Walden UniversityScholarWorksDi$$e#%a%i!$ ad D!c%!#al
S%&die$2015Improving the Qualit of Care in an Acute CareFacilit
"rough Reeducating Nurses AboutManaging Central LinesJacqueline
Ra!aeleWalden UniversityF!ll!( %hi$ ad addi%i!al (!#k$ a%:
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jeie.'e#$%eeg@(alde&.ed&. Walden University College of
Health Sciences This is to certify that the doctoral study by
Jacqueline Raffaele has been found to be complete and satisfactory
in all respects,and that any and all revisions required bythe revie
committee have been made! Revie Committee "r! #llison Terry,
Committee Chairperson, Health Services $aculty "r! Rhonda Struc%
Committee &ember, Health Services $aculty "r! Cassandra Taylor,
University Revieer, Health Services $aculty Chief #cademic 'fficer
(ric Riedel, )h!"! Walden University *+,- #bstract .mproving the
/uality of Care in an #cute Care $acility Through Reeducating
0urses #bout &anaging Central 1ines by Jacqueline 1! Raffaele
&S, Walden University, *++2 3S, California University of
)ennsylvania, *++4 )ro5ect Submitted in )artial $ulfillment of the
Requirements for the "egree of "octor of 0ursing )ractice Walden
University $ebruary *+,- #bstract Central line6associated
bloodstream infections continue to be some of the most deadly
hospital6associated infections in the United States! 7uided by
1ein8s change theory hich focuses on prior learning, re5ection, and
replacement, the purpose of this study as to improve the quality of
care patients receive in an acute care facility by reducing life
threatening central line infections! The research question e9amined
hether additional education using :enous #ccess 0urse ;:#0<
customi=ed nesletters and manager coaching of nurses in an acute
care setting ould improve the quality of care for patients ith
central lines! This as a quantitative none9perimental descriptive
retrospective study using secondary analysis of a hospital dataset!
This dataset included variables relating to nurse tenure and nurse
performance after reeducation and coaching on managing central
lines! :ariables from 4-+ of ,,>++ nurses ere analy=ed in the
current study at a ?-+ bed system in a southestern healthcare
system in $lorida! The pre and post audits consisting of
contributing factors ere obtained from the :#0 audits and post
audits consisting of contributing factors ere obtained from the :an
audits and ere calculated ith descriptive statistics! There ere a
decrease from ,@!,A of the lines audited having , or more
deviations from the guidelines to >!-A! 0urses ith * to - years
of tenure had a greater number of deviations from the guidelines8
standard for managing central lines as compared to staff ith a
lesser or greater amount of tenure! )ositive social change
implications include %noledge useful for staff nurse educators and
other researchers ho are searching for direction in improving
health care associated infection rates to provide a better quality
of life, decrease costs, and increase safety! .mproving the /uality
of Care in an #cute Care $acility Through Reeducating 0urses #bout
&anaging Central 1ines by Jacqueline 1! Raffaele &S, Walden
University, *++2 3S, California University of )ennsylvania, *++4
)ro5ect Submitted in )artial $ulfillment of the Requirements for
the "egree of "octor of 0ursing )ractice Walden University $ebruary
*+,- "edication . dedicate my doctoral degree to my aunt, :ivian
7eruschat, ho passed aay during my 5ourney through this process in
*+,>! #s she as transitioning to her ne life she continued to
encourage me to complete this degree as she as sure she ould not
itness me accomplish this goal! The continual support during her
most difficult times inspired me to complete my degree!
#c%noledgments . ould li%e to than% my mentor Theresa &orrison
for her guidance, %noledge, and resources throughout this "octoral
process! She is an e9pert in evidence6based practice and engages in
research and systems improvement! Her assistance in my practicums
alloed me to apply learned concepts into practice! The %noledge
learned from her is immeasurable and has greatly impacted my
thought process and my career!The support and patience of my long
time significant other Jerry ho stood by me throughout the long
hours of research and riting as endless! There is no doubt in my
mind that ithout his continued tolerance and understanding . could
not have completed this process! The 5ourney to completing this
doctorate degree has been long and overhelming but rearding! Than%
you to everyone ho has helped me and accompanied me in this
endeavor! i Table of Contents 1ist of Tables
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
iv Section ,B 0ature of the )ro5ect
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!,
.ntroduction
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!,
)roblem Statement
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!,
)urpose
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!>
'b5ectives
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!4
Research /uestion
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!4
Significance!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!-
Reduction of
7aps!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
- Social Change .mplications
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
C "efining Terms
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!C
1imitations
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!2
Summary
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!2
Section *B Revie of 1iterature and Theoretical and Conceptual
$rameor% !!!!!!!!!!!!!!!!!!,+ .ntroduction
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!,+
Teaching
Hospitals!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!,+
7uidelines
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!,,
(vidence63ased )ractices
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!,*
.nfections!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!,-
Theoretical $rameor%
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!,C
Summary
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!,C
ii Section >B ðodology
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!,2
"esign
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!,2
/uality .mprovement
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!,@
#pproach
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!,@
)opulation
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!*,
"ata Collection
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!*4
"ata #nalysis
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!*-
(valuation
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!*2
Summary
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!*@
Section 4B $indings, "iscussion, and .mplications
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!>+
Summary and (valuation of
$indings!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!>+
"iscussion of $indings in the $rameor%
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!>-
.mpact on
)ractice!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!>-
.mpact for $uture Research
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!>?
