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Question:

Write about the Nursing for Quantitative Research.

 

Answer:

Introduction:

Research critique mentioned in this essay is a quantitative method. Another method which can be used to critique research is a qualitative method. Quantitative research is mainly emphasised on the numbers, and qualitative research is an expression of the reality of practice. Annals of Emergency Medicine, is the official journal of the American College of Emergency Physicians which is published in the United States of America. Its impact factor is 5.008. Its ERA ranking is A, which is considered as the good ranking of these class journals. This journal ranking is first out of 25 journals in this category. As this research has a good ranking, this evidence can be implemented in practice.

Dr Simon Bugden, who is the first author of this article, is working in the Metro North Hospital and Health Service, Queensland. Gabor Mihala and Claire M. Rickard are the two authors who have prior experience in this field. The expertise of these authors is evident from their publications in this field. This research is carried out in the reputed organisation and its authors have expertise in this filed. Hence, this evidence can be implemented in practice.

 

Title and Abstract:

The title of the paper is matching with the content because, in this paper effect of skin glue on the efficiency of peripheral intravenous catheters was studied and the same was mentioned in the title. The objective of the study is mentioned in the paper. The objective of the study is to investigate whether the addition of skin glue can reduce the failure rate of peripheral intravenous catheters. Abstract of the paper contains information about the research design, sample size, instruments and findings of the study. However, it doesn’t contain information about the aims and hypothesis of the study.

 

Structuring the Study:

A literature review was conducted for both the aspects of problem and solution for the problem. The problem mentioned in this study is the failure of peripheral intravenous catheters. From the literature review, it was mentioned that around 80 % of the hospitalised patients were inserted with catheters. Out of these patients, approximately 33 to 69% devices encountered problems in first 48 hours after insertion (Limm et al., 2013; Wilkinson and Fitz-Henry,2008). The solution put forwarded for this failure problem is the use of skin glue. A literature review was conducted for three clinical trials for the use of skin glue. These trials mentioned that failure of catheter insertion could be reduced by 21-11 %, 20-6 % and 38-14%, after use of skin glue. References mentioned in the literature review for study are recent (Simonova et al., 2012; Edwards et al., 2014 and Reynolds et al., 2015). All these references are less than ten years old. However, mentioned literature is not comprehensive. Number of trials should be mentioned with studies from the broad and diverse geographical areas, from different types of hospital settings and with different types of patients based on age, the severity of the disease condition, sex and socioeconomic factors. Literature didn’t mention the number of participants in study and criteria for the measurement of failure rate. The investigation was carried out by single-site, two arms, non-blinded, randomised and controlled trial in ED department. Ethical approval was taken from the hospital human research ethics committee before initiation of the study, and this trial was registered with the Australian and NewZealand Clinical Trials Registry. In this paper, a scientific hypothesis is mentioned and not the null hypothesis. From the stated hypothesis, it is evident that researcher wishes to study the relation between the addition of skin glue and failure rate of the catheter. Intention to study the difference between control group and intervention group is not evident from the stated hypothesis (LoBiondo-Wood and Haber, 2014).

 

The Sample:

Information about the sample is mentioned in the abstract and the flow chart of the study design. However, it is not mentioned in the materials and methods section of the paper. It should have been mentioned in the materials and methods section of the paper. The sample size was determined by screening the patients with the help of trained ED research nurse. 360 patients were selected, and 380 catheters were inserted. Patients with age above 18 years were selected with the insertion of the upper limb peripheral intravenous catheter. Patency of this catheter insertion was confirmed by the intravenous flush of the 10-mL 0.9% saline solution. Informed consent was taken from the patients. Criteria for an allergic reaction, irritation, infection, agitated patients and non-English speaking patients were set for the exclusion of participants, however, none of the participants was excluded from the study. There was no loss of the participants during the study.      

Data Collection:

Data was collected by the direct observation, visualisation, chart review and standard patient questionnaire. Data was collected by the research nurse in ED department. Data was collected in person, if the patient is in the hospital and it was collected through phone if patients left the hospital. All the data for the primary and secondary outcome are adequately described in the article. It comprises of the number of patients exhibited each outcome and its respective percentage. It also described confidence interval between standard care and skin glue group. Data was also graded by frequency of occurrences. PIVC failure is most prevalent followed by dislodgement, phlebitis and occlusion. More information should have been given for outcome data on the age of the patient, site of insertion and PIVC gauge size. The failure rate of the catheter with particular age of the patient, insertion site and PIVC gauge size would have been helpful in bringing more clarity of the study. Most of the data were collected by observations, chart review and standard patient questionnaire. There was no use of instruments for data collection in this study. There were no details mentioned about the specific criteria or scale for the infection. It would have been clearer on the severity of infection, if redness and swelling of the infected area had been expressed in cut-off values like 10 mm or 20 mm. Hence, it is difficult to make the conclusion whether mentioned data meets certain standard criteria established for each outcome. Details of the patient chart and standard patient questionnaire were not mentioned in this paper. There was no mention of ethical consideration on data collection (Peace and Chen, 2010; Sheridan, 2016). 

