Rationale, aims and objectives Many peripheral intravenous catheter (PIVC) infusion
phlebitis sc... more Rationale, aims and objectives Many peripheral intravenous catheter (PIVC) infusion
phlebitis scales and definitions are used internationally, although no existing scale has
demonstrated comprehensive reliability and validity. We examined inter-rater agreement
between registered nurses on signs, symptoms and scales commonly used in phlebitis
assessment.
Methods Seven PIVC-associated phlebitis signs/symptoms (pain, tenderness, swelling,
erythema, palpable venous cord, purulent discharge and warmth) were observed daily by
two raters (a research nurse and registered nurse). These data were modelled into phlebitis
scores using 10 different tools. Proportions of agreement (e.g. positive, negative), observed
and expected agreements, Cohen’s kappa, the maximum achievable kappa, prevalence- and
bias-adjusted kappa were calculated.
Results Two hundred ten patients were recruited across three hospitals, with 247 sets of
paired observations undertaken. The second rater was blinded to the first’s findings. The
Catney and Rittenberg scales were the most sensitive (phlebitis in >20% of observations),
whereas the Curran, Lanbeck and Rickard scales were the most restrictive (≤2% phlebitis).
Only tenderness and the Catney (one of pain, tenderness, erythema or palpable cord) and
Rittenberg scales (one of erythema, swelling, tenderness or pain) had acceptable (more than
two-thirds, 66.7%) levels of inter-rater agreement.
Conclusions Inter-rater agreement for phlebitis assessment signs/symptoms and scales is
low. This likely contributes to the high degree of variability in phlebitis rates in literature.
We recommend further research into assessment of infrequent signs/symptoms and the
Catney or Rittenberg scales. New approaches to evaluating vein irritation that are valid,
reliable and based on their ability to predict complications need exploration.
Background: Despite a lack of empiric data to support the practice, traditionally, antiseptic sol... more Background: Despite a lack of empiric data to support the practice, traditionally, antiseptic solutions have been used to clean the periurethral area before inserting an indwelling catheter. The purpose of this study was to compare urinary colonization rates of subjects whose periurethral area was cleaned with water versus chlorhexidine 0.1% before the insertion of an indwelling urinary catheter. Methods: Obstetric patients who required urinary catheterization as part of their routine care were randomly assigned to either the “water” or “chlorhexidine” group with a sealed envelope. A sterile specimen of urine was collected 24 hours after insertion of the catheter. Results: Of the 436 patients (86.2%) with complete data (water group, 219; antiseptic group, 217), 38 (8.7%) had urinary tract bacteriuria >106 cfu/L. Rates of urinary tract infection were similar in each group (water group, 8.2%; antiseptic group, 9.2%; odds ratio 1.13; 95% confidence interval 0.58-2.21). Conclusion: The practice of periurethral cleaning with an antiseptic did not decrease the rates of bacteriuria in this population and is probably not useful. (Am J Infect Control 2001:29:389-94.)
To examine the use, management, documentation and complications for intravascular devices in card... more To examine the use, management, documentation and complications for intravascular devices in cardiac, medical and surgical inpatients. A point prevalence survey was undertaken in a large tertiary hospital in Queensland. Descriptive statistics were used to analyse data. Of the 327 patients assessed, 192 (58.7%) had one or more devices in situ. Of the 220 devices, 190 (86.4%) were peripheral venous catheters, 25 (11.4%) were peripherally inserted central catheters and five (2.3%) were central venous catheters. Sixty-two of 220 devices (28.2%) were in situ without a clear purpose, whereas 54 (24.7%) had one or more complications, such as redness, pain, tracking, oedema or oozing. There was no documentation on the daily patient care record to indicate that a site assessment had occurred within the past 8h for 25% of the devices in situ. The present study identified several problems and highlighted areas for improvement in the management and documentation for intravascular devices. Ongoing education, promoting good clinical practice and reauditing, can be applied to improve the management of devices.
