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Analysis of Quantitative Nursing Research Study
Description and Directions:
1. Please use the Quantitative Critique Completion Form (Word file) to complete your
critique of quantitative research.
2. Enter your responses under EACH section of the form.
3. If your opinion is that the research article does not address or infer an answer to a particular
section, then you must so state and JUSTIFY your statement. DO NOT LEAVE ANY
SECTION BLANK.
4. When your paper is complete, upload it to the Unit 6 Dropbox
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R E S E A R C H
The Effects of Focused Nursing Education on 3F
Groshong
TM
PICC Occlusion Rates: The
Experience of One Tertiary Pediatric Care Facility.
Dayna M Holt, RN, MSN, CRNI; Cindy Lewis, RN, MSN, CNS; Kathy Klimpel, RN, MSN, CNS;
Christine Sloan, RN, MSN, CNS; Claire Aguda, RN, BSN
Abstract
OBJECTIVE
: The primary aim of this project is to reduce the incidence of 3 Fr. Groshong
TM
PICC occlusions through
focused nursing education.
BACKGROUND
: The use of Peripherally Inserted Central Catheters (PICC) has become
an essential tool in the care of pediatric patients. The small lumen and long length of PICCs requires specialized skill
and knowledge in proper care, maintenance and flushing in order to prevent catheter occlusion and other complications.
Occluded catheters compromise patient care and increase costs. Reducing the incidence of catheter occlusion, will have
a significant impact on the quality of patient care; patient, family and nursing satisfaction, patient outcomes, and costs.
METHODS
: A pre-test/post-test design using a convenience sample of all the core staff nurses working on the medical/sur
–
gical unit at a Southern California Children’s Hospital was utilized. Objective measures included a written assessment of
nursing knowledge, direct observations of nurses’ flushing technique, and retrospective chart review to determine the rate
of total catheter occlusion.
RESULTS
: Mean written test scores improved from 0.78 to 0.93 (p=0.00) Mean observation
scores improved from 0.88 to 0.95, (p=0.004). The pre-test occlusion rate was 21.11/1000 catheter days. The post test oc
–
clusion rate was 15.49/1000 catheter days (p=0.057). CONCLUSION: Focused nursing education contributed to reducing
3F Groshong
TM
PICC occlusions and the associated costs due to PICC occlusions. KEY WORDS: PICC, Occlusion.
Background
T
he use of Peripherally Inserted Central Catheters (PICC)
has increasingly become an essential tool in the care of
pediatric patients (Knue, Doellman, & Jacobs, 2006).
The small lumen and long length of PICCs requires specialized
skill and knowledge in proper care, maintenance, and flushing
in order to prevent catheter occlusion and other complications
(Funk, 2001; Knue, 2006; Ngo, 2005; & Pettit, 2002). Occlud
–
ed catheters compromise patient care and increase costs. Nec
–
essary medications and fluids are delayed and can affect pa
–
tient outcomes or delay discharge. Considerable nursing time
is required to restore the patency of occluded catheters, and in
–
creased costs are associated with patency restoration. Occluded
PICCs result in additional venapunctures, increased stress and
frustration for the patient and family, increased nursing time,
and costs of supplies (Berger, 2000; Farjo, 2003; Feehery,
2003; Gordon, 2003; Hadaway, 2006; & Ngo, 2005). Reducing
catheter occlusions can have a significant impact on the quality
of patient care; patient, family and nursing satisfaction, patient
outcomes, and organizational costs.
Types of Occlusions
Catheters occlude for several reasons; however, thrombotic
occlusion is the most common cause (Hadaway, 2006; Harris,
1999; Kerner, 2006; & Pettit, 2002). There are three primary
causes for catheter occlusion. They are mechanical, non-throm
–
botic, and thrombotic. Mechanical obstruction is caused by a
kinked catheter, clamped tubing or migration of the catheter
into a smaller vein. Internal mechanical kinking can also occur
when the catheter is “pinched” between the clavicle and the
first rib resulting in “pinch-off syndrome” (Farjo, 2003).
Non thrombotic occlusions occur when medications and oth
–
er infusates precipitate within the lumen of the catheter. These
can occur when incompatible medications are infused together.
These can develop gradually or suddenly. Lipids also have the
potential to occlude catheters (Farjo, 2003; & Kerner, 2006).