 

Data Analysis:

There is a minimal loss in the follow-up in both terms of the number of patients and number of devices. Moreover, follow-up loss is similar in both groups of intervention. Hence, this data would be reliable to compare between these two groups. This assessment is non-blinded to both researcher and the patient. In study design section, it is mentioned that this study is non-blinded. Results for PIVC failure and dislodgement are both statistically and clinically significant. In the case of PIVC failure difference between standard care and skin glue is 10 % which is clinically significant. The confidence interval is –18% to –2% with P=0.2 for PIVC failure which is statistically significant. In the case of dislodgement, the difference between standard care and skin glue is 7 % which is clinically significant. The confidence interval is –13% to –0% for dislodgement which is statistically significant. Data obtained for secondary outcome measures like infection, phlebitis, occlusions are not statistically and clinically significant. Statistics used in this study is mainly the inferential statistics. In inferential statistical analysis, some conclusion about the source population can be drawn, using the results obtained from the sample (Sahu et al., 2015). In this study, the conclusion about standard and skin glue obtained from source sample. In PVIC failure, 95 % times difference between percentage failure falls between values -18 and -2 and 5 % times these values do not falls between -18 and -2. In dislodgement, 95 % times difference between percentage failure falls between values -13 and 0 and 5 % times these values do not falls between -13 and 0. In phlebitis, 95 % times difference between percentage failure falls between values -5 and 3 and 5 % times these values do not falls between -5 and 3. In occlusion, 95 % times difference between percentage failure falls between values -8 and 4 and 5 % times these values do not falls between -8 and 4. 

Findings:

These findings were expected because in the literature also it was mentioned that use of skin glue could be helpful in the reducing failure of the peripheral intravenous catheters. This decrease in the failure rate is also falling in the range mentioned in the literature. Enough information is presented in the paper to judge the results. This information is presented in terms of number of devices failure in each group and its percentage. Confidence interval is also mentioned for comparison. All the information is useful to judge the results in both the terms like clinical and statistical significance. Results are clearly stated in a broad manner; however in-depth results were not mentioned. Results for PIVC failure and dislodgement were presented regarding the number of failures, its percentage and the confidence interval. Expected results were not obtained for the infection, phlebitis, and occlusion. It was clearly mentioned in the article that, there was no difference between the standard care and skin glue group for infection, phlebitis, and occlusion. According to the researcher, the failure rate of catheters in the control group is consistent with reported literature data. Hence, this study, can be considered as valid study and it reflects generalizability of the results. There is the trend in the reduction in failure in phlebitis and occlusion, however, this difference is very small. One of the most important limitations of the study was, measurements were made at 48 hours. Failure of the intravenous catheter beyond 48 hours cannot be extrapolated in this study. The researcher didn’t mention any suggestions for future research from this study. The researcher made suggestion to the healthcare providers that use of skin glue can have beneficial effects for patient comfort, hospital flow and costs. There was no standardised protocol mentioned for outcome measurements, hence it would be difficult to replicate the exactly same study.                   

Conclusion:

Authors concluded that use of skin glue along with standard care would be beneficial in reducing failure of the peripheral intravenous catheter in the adult emergency department in the hospital. This finding would be helpful in improving comfort for the patients with the insertion of the catheter. Reduction in the failure of the catheter would be helpful in reducing irritation to the vein and preventing infection in the patients. This finding also would be effective in reducing the cost of the emergency department. This cost can be reduced by saving the time of the healthcare staff, reducing consumables, hospital stay duration and adverse effect management. Prevention of this catheter failure can also be used in improving treatment for hydration, antibiotics, and analgesia. As intravenous catheters are inserted to a large number of people every year, this reduction in cost would be helpful in reducing the burden of healthcare cost of Government.    