A peripheral venous catheter (PVC) is typically used for short-term delivery of intravascular flu... more A peripheral venous catheter (PVC) is typically used for short-term delivery of intravascular fluids and medications. It is an essential element of modern medicine and the most frequent invasive procedure performed in hospitals. However, PVCs often fail before intravenous treatment is completed: this can occur because the device is not adequately attached to the skin, allowing the PVC to fall out, leading to complications such as phlebitis (irritation or inflammation to the vein wall), infiltration (fluid leaking into surrounding tissues) or occlusion (blockage). An inadequately secured PVC also increases the risk of catheter-related bloodstream infection (CRBSI), as the pistoning action (moving back and forth in the vein) of the catheter can allow migration of organisms along the catheter and into the bloodstream. Despite the many dressings and securement devices available, the impact of different securement techniques for increasing PVC dwell time is still unclear; there is a need to provide guidance for clinicians by reviewing current studies systematically. To assess the effects of PVC dressings and securement devices on the incidence of PVC failure. We searched the following electronic databases to identify reports of relevant randomised controlled trials (RCTs): the Cochrane Wounds Group Register (searched 08 April 2015): The Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 3), Ovid MEDLINE (1946 to March 7 2015); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, March 7 2015); Ovid EMBASE (1974 to March 7 2015); and EBSCO CINAHL (1982 to March 8 2015). RCTs or cluster RCTs comparing different dressings or securement devices for the stabilisation of PVCs. Cross-over trials were ineligible for inclusion, unless data for the first treatment period could be obtained. Two review authors independently selected studies, assessed trial quality and extracted data. We contacted study authors for missing information. We used standard methodological procedures expected by Cochrane. We included six RCTs (1539 participants) in this review. Trial sizes ranged from 50 to 703 participants. These six trials made four comparisons, namely: transparent dressings versus gauze; bordered transparent dressings versus a securement device; bordered transparent dressings versus tape; and transparent dressing versus sticking plaster. There is very low quality evidence of fewer catheter dislodgements or accidental removals with transparent dressings compared with gauze (two studies, 278 participants, RR 0.40; 95% CI 0.17 to 0.92, P = 0.03%). The relative effects of transparent dressings and gauze on phlebitis (RR 0.89; 95% CI 0.47 to 1.68) and infiltration (RR 0.80; 95% CI 0.48 to 1.33) are unclear. The relative effects on PVC failure of a bordered transparent dressing and a securement device have been assessed in only one small study and these were unclear. There was very low quality evidence from the same single study of less frequent dislodgement or accidental catheter removal with bordered transparent dressings than securement devices (RR 0.14, 95% CI 0.03 to 0.63) but more phlebitis with bordered dressings (RR 8.11, 95% CI 1.03 to 64.02) (very low quality evidence). A small single study compared bordered transparent dressings with tape and found very low quality evidence of more PVC failure with the bordered dressing (RR 1.84, 95% CI 1.08 to 3.11) but the relative effects on dislodgement were not clear (very low quality evidence). The relative effects of transparent dressings and a sticking plaster have only been compared in one small study and are unclear. More high quality RCTs are required to determine the relative effects of alternative PVC dressings and securement devices. It is not clear if any one dressing or securement device is better than any other in securing peripheral venous catheters. There is a need for further, independent high quality trials to evaluate the many traditional as well as the newer, high use products. Given the large cost differences between some different dressings and securement devices, future trials should include a robust cost-effectiveness analysis.
Background. The introduction of a new information retrieval system for the use of health service... more Background. The introduction of a new information retrieval system for the use of health service staff at a large tertiary referral hospital provided an excellent opportunity for nurses to make greater use of evidence to inform their practice. However, the extent to which nurses were able to access the resource was unknown.Aim. The aim of the study was to obtain this information and to test nurses' knowledge of computers and their attitudes to using them in their practice.Methods. During October 2001 a computer use questionnaire was attached to the pay advice slips of all nursing staff at the Royal Brisbane and Royal Women's Hospital ( n = 1708). Staff were asked to return their completed questionnaire in a preaddressed return envelope. To encourage this, a prize (a Gold Class cinema pass for two) was offered.Results. Of the 1708 questionnaires distributed, 590 were returned, giving a 34·5% response rate. Computer use was influenced by education, nursing seniority, age, and length of time in the service and, to a lesser extent, gender.Conclusions. Information from the study has assisted planners and educators to identify clusters of nurses to target for interventions in this area. Results will also be used to assess the success of any interventions.
