The Investigation Of Novice Nurses’knowledge, Attitude, Behavior&Skills On Peripheral Vein Indwelling Catheter

BackgroundWith safety awareness of intravenous therapy enhancing, peripheral vein indwelling catheter is widely used as upgrading product for traditional infusion tool in the clinical and has become an essential skill for nurses. Application effect of peripheral vein indwelling catheter is strongly related to nurses’puncture and maintenance skill. There were some research evidence. For example, non-stardard nursing care was primary cause led to catheter-related complications, abnormal discontinue and patients’ refusal to use again. Especially when novice nurses’ occupation protection consciousness was defective, the risk of needle stick injury was increased to a large degree. Repeated puncture and complication not only increased patients’ pain and nurses’workload but also augmented patients’economic burden and risk for nurse-patient disputes. So nursing managers should be attracted to assessing nurses’ knowledge, attitude, behavior&skill of peripheral vein indwelling catheter when they occupy in relevant operation and maintenance.Domestic and foreign researches about peripheral vein indwelling catheter mainly focused on experience of application in different patients, observation and intervention of catheter-related complication&improvement of nurses’operation skill and catheter material. Existing researches about nurses’application ability and cognitive behavior of indwelling catheter were rare. And reseach about nurses’ attitude and behavior of indwelling catheter especially novice nurses’knowledge, attitude, behavior&skill of peripheral vein indwelling catheter was not reported.OBJECTIVES(1) To develop a self-designed questionnaire of novice nurses’knowledge, attitude&behavior of peripheral vein Indwelling catheter and the key element evaluation-form to assess novice nurses’knowledge, attitude, behavior&skill of peripheral vein Indwelling catheter.(2) To explore the current situation of novice nurses’knowledge, attitude, behavior&skill of peripheral vein Indwelling catheter and analyze the frequency of participation in catheter’s care during their internship to attract nursing managers to focus on whether the nurses who participate in catheter’s operation and maintenance have necessary cognitive, behavior&skill.(3) To investigate novice nurses’learning experience about indwelling needle, the frequency of participation in catheter’s care during their internship and learning needs to analyze the influencing factors of knowledge, attitude, behavior&skill, then give reference to nurses’ early standardization training and skill admittance at college, during their internship or at entrance into hospitals.METHODS(1) On the basis of literature review, intravenous therapy team members’ brainstorming and enquiry for nurse specialists, develop a self-designed questionnaire of novice nurses’knowledge, attitude&behavior of peripheral vein Indwelling catheter. Referring to scoring criteria that was developed to score indwelling catheter skill competition within female workers in Guangdong province,2009, then the key element evaluation form of peripheral vein Indwelling catheter’s skill (the key element evaluation form for short below) was revised. Three hundred nurses who had the nurse license and worked within one year in three tertiary hospitals at Longgang district in Shenzhen city were extracted with cluster sampling method to complete the questionnaire pre-text. All quantitative data of questionnaire survey was analyzed by SPSS17.0. Item analysis was used to evaluate every item’s diagnostic degree, then items beyond requirement were removed. Split-half reliability coefficient, Cronbach’s alpha coefficient were used to evaluate the reliability and Correlation analysis and factor analysis were used to test the validity.(2) Four hundred and twenty-three novice nurses who worked in three tertiary hospitals at Longgang district in Shenzhen city were extracted with convenience sampling method from June,2012to June,2013to finish the questionnaires and the skill assessment. And investigate their basic information, learning experience about indwelling needle, the frequency of participation in catheter’s care during their internship and learning needs. All quantitative data of questionnaire survey was analyzed by SPSS17.0. The scores of knowledge, attitude, behavior&skills were described in form of mean±standard deviation, and the care frequency, learning style&learning needs were described with percentage. Multiple linear step wise regression analysis was used to finding out influencing factors of knowledge, attitude, behavior&skill of peripheral vein Indwelling catheter.RESULTS(1) Four items of questionnaire of novice nurses’knowledge of peripheral vein Indwelling catheter were removed, and Exploratory principal component analysis of the questionnaire’s items identified a five first-order factors model that