Effectiveness of vein viewing device during venipuncture among children in improving the competency of nurses at selected hospitals Chennai

Nesa Sathya Satchi, (2018) Effectiveness of vein viewing device during venipuncture among children in improving the competency of nurses at selected hospitals Chennai. Doctoral thesis, The Tamilnadu Dr. M.G.R. Medical University, Chennai.

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Abstract

Venipuncture is a very common procedure in the hospital for hospitalized pediatric patients. It is also a frequent cause of pain and anxiety in children. In children cannulation can often be difficult due to the inability to identify peripheral veins. The success of this procedure may be influenced by various factors like the child‘s age, diagnosis, venous access history, hydration level, vein size and location, depth of subcutaneous tissue, skin pigmentation and child‘s cooperation during procedure. Delayed cannulation may result in an increased risk of complications from the delay in IV treatment. In addition family‘s satisfaction with the entire process may decrease substantially. Reviews have made it clear that, even in very young children, pain, stress, and anxiety responses are associated with invasive procedures, including needle sticks. Failure to treat procedural pain and distress is harmful to children in 2 major ways. First, the child experiences unnecessary suffering during the procedure itself. Second, there may be long-term consequences including lasting changes in pain systems and pain responses that could have deleterious effects for years to come. This chapter presents the major findings of the study, conclusions drawn and nursing implications of the study, limitations encountered and the recommendations for the future research. The aim of this study was to assess the effectiveness of vein viewing device during venipuncture among children in improving the competency of nurses at selected hospitals, Chennai. This research work was conducted in partial fulfillment of the requirements for the award of doctor of philosophy in nursing under The Tamil Nadu Dr. MGR Medical University, Chennai. The Objectives of the Study were 1. To assess the competency and compliance of nurses during venipuncture in control and experimental group of children. 2. To evaluate the effectiveness of vein viewing device during venipuncture on competency and compliance of nurses. 3. To determine the effectiveness of vein viewing device upon the level of pain and anxiety during venipuncture in control and experimental group of children. 4. To determine the level of acceptability of nurses regarding vein viewing device during venipuncture among the experimental group of children. 5. To find out the correlation between pain and anxiety in control and experimental group of children. 6. To associate the selected variables of nurses with competency and compliance of nurses during venipuncture in control and experimental group of children. 7. To associate the selected variables of children with competency and compliance of nurses during venipuncture in control and experimental group of children. The conceptual framework of the present study was developed based on ―King‘s Goal Attainment Theory‖. This framework helped to identify the problems through perception and communication and also in setting the goals. An extensive search of research and non-research literature helped to synthesize evidence of studies. In addition, this study pursued an extensive systematic review by using Johns Hopkins Evidence Based Practice Model which laid the foundation towards developing the tools. In this study quasi experimental-post test only research design was adopted. The study was conducted in Apollo Children Hospital, Chennai among 284 children and 85 nurses. The samples were selected using purposive sampling technique. Data was collected using pretested and predetermined instruments. The researcher collected the information on background variables of nurses and baseline variables of children by interviewing the parents, children, nurses and reviewing the records. Modified Venham‘s anxiety scale, competency and compliance of nurses performing venipuncture was assessed by observation method. The pain perceived by children was assessed by self- report method using Wong-Baker's FACES pain rating scale. Venipuncture for children in the control group was done by routine method without any intervention. After collecting the required samples in control group all the nurses were given hands on training to use vein viewing device for two weeks. In the experimental group, the nurses were asked to use the vein viewing device during venipuncture. Acceptability of nurses regarding vein viewing device was done using rating scale in the experimental group of nurses. The data collected was analyzed according to the objectives and hypothesis of the study. The analysis of data was done through an integrated system of computer program known as statistical package for social sciences (SPSS) 20.0. The major findings of the study are given below. The Major findings of the Study * The baseline variables of children showed that they were aged 6 years (24.7%, 31%), boys (53.9%, 58.7%), fair in complexion (47.5%, 51%) with an average weight of 20 -30 kgs (58.2%, 44.1%) and height 130-140 cms (38.3%, 28%) with (80.9%, 62.2%) having a normal BMI in control and experimental group respectively. * In this study, with regard to venipuncture related variables of children majority of children had venipuncture with venflon (66.7%, 74.1%) were cannulated with 22 gauge & 20 gauge (37.6%, 44.1%) in the dorsal venous network (35.5%, 29.4%) and 63.8%, 54.5% had previous experience of venipuncture, 80.9%, 70.6% did not have the caregivers with them during procedure, experienced severe pain (36.2%, 34.2%) and moderate anxiety (42.6%, 34.3%) during venipuncture in control and experimental group respectively. * The findings on background variables of nurses revealed that majority of the nurses were aged between 20-29 years (65.2%, 64.3%), females (79.4%, 85.3%). With regard to other variables 46.1%, 51% were GNM trained working in the medical wards (35.5%, 35%), with a total of 1-5 years‘ experience (47.5%, 39.2%) in control and experimental