Aims To explore the underlying organizational issues affecting a nurses’ decision to leave and t... more Aims To explore the underlying organizational issues affecting a nurses’ decision to leave and to develop a contemporary practice environment measure based on the experiences of nurses working lives.Background Turnover had reached an unacceptable level in our organization but underlying reasons for leaving were unknown.Method In-depth interviews were conducted with 13 nurses who had resigned. Transcripts were analysed using the constant comparative method. Information from the interviews informed the development a new practice environment tool, which has undergone initial testing using the Content Validity Index and Chronbach's alpha.Results Two domains (‘work life’ and ‘personal life/professional development’) and five themes (‘feeling safe’, ‘feeling valued’, ‘getting things done’, ‘professional development’ and ‘being flexible’) emerged from the interviews. A content validity score for the new instrument was 0.79 and Chronbach’s alpha 0.93.Conclusion The new practice environment tool has shown useful initial reliability and validity but requires wider testing in other settings.Implications for nursing management The reality and experiences of nurses working lives can be identified through exit interviews conducted by an independent person. Information from such interviews is useful in identifying an organization’s strength and weaknesses and to develop initiatives to support retention.
To examine the use, management, documentation and complications for intravascular devices in card... more To examine the use, management, documentation and complications for intravascular devices in cardiac, medical and surgical inpatients. A point prevalence survey was undertaken in a large tertiary hospital in Queensland. Descriptive statistics were used to analyse data. Of the 327 patients assessed, 192 (58.7%) had one or more devices in situ. Of the 220 devices, 190 (86.4%) were peripheral venous catheters, 25 (11.4%) were peripherally inserted central catheters and five (2.3%) were central venous catheters. Sixty-two of 220 devices (28.2%) were in situ without a clear purpose, whereas 54 (24.7%) had one or more complications, such as redness, pain, tracking, oedema or oozing. There was no documentation on the daily patient care record to indicate that a site assessment had occurred within the past 8h for 25% of the devices in situ. The present study identified several problems and highlighted areas for improvement in the management and documentation for intravascular devices. Ongoing education, promoting good clinical practice and reauditing, can be applied to improve the management of devices.
A peripheral venous catheter (PVC) is typically used for short-term delivery of intravascular flu... more A peripheral venous catheter (PVC) is typically used for short-term delivery of intravascular fluids and medications. It is an essential element of modern medicine and the most frequent invasive procedure performed in hospitals. However, PVCs often fail before intravenous treatment is completed: this can occur because the device is not adequately attached to the skin, allowing the PVC to fall out, leading to complications such as phlebitis (irritation or inflammation to the vein wall), infiltration (fluid leaking into surrounding tissues) or occlusion (blockage). An inadequately secured PVC also increases the risk of catheter-related bloodstream infection (CRBSI), as the pistoning action (moving back and forth in the vein) of the catheter can allow migration of organisms along the catheter and into the bloodstream. Despite the many dressings and securement devices available, the impact of different securement techniques for increasing PVC dwell time is still unclear; there is a need to provide guidance for clinicians by reviewing current studies systematically. To assess the effects of PVC dressings and securement devices on the incidence of PVC failure. We searched the following electronic databases to identify reports of relevant randomised controlled trials (RCTs): the Cochrane Wounds Group Register (searched 08 April 2015): The Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 3), Ovid MEDLINE (1946 to March 7 2015); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, March 7 2015); Ovid EMBASE (1974 to March 7 2015); and EBSCO CINAHL (1982 to March 8 2015). RCTs or cluster RCTs comparing different dressings or securement devices for the stabilisation of PVCs. Cross-over trials were ineligible for inclusion, unless data for the first treatment period could be obtained. Two review authors independently selected studies, assessed trial quality and extracted data. We contacted study authors for missing information. We used standard methodological procedures expected by Cochrane. We included six RCTs (1539 participants) in this review. Trial sizes ranged from 50 to 703 participants. These six trials made four comparisons, namely: transparent dressings versus gauze; bordered transparent dressings versus a securement device; bordered transparent dressings versus tape; and transparent dressing versus sticking plaster. There is very low quality evidence of fewer catheter dislodgements or accidental removals with transparent dressings compared with gauze (two studies, 278 participants, RR 0.40; 95% CI 0.17 to 0.92, P = 0.03%). The relative effects of transparent dressings and gauze on phlebitis (RR 0.89; 95% CI 0.47 to 1.68) and infiltration (RR 0.80; 95% CI 0.48 to 1.33) are unclear. The relative effects on PVC failure of a bordered transparent dressing and a securement device have been assessed in only one small study and these were unclear. There was very low quality evidence from the same single study of less frequent dislodgement or accidental catheter removal with bordered transparent dressings than securement devices (RR 0.14, 95% CI 0.03 to 0.63) but more phlebitis with bordered dressings (RR 8.11, 95% CI 1.03 to 64.02) (very low quality evidence). A small single study compared bordered transparent dressings with tape and found very low quality evidence of more PVC failure with the bordered dressing (RR 1.84, 95% CI 1.08 to 3.11) but the relative effects on dislodgement were not clear (very low quality evidence). The relative effects of transparent dressings and a sticking plaster have only been compared in one small study and are unclear. More high quality RCTs are required to determine the relative effects of alternative PVC dressings and securement devices. It is not clear if any one dressing or securement device is better than any other in securing peripheral venous catheters. There is a need for further, independent high quality trials to evaluate the many traditional as well as the newer, high use products. Given the large cost differences between some different dressings and securement devices, future trials should include a robust cost-effectiveness analysis.
