of the patients had diagnosis of cancer). For every patient, nurses put down the data which could elucidate the difficult IV cannulation, which includes the one that needs more than one minute. The data comprises patient data, cannula administred, venipuncture administered and the operator(s) present. The analyses were done using the logistic regression technique as univariate and multivariate correlations.

Results/findings: The speed of insertion ranged from 45 to 125 minutes. Overall, most IV are delivered through peripheral cannulas (OR=1.42), hard to assess veins with many valves (OR=3.67), hard partially (OR=3.29), edema (OR=0.87) and palpanability (OR=0. There were 763 patients (71 3%) selected out of a total of the patients from the pilot. The documented records only refer to measurements on other occasions when nurses had to allocate most of their attention on the patients. This meanwhile, not unexpectedly, might not be systematic because of the probability of vaccine wasting when, alike; both easy and difficult venepunctures were withdrawn. No patient with acute illness was excluded as all the patients who required radiological service had the venous access already set up. Even the non‑consent rate was only 1.7% which is too small to worry about. The female of the survey contested the male, having 52 Heinrich 6%, and the mean age of the sample was 63 years-old (SD 12 Heinrich 9; range of age was 20-95) as well as the mean BMI was 25 Heinrich 5 (SD 4 Heinrich 4; BMI was 15 Heinrich 51 Heinrich 5). The great majority of patients in the study were Caucasian (n = 761, 997%). Outpatients which made up 955%(n = 729) were most represented among the survey respondents. The remaining 45%(n = 34) were inpatients with an average stay of 46 days (SD 6

Critical Appraisal tool used: The main study parameter was considered to be difficult cannulation, expressed as the time of the process for each patient to achieve an intravenous access (>60 seconds). I've specified these times to describe my final medical procedure which contained multiple venous punctures again. The endpoint number of attempts was considered in the absence of sufficient statistical power. Data of patients’ clinical characteristics and demographic data (experience) and nurses’ additional job-specific data (age, types of job, and so on) and data.

Critical Appraisal summary: The study titled "Factors affecting difficult peripheral intravenous cannulation in adults: A "prospective observational study" evaluates the hazards involved in improper proxmaticaization in adult patients needing radiology services. The research adopts an observational prospective approach conducted in the radiology service of a university teaching hospital situated in Italy from January to August 2013.

Recommendation

In light of the findings from the three articles focusing on difficult peripheral intravenous cannulation (DIVA), several recommendations can be made for nursing practice to improve patient care and outcomes in acute care settings:

• Risk Assessment and Identification: Nurses shall periodically assess the patients and those who have no visible veins, previous DIVAngo history and heath problems like cardiovascular diseases and osteoarticular conditions should be taken into account. Through the carrying out of an admissions protocol that involves screening the patients who are most likely to require special programs, the danger of failure may be reduced (Ahmed, 2024).

• Utilization of Ultrasound Guidance: The utilization of ultrasound image guidance to assist in the insertion of peripheral intravenous catheters (PIVC) might be a way to increase the success rate especially in the challenging subgroup of patients with difficult venous access. Nurses require extensive training on sonography-assisted techniques to appropriately depict veins and increase the probability of successful first-time insertion of the IV cannula, thus saving the patient discomfort and reducing the number of their IV catheter insertion efforts (Evans et al., 2024).

• Tailored Cannulation Strategies: The tailored cannulation approach, which considers the vein peculiarities and the patient’s physiology, is the one that should be used by nurses. Such may involve selection of appropriate catheter sizes, turning to alternative perfusion sites like wrists or hands, using tropism such as vein palpation and transillumination to recognize useful veins for the cannulation.

• Multidisciplinary Collaboration: The integration among the nurses, doctors, and the radiology department becomes a relevant factor in the management of DIVA patients. Implementing multidisciplinary teams specifically centered on difficult venous access may be useful in enabling the timely application of interventions, including expert consultations via vascular access specialists or use of central venous access devices, when peripheral access is complicated (Ballard et al., 2024).