Thrombotic occlusions can occur either inside or outside of
the catheter lumen. Extra-luminal occlusions are often the re
–
sult of a fibrin tail or sheath which partially or totally blocks the
catheter tip opening. A fibrin tail or sheath is the accumulation of
fibrin, blood cells and platelets that adhere to the tip of the cath
–
Correspondence concerning this article should be addressed to
dmholt@rchsd.org
DOI: 10.2309/java.15-4-6
CE
TEST
MATERIAL
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eter. These can occlude the back flow of blood creating a one-
way valve resulting in the inability to withdraw blood from the
catheter. This is typically referred to as a withdrawal occlusion.
Infusion is still possible with a withdrawal occlusion. Almost all
catheters will develop fibrin tails. Withdrawal occlusions should
be treated with a thrombolytic agent, such as alteplase to prevent
progression to a complete occlusion and prevent the potential
for infection to develop. It is not acceptable practice to ignore
a withdrawal occlusion just because you have another lumen
available for use. (Farjo, 2003; & Kerner, 2006). Intra-luminal
occlusions occur when blood back flows into the catheter lu
–
men. This occurs when catheters are not flushed properly; when
negative pressure occurs within the catheter, as occurs when the
catheter is compressed; when there is an increase in intrathroacic
venous pressure; when there is an empty IV fluid container, or
whenever venous pressure exceeds the infusion pressure (Farjo,
2003; Hadaway, 2006; & Kerner, 2006).
For the purpose of this project, occlusion will be used to refer
to a complete thrombotic occlusion in which the catheter can
not be flushed nor aspirated. Because withdrawal occlusions
are common and can not be prevented, they are not included
in the study results. Early recognition and treatment of with
–
drawal occlusion as a measure to prevent complete thrombotic
occlusion was included in the educational program.
Literature review
A review of the literature was conducted to investigate what
is known about the causes of PICC catheter occlusion and the
preventative measures that can be used. The databases searched
were CINAL, Pub Med, and ProQuest Nursing. The key words
used during the search were
“catheter occlusion”; “central
venous catheter AND occlusion AND pediatrics”; and “PICC
AND occlusion AND pediatrics”
. Fourteen articles from peer
reviewed journals were reviewed. The literature was published
between 1999 and 2006.
The literature was reviewed for the potential causes of cathe
–
ter occlusions and for preventative measures including flushing
technique, product choices, and nursing/provider education.
Three studies discussed the value of positive pressure displace
–
ment needless connectors and found that the use of these de
–
vices significantly reduced the occlusion rates of central ve
–
nous access devices when compared to negative displacement
devices. Variances in flushing technique, as a variable, was not
discussed (Berger, 2000; & Lenhart, 2001). Twelve studies
discussed the importance of proper care and maintenance of
PICCs and other central venous catheters as an essential ele
–
ment in preventing catheter occlusions. Flushing technique and
the importance of nursing knowledge was reported as highly
important in preventing catheter occlusions (Berger, 2000;
Farjo, 2003; Feehery, 2003; Funk, 2001; Hadaway, 2006; Har
–
ris, 1999; Kerner, 2006; Knue, 2005, 2006; Ngo, 2005; Pettit,
2002). One Study (Gordon and Dearmun, 2003) discussed the
family and patient perceptions emotional outcomes and cop
–
ing measures related to central catheter occlusion events. They
found that families felt anxious, angry and helpless when oc
–
clusions occurred. They recommended, in addition to health
care professionals being adequately trained, that parents be
provided with essential education pertaining to flushing, care
and maintenance of central venous devices. Harris and Maguire
(1999) developed a protocol in their facility to prevent and treat
pediatric central venous catheter occlusions. They concluded
that staff education is important in preventing catheter occlu
–
sion. Ngo and Murphy (2005) also developed an education
program which was aimed at increasing knowledge, accurate
flushing technique, and self-efficacy of the nursing staff with
the goal of reducing the rate of PICC occlusion. The results of
their study had a positive impact on patient outcomes. They
found an overall increase in nurses’ knowledge and self-effica
–
cy related to PICC care, and a reduction of catheter occlusions
from 29% to 8.5% over a 6 month period. This evidence and
the clinical experiences of the principal investigator formed the
basis for the development of this project.