Background. The introduction of a new information retrieval system for the use of health service... more Background. The introduction of a new information retrieval system for the use of health service staff at a large tertiary referral hospital provided an excellent opportunity for nurses to make greater use of evidence to inform their practice. However, the extent to which nurses were able to access the resource was unknown.Aim. The aim of the study was to obtain this information and to test nurses' knowledge of computers and their attitudes to using them in their practice.Methods. During October 2001 a computer use questionnaire was attached to the pay advice slips of all nursing staff at the Royal Brisbane and Royal Women's Hospital ( n = 1708). Staff were asked to return their completed questionnaire in a preaddressed return envelope. To encourage this, a prize (a Gold Class cinema pass for two) was offered.Results. Of the 1708 questionnaires distributed, 590 were returned, giving a 34·5% response rate. Computer use was influenced by education, nursing seniority, age, and length of time in the service and, to a lesser extent, gender.Conclusions. Information from the study has assisted planners and educators to identify clusters of nurses to target for interventions in this area. Results will also be used to assess the success of any interventions.
Aims To explore the underlying organizational issues affecting a nurses’ decision to leave and t... more Aims To explore the underlying organizational issues affecting a nurses’ decision to leave and to develop a contemporary practice environment measure based on the experiences of nurses working lives.Background Turnover had reached an unacceptable level in our organization but underlying reasons for leaving were unknown.Method In-depth interviews were conducted with 13 nurses who had resigned. Transcripts were analysed using the constant comparative method. Information from the interviews informed the development a new practice environment tool, which has undergone initial testing using the Content Validity Index and Chronbach's alpha.Results Two domains (‘work life’ and ‘personal life/professional development’) and five themes (‘feeling safe’, ‘feeling valued’, ‘getting things done’, ‘professional development’ and ‘being flexible’) emerged from the interviews. A content validity score for the new instrument was 0.79 and Chronbach’s alpha 0.93.Conclusion The new practice environment tool has shown useful initial reliability and validity but requires wider testing in other settings.Implications for nursing management The reality and experiences of nurses working lives can be identified through exit interviews conducted by an independent person. Information from such interviews is useful in identifying an organization’s strength and weaknesses and to develop initiatives to support retention.
Rationale, aims and objectives Many peripheral intravenous catheter (PIVC) infusion
phlebitis sc... more Rationale, aims and objectives Many peripheral intravenous catheter (PIVC) infusion
phlebitis scales and definitions are used internationally, although no existing scale has
demonstrated comprehensive reliability and validity. We examined inter-rater agreement
between registered nurses on signs, symptoms and scales commonly used in phlebitis
assessment.
Methods Seven PIVC-associated phlebitis signs/symptoms (pain, tenderness, swelling,
erythema, palpable venous cord, purulent discharge and warmth) were observed daily by
two raters (a research nurse and registered nurse). These data were modelled into phlebitis
scores using 10 different tools. Proportions of agreement (e.g. positive, negative), observed
and expected agreements, Cohen’s kappa, the maximum achievable kappa, prevalence- and
bias-adjusted kappa were calculated.
Results Two hundred ten patients were recruited across three hospitals, with 247 sets of
paired observations undertaken. The second rater was blinded to the first’s findings. The
Catney and Rittenberg scales were the most sensitive (phlebitis in >20% of observations),
whereas the Curran, Lanbeck and Rickard scales were the most restrictive (≤2% phlebitis).
Only tenderness and the Catney (one of pain, tenderness, erythema or palpable cord) and
Rittenberg scales (one of erythema, swelling, tenderness or pain) had acceptable (more than
two-thirds, 66.7%) levels of inter-rater agreement.
Conclusions Inter-rater agreement for phlebitis assessment signs/symptoms and scales is
low. This likely contributes to the high degree of variability in phlebitis rates in literature.