Conclusion

Finally, challenging peripheral intravenous cannulation (DIVA) is a great problem of acute care settings. First the patients experience inconvenience. Secondly the time and resources are wasted. And also the quality of care becomes low. First, nurses should give top priority to the assessment of risks and identification of such patients for DIVA who are more likely to face some difficulties, with the aid of structured screening tools to identify these issues as early as possible (Benton et al., 2024). Inclusion of ultrasound guidance into PIVC placement can help increase the chances of success for both patients with great and those with difficult vascular access. Communication which sometimes can be challenging among patient care personnel that includes nurses, doctors and radiologists as part of the provision of patient care for patients with DIVA is necessary. It is protean that patients be adequately educated and well-communicated to reduce anxiety and increase cooperation during cannulation attempts.

References

Ahmed, S. K. (2024). Artificial intelligence in nursing: Current trends, possibilities and pitfalls. Journal of Medicine, Surgery, and Public Health, 100072. https://www.sciencedirect.com/science/article/pii/S2949916X24000252

Armenteros‐Yeguas, V., Gárate‐Echenique, L., Tomás‐López, M. A., Cristóbal‐Domínguez, E., Moreno‐de Gusmão, B., Miranda‐Serrano, E., & Moraza‐Dulanto, M. I. (2017). Prevalence of difficult venous access and associated risk factors in highly complex hospitalised patients. Journal of clinical nursing, 26(23-24), 4267-4275. https://onlinelibrary.wiley.com/doi/abs/10.1111/jocn.13750

Bahl, A., Alsbrooks, K., Zazyczny, K. A., Johnson, S., & Hoerauf, K. (2024). An Improved Definition and SAFE Rule for Predicting Difficult Intravascular Access (DIVA) in Hospitalized Adults. Journal of Infusion Nursing, 47(2), 96-107. https://journals.lww.com/journalofinfusionnursing/fulltext/2024/03000/an_improved_definition_and_safe_rule_for.3.aspx

Ballard, A., Thamm, C., Ogle, T., & Phillips, J. L. (2024, February). Influences Shaping Clinicians’ Monoclonal Antibody and Immune Checkpoint Inhibitor Preparation and Administration Management Practices: A Systematic Review. In Seminars in Oncology Nursing (p. 151583). WB Saunders. https://www.sciencedirect.com/science/article/pii/S0749208124000044

Benton, M., Wittkowski, A., Edge, D., Reid, H., Quigley, T., Sheikh, Z., & Smith, D. M. (2024). Best practice recommendations for the integration of trauma-informed approaches in maternal mental health care within the context of perinatal trauma and loss: A systematic review of current guidance. Midwifery, 103949. https://www.sciencedirect.com/science/article/pii/S0266613824000330

dos Santos¹, T. S., Anacleto, J. C., Cesar, V. S., Lino, R. L. B., de Assunção Lino, A., & Garbuio, D. C. (2024). Incidence of phlebitis and related factors in peripheral venous access in adults. Enfermería Global, (74), 48. https://revistas.um.es/eglobal/article/download/587911/360121/2293861

Evans, R. P., Bryant, L. D., Russell, G., & Absolom, K. (2024). Trust and acceptability of data-driven clinical recommendations in everyday practice: A scoping review. International Journal of Medical Informatics, 105342. https://www.sciencedirect.com/science/article/pii/S1386505624000054

Piredda, M., Biagioli, V., Barrella, B., Carpisassi, I., Ghinelli, R., Giannarelli, D., & De Marinis, M. G. (2017). Factors affecting difficult peripheral intravenous cannulation in adults: a prospective observational study. Journal of Clinical Nursing, 26(7-8), 1074-1084. https://onlinelibrary.wiley.com/doi/abs/10.1111/jocn.13444

Sweeny, A., Archer-Jones, A., Watkins, S., Johnson, L., Gunter, A., & Rickard, C. (2022). The experience of patients at high risk of difficult peripheral intravenous cannulation: an Australian prospective observational study. Australasian Emergency Care, 25(2), 140-146. https://www.sciencedirect.com/science/article/pii/S2588994X21000518

Xu, H. G., Hyun, A., Kang, E., Marsh, N., & Corley, A. (2024). Exploring clinicians' insertion experience with a new peripheral intravenous catheter in the emergency department. Australasian Emergency Care. https://www.sciencedirect.com/science/article/pii/S2588994X24000204