group respectively. * Majority of nurses performed venipuncture successfully in the first attempt ( 71.6%, 79.7%), time taken for the procedure was 5-20 mts (80.2%, 86.7%) with no pain (85.1%, 86%) and no swelling (83%, 85.3%) in control and experimental group respectively. * Majority of the nurses were compliant with the venipuncture procedure (80.1%, 85.3%) in control and experimental group respectively. * The mean number of attempts in control group was 1.4 ± 0.8 and in the experimental group was 1.3 ± 0.5. The difference between them was statistically significant (p < 0.05). The mean preparation time of control group was 4.0 ± 1.2 minutes and the experimental group was 4.4 ± 0.9 minutes. The difference between them was statistically significant (p < 0.05). The mean manipulation time of control group was 3.8 ± 1.6 minutes and the experimental group was 3.4 ± 1.2 minutes. The difference between them was statistically significant (p < 0.05). * The mean confirmation time of control group was 26.2 ± 13.6 seconds and the experimental group was 22.9 ± 11.8 seconds. The difference between them was statistically significant (p < 0.05). The mean duration of procedure between the two groups was 8.3 ± 2.0 minutes and 8.2 ± 1.8 minutes in control and experimental group respectively. The difference was statistically not significant (p > 0.05). * The mean pain score of control group was 3.8 ± 2.4 and experimental group was 3.9 ± 2.3. The difference between them was not statistically significant (p > 0.05). The mean anxiety score of control group was 17.9 ± 8.2 and in experimental group was 19.7 ± 8.5. The difference was not statistically significant (p > 0.05). * The mean compliance scores of control and experimental groups were 38.4 ± 3.7 and 40.8 ± 3.3 respectively. The difference between the two groups was statistically significant (p < 0.001). * A significant positive correlation was found between pain and anxiety scores in control and experimental group respectively(r = 0.664, p < 0.001 & r = 0.828, p < 0.001). * Most of the nurses in the experimental group found the use of vein viewing device during venipuncture to be highly acceptable (90.0%). * There was a significant association between the competency (number of attempts) and selected background variables like age of the nurses (p < 0.05), years of experience (p < 0.001) and pediatric experience in years (p < 0.001) in the experimental group, but there was no significant association between other background variables and competency of nurses (number of attempts). * There was a significant association between competency (duration of procedure) and selected background variables like age of the nurses (p < 0.05), area of work (p < 0.05, p < 0.01) years of experience (p < 0.05, p < 0.001) and pediatric experience in years (p < 0.05, p < 0.001) in both groups, but there was no significant association between background variables and competency of nurses (duration of procedure). * There was no significant association between selected background variables and competency of nurses related to presence of pain after venipuncture. * There was a significant association between presence of swelling after venipuncture and selected background variables like nurses working in medical wards (p < 0.05), with 1-5 years of experience (p < 0.001) and 1-5 years of pediatric experience (p < 0.001) in the experimental group, but there was no significant association between background variables and competency of nurses related to presence of swelling after venipuncture. * There was a significant association between compliance of nurses and selected background variables like age of the nurses 20-29 years (p < 0.05), nurses working in medical wards (p < 0.01) with 1-5 years of experience (p < 0.001) and 1-5 years pediatric experience (p < 0.001) in the experimental group, but there was no significant association between other background variables and compliance of nurses during venipuncture. * There was a significant association between the selected variables like age of the children (p < 0.01), BMI (p > 0.05) in the experimental group, but there was no significant association between selected variables and competency of nurses (number of attempts). * There was a significant association between selected variables like gender of the child (p < 0.05), skin colour (p < 0.05) in the experimental group, but there was no significant association between selected variables and competency of nurses (duration of procedure). * There was a significant association between the selected variables like age of child (p < 0.05) in both groups and competency of nurses related to presence of pain after venipuncture. * There was no significant association between selected variables and competency of nurses related to presence of swelling after venipuncture. RECOMMENDATIONS: * The present study could be replicated in different settings. * A comparative study can be done using different vein viewing devices. * A survey can be done to assess the usage of vein viewing device during venipuncture in various hospitals. * A comparative study can be conducted between different age groups of children. * A study can be done to assess the impact of vein viewing device in emergency settings. * A comparative study can be conducted between children and adults. * A comparative study of using vein viewing device can be conducted between upper and lower extremities. CONCLUSION: Nurses encounter children with peripheral venipuncture on a daily basis. Anxiety worsens when multiple attempts to establish an intravenous line are needed. If venous access cannot be achieved after 2 to 4 attempts, alternative routes of administration should be considered. Standards of practice and treatment algorithms are needed to ensure that children with peripheral venous access are managed effectively. Increased awareness, coupled with better management of venous access, will minimize its immediate and long-term impact on the child, family, and health care provider.

Item Type: Thesis (Doctoral)
Subjects: NURSING > Paediatric Nursing
Depositing User: Subramani R
Date Deposited: 23 Jan 2022 15:01
Last Modified: 23 Jan 2022 15:01
URI: http://repository-tnmgrmu.ac.in/id/eprint/19074

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