We recommend further research into assessment of infrequent signs/symptoms and the
Catney or Rittenberg scales. New approaches to evaluating vein irritation that are valid,
reliable and based on their ability to predict complications need exploration.
Background: Despite a lack of empiric data to support the practice, traditionally, antiseptic sol... more Background: Despite a lack of empiric data to support the practice, traditionally, antiseptic solutions have been used to clean the periurethral area before inserting an indwelling catheter. The purpose of this study was to compare urinary colonization rates of subjects whose periurethral area was cleaned with water versus chlorhexidine 0.1% before the insertion of an indwelling urinary catheter. Methods: Obstetric patients who required urinary catheterization as part of their routine care were randomly assigned to either the “water” or “chlorhexidine” group with a sealed envelope. A sterile specimen of urine was collected 24 hours after insertion of the catheter. Results: Of the 436 patients (86.2%) with complete data (water group, 219; antiseptic group, 217), 38 (8.7%) had urinary tract bacteriuria >106 cfu/L. Rates of urinary tract infection were similar in each group (water group, 8.2%; antiseptic group, 9.2%; odds ratio 1.13; 95% confidence interval 0.58-2.21). Conclusion: The practice of periurethral cleaning with an antiseptic did not decrease the rates of bacteriuria in this population and is probably not useful. (Am J Infect Control 2001:29:389-94.)
To examine the use, management, documentation and complications for intravascular devices in card... more To examine the use, management, documentation and complications for intravascular devices in cardiac, medical and surgical inpatients. A point prevalence survey was undertaken in a large tertiary hospital in Queensland. Descriptive statistics were used to analyse data. Of the 327 patients assessed, 192 (58.7%) had one or more devices in situ. Of the 220 devices, 190 (86.4%) were peripheral venous catheters, 25 (11.4%) were peripherally inserted central catheters and five (2.3%) were central venous catheters. Sixty-two of 220 devices (28.2%) were in situ without a clear purpose, whereas 54 (24.7%) had one or more complications, such as redness, pain, tracking, oedema or oozing. There was no documentation on the daily patient care record to indicate that a site assessment had occurred within the past 8h for 25% of the devices in situ. The present study identified several problems and highlighted areas for improvement in the management and documentation for intravascular devices. Ongoing education, promoting good clinical practice and reauditing, can be applied to improve the management of devices.
A peripheral venous catheter (PVC) is typically used for short-term delivery of intravascular flu... more A peripheral venous catheter (PVC) is typically used for short-term delivery of intravascular fluids and medications. It is an essential element of modern medicine and the most frequent invasive procedure performed in hospitals. However, PVCs often fail before intravenous treatment is completed: this can occur because the device is not adequately attached to the skin, allowing the PVC to fall out, leading to complications such as phlebitis (irritation or inflammation to the vein wall), infiltration (fluid leaking into surrounding tissues) or occlusion (blockage). An inadequately secured PVC also increases the risk of catheter-related bloodstream infection (CRBSI), as the pistoning action (moving back and forth in the vein) of the catheter can allow migration of organisms along the catheter and into the bloodstream. Despite the many dressings and securement devices available, the impact of different securement techniques for increasing PVC dwell time is still unclear; there is a need to provide guidance for clinicians by reviewing current studies systematically. To assess the effects of PVC dressings and securement devices on the incidence of PVC failure. We searched the following electronic databases to identify reports of relevant randomised controlled trials (RCTs): the Cochrane Wounds Group Register (searched 08 April 2015): The Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 3), Ovid MEDLINE (1946 to March 7 2015); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, March 7 2015); Ovid EMBASE (1974 to March 7 2015); and EBSCO CINAHL (1982 to March 8 2015). RCTs or cluster RCTs comparing different dressings or securement devices for the stabilisation of PVCs. Cross-over trials were ineligible for inclusion, unless data for the first treatment period could be obtained. Two review authors independently selected studies, assessed trial quality and extracted data. We contacted study authors for missing information. We used standard methodological procedures expected by Cochrane. We included six RCTs (1539 participants) in this review. Trial sizes ranged from 50 to 703 participants. These six trials made four comparisons, namely: transparent dressings versus gauze; bordered transparent dressings versus a securement device; bordered transparent dressings versus tape; and transparent dressing versus sticking plaster. There is very low quality evidence of fewer catheter dislodgements or accidental removals with transparent dressings compared with gauze (two studies, 278 participants, RR 0.40; 95% CI 0.17 to 0.92, P = 0.03%). The relative effects of transparent dressings and gauze on phlebitis (RR 0.89; 95% CI 0.47 to 1.68) and infiltration (RR 0.80; 95% CI 0.48 to 1.33) are unclear. The relative effects on PVC failure of a bordered transparent dressing and a securement device have been assessed in only one small study and these were unclear. There was very low quality evidence from the same single study of less frequent dislodgement or accidental catheter removal with bordered transparent dressings than securement devices (RR 0.14, 95% CI 0.03 to 0.63) but more phlebitis with bordered dressings (RR 8.11, 95% CI 1.03 to 64.02) (very low quality evidence). A small single study compared bordered transparent dressings with tape and found very low quality evidence of more PVC failure with the bordered dressing (RR 1.84, 95% CI 1.08 to 3.11) but the relative effects on dislodgement were not clear (very low quality evidence). The relative effects of transparent dressings and a sticking plaster have only been compared in one small study and are unclear. More high quality RCTs are required to determine the relative effects of alternative PVC dressings and securement devices. It is not clear if any one dressing or securement device is better than any other in securing peripheral venous catheters. There is a need for further, independent high quality trials to evaluate the many traditional as well as the newer, high use products. Given the large cost differences between some different dressings and securement devices, future trials should include a robust cost-effectiveness analysis.