The Relevance of Nursing Practice and Case Study:

There should be the integration of available evidence with clinical expertise and patient value for the effective implementation of the evidence-based practice. This paper also incorporated evidence-based practice and followed all the steps required for nursing practice. These steps comprise of the development of answerable question of clinical practice, the literature search for the evidence, application of the evidence and evaluation of the performance of the evidence in addressing the clinical question. Opinions and values of the patients and their family members should be considered along with clinical expertise for addressing clinical question in evidence-based practice. Solely evidence should not consider for providing treatment to the patient. Other aspects of personal experience, judgment, skills and above all patient values should be considered. In this research also importance is giving to patient values by helping them in removing preexisting peripheral intravenous catheter dressing and anchoring tapes. In evidence-based practice, there should be a minimal discomfort to the patient. In this study also, efforts were made to reduce discomfort to the patient by reducing the failure rate of catheters which would be helpful in improving medication administration to the patients and reducing stay duration of the patient in the hospital. Before implementation of evidence to the patients, this evidence should be discussed with patient and family members and informed consent should be taken from the patient. In this case study also, informed consent was taken from the patient before enrolment in the study (Burman et al., 2013).          

In evidence-based practice healthcare provider should be open minded and implement new things to improve patient condition. Healthcare professional should be skilled and trained to search evidence for the clinical problem and implement this evidence in their own practice. In this study also, research nurse at the emergency department searched the evidence for catheter insertion, identified its problem of failure, identified solution for failure regarding use of skin glue and searched for the evidence for the use of skin glue for the reducing failure rate of catheter insertion. Research nurse in this case study also implemented the use of skin glue in the emergency department for reducing catheter failure, and these nurses achieved promising outcome from this intervention (Earle-Foley, 2011). 

In evidence-based practice, available evidence also should be helpful in reducing the cost of the intervention. In this study also, authors mentioned that available evidence is helpful in reducing cost of the nursing practice. Available evidence should be used effectively to evaluate the performance of the evidence implemented in the healthcare facility. In this study, reduction in catheter failure rate is in the range mentioned in the literature. The efficiency of available evidence depends on the development of answerable question, searching suitable evidence, appraising the evidence and integrating clinical expertise and patient’s values in practice. In this case study, all these steps are followed (Stevens, 2013).

 

References:

Burman, M.E., Robinson, B., and Hart, A.M. (2013). Linking evidence-based nursing practice and patient-centered care through patient preferences. Nursing administration Quarterly, 37(3), 231-41. 

Earle-Foley, V. (2011). Evidence-based practice: issues, paradigms, and future pathways. Nursing Forum, 46(1), 38-44. 

Edwards, M., Rickard, C.M., Rapchuk, I., et al. (2014). A pilot trial of bordered polyurethane dressings, tissue adhesive and sutureless devices compared with standard polyurethane dressings for securing shortterm arterial catheters. Critical Care and Resuscitation, 16, 175-183. 

LoBiondo-Wood, G., and Haber, J.  (2010). Nursing Research: Methods and Critical Appraisal for Evidence-Based Practice. Elsevier Health Sciences. 

Limm, E.I., Fang, X., Dendle, C., et al. (2013). Half of all peripheral intravenous lines in an Australian tertiary emergency department are unused: pain with no gain? Annals of Emergency Medicine, 62, 521-525. 

Marsh, N., Webster, J., Mihala, G., et al. (2015).  Devices and dressings to secure peripheral venous catheters to prevent complications. Cochrane Database of Systematic Reviews, 6, CD011070. 

Peace, K. E., and  Chen, D.G. (2010).  Clinical Trial Methodology. CRC Press. 

Reynolds, H., Taraporewalla, K., Tower, M., et al. (2015). Novel technologies can provide effective dressing and securement for peripheral arterial catheters: a pilot randomised controlled trial in the operating theatre and the intensive care unit. Australian Critical Care, 28, 140-148. 

Sahu, P. K., Pal, S. ., and Das, A. K. (2015). Estimation and Inferential Statistics. Springer. 

Sheridan, D. J. (2016). Evidence-Based Medicine: Best Practice or Restrictive Dogma. World Scientific. 

Simonova, G., Rickard, C.M., Dunster, K.R., et al. (2012). Cyanoacrylate tissue adhesives—effective securement technique for intravascular catheters: in vitro testing of safety and feasibility. Anaesthesia & Intensive Care, 40, 460-466. 

Stevens, K.R. (2013). The impact of evidence-based practice in nursing and the next big ideas.Online Journal of Issues in Nursing, 18(2), 4. 

Wilkinson, J.N., and Fitz-Henry, J. (2008). Securing epidural catheters with Histoacryl glue. Anaesthesia, 63, 324.

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