Purpose
The primary purpose of this project was to reduce the inci
–
dence of 3 Fr. Groshong™ PICC occlusions through focused
nursing education. The major contributing factors leading to
the incidence of 3 Fr. Groshong™ PICC catheter occlusions
are flushing technique, and knowledge of the practitioner. It
was hypothesized that knowledge deficits existed, among the
pediatric nurses at our facility, regarding the management of
PICCs. This evidence-based practice project was developed to
determine if nursing education, specific to the care and main
–
tenance of 3F Groshong™ PICCs, would reduce the incidence
of catheter occlusion. The PICO question for this project was
“In patients with 3 Fr. Groshong™ PICCs, does implementing
a focused nursing education, as compared to basic orientation
and the availability of policy and procedures decrease catheter
occlusion rates?”
Materials utilized
3 French Groshong™ PICC: A Peripherally Inserted Central
Catheter, size 3 French, manufactured by Bard Access Sys
–
tems. The Groshong™ product line incorporates a check valve
at the tip of the catheter designed to reduce the incidence of
blood reflux into the catheter tip. Injection Cap: A mechanical
positive pressure displacement injection cap was utilized on all
the 3 French Groshong™ PICCs. Extension set and securement
device: a manufactured securement device and compatible
luer-lock microbore extension set was attached to the 3 French
Groshong™ PICC hub. Syringes and flushing: All PICCs were
flushed using a 10 ml syringe.
Methodology
P
roject design
A descriptive, correlational, quasi-experimental pre-test/
post-test design was used. A convenience sample of all the core
staff nurses working on the medical/surgical unit at our facility
from May 2007 through August 2007 was used.
Participants
The project was reviewed and approved by this institution’s
Institutional Review Board in accordance with the require
–
ments of the Code of Federal Regulations on the Protection of
MN504 QUANTITATIVE CRITIQUE
use the below Quantitative Critique Completion Form to complete your critique of quantitative research. Type in your responses under EACH section. If your opinion is that the research article does not address or infer an answer to a particular section, then you must so state and JUSTIFY your statement.
IMPORTANT:
• Do not leave any section blank!
• Do not provide a “yes” or “no” answer without an explanation. You must justify all your responses.
• You must submit the full article in PDF form. Critiques submitted without the PDF will not be accepted.
• Save your file as YourName_QuantitativeCritique.doc and upload to the unit Dropbox.
PROBLEM:
What is the problem the study was conducted to research?
Why is the problem an important one for nursing to research?
STUDY PURPOSE
What is the purpose of the study?
RESEARCH QUESTION
What is the main research question?
HYPOTHESIS/HYPOTHESES
What is the study hypothesis? If it is not stated, what would you say the hypothesis is?
STUDY VARIABLES
Identify and describe the major study variables. Identify the study variables by examining the purpose, the objectives, questions, or hypotheses, and the results section of the research article.
INDEPENDENT
Define the meaning of the term “independent variable.”
Identify the independent variables in this study and provided a definition of the variable.
How is the independent variable carried out in this study?
DEPENDENT
Define the meaning of the term “dependent variable.”
Identify the dependent variables in this study and provide a definition of the variable.
How is the dependent variable measured in this study?
CONCEPTUAL MODEL/THEORETICAL FRAMEWORK –
Note: This is determined in the literature review … it does not refer to the methodology.
Is the framework explicitly expressed or must the reviewer extract the framework from implicit statements in the literature review? JUSTIFY your response!
Is the framework based on scientific, substantive, or tentative theory?
Does the framework identify, define, and describe relationships among the concepts of interest? Provide examples and rationale for your response.
How is the framework related to the body of knowledge in nursing?
REVIEW OF THE RELATED LITERATURE
Are the articles relevant with previous studies and theories described?
Are the references current? Identify the number of sources within past 10 years and the number of sources within past five years.
Describe the current knowledge about the research problem.
Specify the gap in the literature that justifies the need for the research.
STUDY METHODOLOGY
NAME the specific quantitative methodology of the study.
Provide a clear description/definition of this methodology (in your own words); use an article or your text to support the definition and provide a citation.
Why was the choice of this methodology appropriate for this study? JUSTIFY your response.
SAMPLE AND SETTING
Identify inclusion and exclusion sample criteria.
Indicate the method used to obtain the sample. Provide a definition of the method and discuss why it was an appropriate choice for this study
State the sample size. Indicate if a power analysis was conducted to determine the sample size.
Identify the SPECIFIC characteristics (demographics) of the sample.
Identify the sample mortality (or attrition) number and percentage.
Indicate the type of consent obtained and institutional review board approval.
Identify the study setting and indicate if it is appropriate for the study purpose. JUSTIFY your response!
IDENTIFICATION AND CONTROL OF EXTRANEOUS VARIABLES
Define extraneous variables
What are the extraneous variables in this study? In what way(s) were appropriate measures used to control for the influence of the extraneous variables? Describe fully. If not addressed, explain how you know this and identify the extraneous variables you would note.