Background. The introduction of a new information retrieval system for the use of health service... more Background. The introduction of a new information retrieval system for the use of health service staff at a large tertiary referral hospital provided an excellent opportunity for nurses to make greater use of evidence to inform their practice. However, the extent to which nurses were able to access the resource was unknown.Aim. The aim of the study was to obtain this information and to test nurses' knowledge of computers and their attitudes to using them in their practice.Methods. During October 2001 a computer use questionnaire was attached to the pay advice slips of all nursing staff at the Royal Brisbane and Royal Women's Hospital ( n = 1708). Staff were asked to return their completed questionnaire in a preaddressed return envelope. To encourage this, a prize (a Gold Class cinema pass for two) was offered.Results. Of the 1708 questionnaires distributed, 590 were returned, giving a 34·5% response rate. Computer use was influenced by education, nursing seniority, age, and length of time in the service and, to a lesser extent, gender.Conclusions. Information from the study has assisted planners and educators to identify clusters of nurses to target for interventions in this area. Results will also be used to assess the success of any interventions.
Aims To explore the underlying organizational issues affecting a nurses’ decision to leave and t... more Aims To explore the underlying organizational issues affecting a nurses’ decision to leave and to develop a contemporary practice environment measure based on the experiences of nurses working lives.Background Turnover had reached an unacceptable level in our organization but underlying reasons for leaving were unknown.Method In-depth interviews were conducted with 13 nurses who had resigned. Transcripts were analysed using the constant comparative method. Information from the interviews informed the development a new practice environment tool, which has undergone initial testing using the Content Validity Index and Chronbach's alpha.Results Two domains (‘work life’ and ‘personal life/professional development’) and five themes (‘feeling safe’, ‘feeling valued’, ‘getting things done’, ‘professional development’ and ‘being flexible’) emerged from the interviews. A content validity score for the new instrument was 0.79 and Chronbach’s alpha 0.93.Conclusion The new practice environment tool has shown useful initial reliability and validity but requires wider testing in other settings.Implications for nursing management The reality and experiences of nurses working lives can be identified through exit interviews conducted by an independent person. Information from such interviews is useful in identifying an organization’s strength and weaknesses and to develop initiatives to support retention.
To examine the use, management, documentation and complications for intravascular devices in card... more To examine the use, management, documentation and complications for intravascular devices in cardiac, medical and surgical inpatients. A point prevalence survey was undertaken in a large tertiary hospital in Queensland. Descriptive statistics were used to analyse data. Of the 327 patients assessed, 192 (58.7%) had one or more devices in situ. Of the 220 devices, 190 (86.4%) were peripheral venous catheters, 25 (11.4%) were peripherally inserted central catheters and five (2.3%) were central venous catheters. Sixty-two of 220 devices (28.2%) were in situ without a clear purpose, whereas 54 (24.7%) had one or more complications, such as redness, pain, tracking, oedema or oozing. There was no documentation on the daily patient care record to indicate that a site assessment had occurred within the past 8h for 25% of the devices in situ. The present study identified several problems and highlighted areas for improvement in the management and documentation for intravascular devices. Ongoing education, promoting good clinical practice and reauditing, can be applied to improve the management of devices.