.mpact on Social Change
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!>2
)ro5ect Strengths and 1imitations
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!>@
Strengths
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
>@ 1imitations
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
>@ Recommendations for Remediation of 1imitations
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 4+ Self6#nalysis
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!4+
Scholarly
Reflection!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
4, )ractitioner Self6#nalysis
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
4* iii )ro5ect "eveloper Self6#nalysis
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
4* $uture )rofessional "evelopment
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
4> Conclusion
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!4-
Section -B Scholarly )roduct
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!4?
&anuscript for )ublication
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!4?
3ac%ground, )urpose, and 0ature of the )ro5ect
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! -+ Research
"esign, setting, and "ata Collection
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! -,
)resentation of Results
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
-* )rimary Study
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
-4 Secondary Study
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
-4 References
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!C+
#ppendi9 #B Submission of Chec%list
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!C@
#ppendi9 3B Cover 1etter
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!?,
#ppendi9 CB Clinical Significance
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!?*
Curriculum :itae
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!?>
iv 1ist of Tables Table ,! C1#3S. Contributing $actors That the
:#0s "etermine is a "eviation $rom the 7uidelines
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
>, Table *! 1ist of Units Used in Study $rom to Southestern
Health Care $acilities in $lorida
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
44 Table >! #udit "ata
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
4- Table 4! Dears of (9perience
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
4- Table ,! C1#3S. Contributing $actors That the :#0s "etermine is
a "eviation $rom the 7uidelines
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
-? Table *! 1ist of Units Used in Study $rom to Southestern Health
Care $acilities in $lorida
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
-2 Table >! #udit "ata
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
-@ Table 4! Dears of (9perience
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
-@ , Section ,B 0ature of the )ro5ect Introduction #ccording to the
Centers for "isease Control and )revention ;C"CE *+,, years cost a
* ?,-6bed southestern nonprofit health care system consisting of to
facilities in $lorida employing >,@++ people, an estimated
F*,*?-,+++ ;0aples Community Hospital, *+,>< change theory is
most applicable! This model of change shos the process as it
happens in human beings! .t is a three6stage model %non as the
unfree=ing6change6refree=e model ;1ein, *+,>< hich involves
prior learning to be re5ected and replaced! There is a direct
application to this study as the staff ill release previously
learned behavior, understand the e9pectation of them, and continue
ith that ne learned behavior hen managing central lines and
completing relevant documentation! 3ehavior is thought to be a
balance of forces that or% in opposite directions ;1ein, *+,> is
an e9planation of the methodology used in this study! ,2 Section
>B ðodology Design The design is a secondary analysis of
an ongoing quantitative study! This means that data that have
already been collected by one person or group are repurposed and
reanaly=ed by another person or group to anser a ne research
question ;)olit G 3ec%, *++4 C1#3S.! The secondary study shoed that
yearly educational reinforcement of managing central lines can
occur through yearly mandatory s%ills fairs! Population #ccording
to the Health Resources G Service #dministration ;HRS#E n!d!+ has
increased, >>A of the nursing or%force is older than -+, and
the largest age group of nurses is 4, to -+ years of age ;HRS#,
n!d!++ members at one southestern healthcare system consisting of
to facilities in $lorida! The differences of employment in staff
includes full time, part time, seasonal, and nurses required to or%
to shifts a month to manage central lines! The :#0 audit suggested
a deviation in this process and as identified as a C1#3S.