STUDY INSTRUMENTS/TOOLS
Identify the instruments used in the research
FOR EACH INSTRUMENT: Instrument #1; Name of Instrument: Discuss how the instrument was developed or purpose of use. Cite the source for the background information about the instrument.
Identify the type of measurement strategy (e.g., Likert scale, visual analog scale, physiological Measure, questionnaire, observation, or interview).
Identify the level of measurement (nominal, ordinal, interval/ratio) achieved by the measurement strategy. Provide a definition of the level of measurement(s) you identified and justify WHY you believe the instruments represent this level of measurement.
Report the reliability of the instrument from previous studies and the current study.
Report the validity of the instrument from previous studies and the current study.
Instrument #2; Name of Instrument: Discuss how the instrument was developed or purpose of use. Cite the source for the background information about the instrument.
Identify the type of measurement strategy (i.e. Likert scale, visual analog scale, physiological Measure, questionnaire, observation, or interview).
Identify the level of measurement (nominal, ordinal, interval/ratio) achieved by the measurement strategy. Provide a definition of the level of measurement(s) you identified and justify WHY you believe the instruments represent this level of measurement.
Report the reliability of the instrument from previous studies and the current study.
Report the validity of the instrument from previous studies and the current study.
Instrument #3; Name of Instrument: Discuss how the instrument was developed or purpose of use. Cite the source for the background information about the instrument.
Identify the type of measurement strategy (e.g., Likert scale, visual analog scale, physiological Measure, questionnaire, observation, or interview).
Identify the level of measurement (nominal, ordinal, interval/ratio) achieved by the measurement strategy. Provide a definition of the level of measurement(s) you identified and justify WHY you believe the instruments represent this level of measurement.
Report the reliability of the instrument from previous studies and the current study.
Report the validity of the instrument from previous studies and the current study. Note: If more than 3 instruments, please add more descriptions.
DATA COLLECTION METHODS
Detail how the data were collected.
In what way(s) is the data collection procedures appropriate for this study?
In what way were appropriate steps taken to protect the rights of the subjects?
STATISTICAL ANALYSIS PROCEDURES
Identify the statistical procedures used in the study: Statistical Procedure #1 (Name and definition):
How was it used in the study?
Statistical Procedure #2 (Name and definition):
How was it used in the study?
Statistical Procedure #3 (Name and definition):
How was it used in the study?
Statistical Procedure #3 (Name and definition):
How was it used in the study?
Note: If more than 3 statistical procedures, please add more descriptions.
Complete the table below with the analysis techniques conducted in the study:
Statistical Procedure Statistical Findings Significance (provide a narrative description of the significance as well as the actual statistical values
What are the specific results of the study? Provide DEPTH and write IN YOUR OWN WORDS.
STRENGTHS\LIMITATIONS
What are two major strengths of the scientific merit of this study? (This does not refer to findings of the study)
What are two major limitations of the scientific merit of this study?
How did the researcher generalize the findings?
What did the researchers say the relevance of the data was? Describe the researchers’ interpretation of the findings.
Where in nursing can the results of the data be applied?
What suggestions for further study were identified?
Is the description of the study sufficiently clear for replication? Explain and Justify your response
REFLECTION
Reflect upon your newly developed understanding of quantitative research. What has this experience critiquing a quantitative research study meant to you and how will this make a difference in your overall practice of nursing? Please provide depth and be sure you respond to the question. This is a subjective response and must be at least 2 full paragraphs. Please respond in reference to understanding quantitative methodology and not the specific focus of the research study.
What has the experience of reading and critiquing a quantitative study meant to you?
How will understanding and using quantitative research findings make a difference in your practice of nursing?
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38.
the history of the corrections system and varying approaches to corrections by era
Examine the issues related to corrections as well as the best strategies and options designed to meet the goals of corrections.
The paper should include the following:
-An explanation of the history of the corrections system and varying approaches to corrections by era.
-A complete description of the participants of the corrections system and their roles.
-A detailed analysis of the impediments, or issues, faced by corrections administrations when running a prison.
-A complete description of the rights of prisoners, and the administration of required services by prison officials.
-A detailed description of alternative forms of corrections, including methods of rehabilitation and reintroduction to society.
-A comprehensive list of alternative strategies to incarceration with an assessment, both pro and con, showing their worth as related to traditional, incarceration strategies.
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