A peripheral venous catheter (PVC) is typically used for short-term delivery of intravascular flu... more A peripheral venous catheter (PVC) is typically used for short-term delivery of intravascular fluids and medications. It is an essential element of modern medicine and the most frequent invasive procedure performed in hospitals. However, PVCs often fail before intravenous treatment is completed: this can occur because the device is not adequately attached to the skin, allowing the PVC to fall out, leading to complications such as phlebitis (irritation or inflammation to the vein wall), infiltration (fluid leaking into surrounding tissues) or occlusion (blockage). An inadequately secured PVC also increases the risk of catheter-related bloodstream infection (CRBSI), as the pistoning action (moving back and forth in the vein) of the catheter can allow migration of organisms along the catheter and into the bloodstream. Despite the many dressings and securement devices available, the impact of different securement techniques for increasing PVC dwell time is still unclear; there is a need to provide guidance for clinicians by reviewing current studies systematically. To assess the effects of PVC dressings and securement devices on the incidence of PVC failure. We searched the following electronic databases to identify reports of relevant randomised controlled trials (RCTs): the Cochrane Wounds Group Register (searched 08 April 2015): The Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 3), Ovid MEDLINE (1946 to March 7 2015); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, March 7 2015); Ovid EMBASE (1974 to March 7 2015); and EBSCO CINAHL (1982 to March 8 2015). RCTs or cluster RCTs comparing different dressings or securement devices for the stabilisation of PVCs. Cross-over trials were ineligible for inclusion, unless data for the first treatment period could be obtained. Two review authors independently selected studies, assessed trial quality and extracted data. We contacted study authors for missing information. We used standard methodological procedures expected by Cochrane. We included six RCTs (1539 participants) in this review. Trial sizes ranged from 50 to 703 participants. These six trials made four comparisons, namely: transparent dressings versus gauze; bordered transparent dressings versus a securement device; bordered transparent dressings versus tape; and transparent dressing versus sticking plaster. There is very low quality evidence of fewer catheter dislodgements or accidental removals with transparent dressings compared with gauze (two studies, 278 participants, RR 0.40; 95% CI 0.17 to 0.92, P = 0.03%). The relative effects of transparent dressings and gauze on phlebitis (RR 0.89; 95% CI 0.47 to 1.68) and infiltration (RR 0.80; 95% CI 0.48 to 1.33) are unclear. The relative effects on PVC failure of a bordered transparent dressing and a securement device have been assessed in only one small study and these were unclear. There was very low quality evidence from the same single study of less frequent dislodgement or accidental catheter removal with bordered transparent dressings than securement devices (RR 0.14, 95% CI 0.03 to 0.63) but more phlebitis with bordered dressings (RR 8.11, 95% CI 1.03 to 64.02) (very low quality evidence). A small single study compared bordered transparent dressings with tape and found very low quality evidence of more PVC failure with the bordered dressing (RR 1.84, 95% CI 1.08 to 3.11) but the relative effects on dislodgement were not clear (very low quality evidence). The relative effects of transparent dressings and a sticking plaster have only been compared in one small study and are unclear. More high quality RCTs are required to determine the relative effects of alternative PVC dressings and securement devices. It is not clear if any one dressing or securement device is better than any other in securing peripheral venous catheters. There is a need for further, independent high quality trials to evaluate the many traditional as well as the newer, high use products. Given the large cost differences between some different dressings and securement devices, future trials should include a robust cost-effectiveness analysis.
Background. The introduction of a new information retrieval system for the use of health service... more Background. The introduction of a new information retrieval system for the use of health service staff at a large tertiary referral hospital provided an excellent opportunity for nurses to make greater use of evidence to inform their practice. However, the extent to which nurses were able to access the resource was unknown.Aim. The aim of the study was to obtain this information and to test nurses' knowledge of computers and their attitudes to using them in their practice.Methods. During October 2001 a computer use questionnaire was attached to the pay advice slips of all nursing staff at the Royal Brisbane and Royal Women's Hospital ( n = 1708). Staff were asked to return their completed questionnaire in a preaddressed return envelope. To encourage this, a prize (a Gold Class cinema pass for two) was offered.Results. Of the 1708 questionnaires distributed, 590 were returned, giving a 34·5% response rate. Computer use was influenced by education, nursing seniority, age, and length of time in the service and, to a lesser extent, gender.Conclusions. Information from the study has assisted planners and educators to identify clusters of nurses to target for interventions in this area. Results will also be used to assess the success of any interventions.