accounted for77.164%of the total variance, and the Cronbach’s alpha coefficient for the questionnaire was0.89. And two items of questionnaire of novice nurses’attitude of peripheral vein Indwelling catheter were removed, and Exploratory principal component analysis of the questionnaire’s items identified a three first-order factors model that accounted for64.061%of the total variance, and the Cronbach’s alpha coefficient for the questionnaire was0.765. and zero item of questionnaire of novice nurses’behavior of peripheral vein Indwelling catheter was removed, and Exploratory principal component analysis of the questionnaire’s items identified a four first-order factors model that accounted for68.421%of the total variance, and the Cronbach’s alpha coefficient for the questionnaire was0.744. The revised key element evaluation form’s Cronbach’s alpha coefficient was0.77. It suggested that the self-designed questionnaire and evaluation form has good reliability and validity.(2) The standardized score of novice nurses’knowledge was (42.11±20.68), at a low level, and the standardized scores of its two dimensions namely assessment before operation&assessment of catheter’s function and complications during indwelling period was (13.95±10.51) and (30.67±30.41) respectively, at an extremely low level. The standardized score of indwelling catheter’s skill was (71.93±16.54), at a middle and lower level. But the percentage of independent tube drawing, flushing and sealing tube, using again&independent puncture with guidance were81.32%,79.43%,60.28%and37.77%respectively. The standardized scores of novice nurses’ attitude and behavior were (81.10±7.24) and (81.36±8.56) respectively, at a higher level, but the standardized scores of active promoting to use indwell catheter dimension in the two questionnaires were (76.55±12.33) and (75.97±12.03) respectively, at a middle level, and both of them were lower than the standardized scores of novice nurses’attitude and behavior.(3) The key factors that influence the skill of peripheral vein indwelling catheter include knowledge level about indwelling catheter, whether novice nurses were theory instructed and practiced, the class time of indwelling catheter during their internship, whether novice nurses accepted standardized courses and were instructed indwelling catheter’s skill and practiced during their internship, frequency of independent puncture with guidance during their internship, and so on. The key factors that influence the knowledge of peripheral vein indwelling catheter include skill level, class time of indwelling catheter at school, whether novice nurses viewed and emulated the material at school, frequency of using indwelling catheter again during their internship. And the key factors that influence the attitude of peripheral vein indwelling catheter include class time at school, whether novice nurses learned catheter operation process during their internship or at school. The key factors that influence the behavior of peripheral vein indwelling catheter include skill level of indwelling catheter and frequency of independent puncture with guidance.(4) According to learning needs, the top three of learning style were simulated training(82.7%), standardized skill instruction(69.3%) and standardized courses of multiple ways combined (64.1%). The top three of learning content were puncture skill(75.7%), basic theory(61.2%) and maintenance skill(60.8%).CONCLUSIONS(1) The self-designed questionnaire and skill evaluation form have good reliability and validity, and can steadily reflect the subjects’s true features also assess novice nurses’ situation of knowledge, attitude, behavior&skill of peripheral vein indwelling catheter.(2) The knowledge of novice nurses about indwelling catheter was at a low level, and their indwelling catheter skill was at a middle level, but they often participated in catheter care, so there was potential safety hazard. The attitude and behavior were at a higher level, but it should be enhanced that actively promote to use indwelling catheter. Teachers in medical college should increase class time of theory and practice about indwelling catheter, then force nursing students to form correct cognition and concept of IV therapy and care at the beginning of the contact of intravenous therapy. Clinical nursing managers should attach importance to assessing nursing students’ knowledge and skill level during their internship or at entrance into hospitals and make project of early standardization training and skill admittance.(3) Intravenous infusion with indwelling catheter is strongly practical. Teaching methods should be diversified according to influencing factors and learning needs at school or during their internship. Practice should be more. The learning style of standardized courses and normalized skill instruction are very important, as well as the clinical simulation training. We should focus on assessment ability and puncture and maintenance skills.