Aims To explore the underlying organizational issues affecting a nurses’ decision to leave and t... more Aims To explore the underlying organizational issues affecting a nurses’ decision to leave and to develop a contemporary practice environment measure based on the experiences of nurses working lives.Background Turnover had reached an unacceptable level in our organization but underlying reasons for leaving were unknown.Method In-depth interviews were conducted with 13 nurses who had resigned. Transcripts were analysed using the constant comparative method. Information from the interviews informed the development a new practice environment tool, which has undergone initial testing using the Content Validity Index and Chronbach's alpha.Results Two domains (‘work life’ and ‘personal life/professional development’) and five themes (‘feeling safe’, ‘feeling valued’, ‘getting things done’, ‘professional development’ and ‘being flexible’) emerged from the interviews. A content validity score for the new instrument was 0.79 and Chronbach’s alpha 0.93.Conclusion The new practice environment tool has shown useful initial reliability and validity but requires wider testing in other settings.Implications for nursing management The reality and experiences of nurses working lives can be identified through exit interviews conducted by an independent person. Information from such interviews is useful in identifying an organization’s strength and weaknesses and to develop initiatives to support retention.
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Papers by Joan Webster
phlebitis scales and definitions are used internationally, although no existing scale has
demonstrated comprehensive reliability and validity. We examined inter-rater agreement
between registered nurses on signs, symptoms and scales commonly used in phlebitis
assessment.
Methods Seven PIVC-associated phlebitis signs/symptoms (pain, tenderness, swelling,
erythema, palpable venous cord, purulent discharge and warmth) were observed daily by
two raters (a research nurse and registered nurse). These data were modelled into phlebitis
scores using 10 different tools. Proportions of agreement (e.g. positive, negative), observed
and expected agreements, Cohen’s kappa, the maximum achievable kappa, prevalence- and
bias-adjusted kappa were calculated.
Results Two hundred ten patients were recruited across three hospitals, with 247 sets of
paired observations undertaken. The second rater was blinded to the first’s findings. The
Catney and Rittenberg scales were the most sensitive (phlebitis in >20% of observations),
whereas the Curran, Lanbeck and Rickard scales were the most restrictive (≤2% phlebitis).
Only tenderness and the Catney (one of pain, tenderness, erythema or palpable cord) and
Rittenberg scales (one of erythema, swelling, tenderness or pain) had acceptable (more than
two-thirds, 66.7%) levels of inter-rater agreement.
Conclusions Inter-rater agreement for phlebitis assessment signs/symptoms and scales is
low. This likely contributes to the high degree of variability in phlebitis rates in literature.
We recommend further research into assessment of infrequent signs/symptoms and the
Catney or Rittenberg scales. New approaches to evaluating vein irritation that are valid,
reliable and based on their ability to predict complications need exploration.
phlebitis scales and definitions are used internationally, although no existing scale has
demonstrated comprehensive reliability and validity. We examined inter-rater agreement
between registered nurses on signs, symptoms and scales commonly used in phlebitis
assessment.
Methods Seven PIVC-associated phlebitis signs/symptoms (pain, tenderness, swelling,
erythema, palpable venous cord, purulent discharge and warmth) were observed daily by
two raters (a research nurse and registered nurse). These data were modelled into phlebitis
scores using 10 different tools. Proportions of agreement (e.g. positive, negative), observed
and expected agreements, Cohen’s kappa, the maximum achievable kappa, prevalence- and
bias-adjusted kappa were calculated.
Results Two hundred ten patients were recruited across three hospitals, with 247 sets of
paired observations undertaken. The second rater was blinded to the first’s findings. The
Catney and Rittenberg scales were the most sensitive (phlebitis in >20% of observations),
whereas the Curran, Lanbeck and Rickard scales were the most restrictive (≤2% phlebitis).
Only tenderness and the Catney (one of pain, tenderness, erythema or palpable cord) and
Rittenberg scales (one of erythema, swelling, tenderness or pain) had acceptable (more than
two-thirds, 66.7%) levels of inter-rater agreement.
Conclusions Inter-rater agreement for phlebitis assessment signs/symptoms and scales is
low. This likely contributes to the high degree of variability in phlebitis rates in literature.
We recommend further research into assessment of infrequent signs/symptoms and the
Catney or Rittenberg scales. New approaches to evaluating vein irritation that are valid,
reliable and based on their ability to predict complications need exploration.