Contributing $actor in the primary study! The nurses ere identified
in the primary study through their employee number! . as provided
de6identified employee numbers for use in this study!There ere no
patients involved in the study! There as no personal information
used from any patient other than the fact they had a central line
during their hospitali=ation! "ata from the patients8 medical
record, including se9, age, or even reason for the central line,
are irrelevant in the collection of data for the study! The study
pertains to data collected before and after the reeducation
C0S6developed nesletters ere administered to staff by hand delivery
by the unit8s manager, along ith coaching, for use in the secondary
study! The original data collection as performed and completed by
one of the :#0s ho rounded ee%ly and assessed every line e9isting
ithin to facilities! This auditing process is in place in part due
to the recommendation from the Joint Commission to monitor central
lines! The :#0 sent a list of central lines found to have a
deviation to the Clinical 0urse Specialist, ho then subsequently
collected data from the patients8 charts in order to find the
specific deviation involved in the managing of central lines! The
C0S prepared a nesletter after investigating the specific deviation
found in the medical record and sent it to the manager ho hand
delivered the nesletter to the identified staff *> member and
coached the staff member on the deviation! :#0s utili=ed a
chec%list of certain factors to assess and clarify any deviating
factors that ere not in line ith the guidelines for managing
lines!The primary study performed by Theresa &orrison )h!"! in
*+,4 utili=ed the nurse8s employee number to identify their unit
and manager! The secondary study8s analysis included management of
the dressing, lines, completion of the required documentation and
years of service! The staff as given a customi=ed nesletter from
their managers in a face6to6face meeting here the employee
e9perienced a coaching session and had to reread the part of the
guidelines pertaining to their deviation! Secondary research
included collecting the data from the original research to see if
reeducating staff as effective in preventing central line
infections! "ata ere placed into an (9cel spreadsheet from hich
analysis occurred! #ccording to the 0ational .nstitute of Health
;*+,>+C at both Walden University and this southestern
healthcare system to assist in the oversight of the study and to
assure proper precautions to prevent breaches in confidentiality
ere used! Data Collection The data collected from the primary study
contained the ,- contributing factors gathered from the :#0 audits!
#n available :#0 nurse on staff performed the audits once a ee%
every Thursday using an audit form that is more of a chec%list that
as constructed by the :#0 nurse! The :#0 audit as used to perform
the original study of finding and identifying hich particular
component of the guidelines had a deviation! .n this quantitative,
none9perimental descriptive retrospective study using secondary
analysis, . used e9isting recorded data! "ata collection often
occurs as chart audits in hospitals because the data source is the
patients8 medical record!*- .n the case of the primary study, the
data ere collected from :#08s auditsE :#0s carried a clipboard,
visited each patient ith a central line, observed and recorded the
site, dressing and intravenous ;.:< tubing deviation from the
guidelines! #fter the managers coached each nurse staff member
identified as deviating from the guidelines for central line
management and documentation, an attempt as made to evaluate if
re6education improved documentation and management of central
lines! The data available, hen revieed, alloed for the
identification of a relationship beteen nurses8 tenure and number
of C1#3S. contributing factors! Data )nal!sis "ata analysis in this
secondary study consisted of reliability, validity, and analytical
techniques hich included percentages and frequencies! :alidity of
research findings refers to the e9tent to hich the findings are an
accurate representation of the phenomena they are intended to
represent ;#nderson, *+,+ to January *+,4! "ata collected indicated
there ere C*? lines audited on ,2 nursing units for deviations on
managing central lines! The ,- compliance issues %non as
contributing factors are divided into three typesB ;a< dressing
related, ;b< .: tubing administration set related, and ;c<
documentation related ;Table ,!-A! "ata consisted of to dressings,
five tubing and seven documentation deviations! The secondary
study8s results ere obtained and analy=ed several months after the
primary studyPs completion! The selected evaluation time frame as -
random ee%s after the conclusion of the primary study and as beteen
June and #ugust of *+,4! .n this -6ee% period after the reeducation
process, there ere ,4 deviations! "ata consisted of to dressings,
five tubing and seven documentation deviations! #udited lines ere
,C2 on ,2 nursing units ith ,4 deviations from the guidelines!
#bout >!-A of central lines had a deviation found through the
:#0 audit!.n the primary study, C*? lines ere audited on ,2 nursing
units for deviations on managing central lines! #bout ,@!,A of the
lines audited had one or more deviations! "ata from several months
later, after nurse8s reeducation, ere collected during - randomly
selected ee%s from June *+,46#ugust *@+,4! These results, from ,C2
lines audited on ,2 nursing units ere >!-A of the lines audited
had one of more deviations ;Table >>4 documentation
deviations calculated as ->!>A of C*, total
deviations!>> .n the secondary study the total number of
found deviations as ,4 of ,C2 total lines and si9 lines ith ,4
deviations or >!-A! There ere to dressing deviations calculated
as ,4!*A of ,4 total deviations! There ere five tubing deviations
calculated as >-!?A of ,4 total deviations! There ere seven
documentation deviations calculated as -+A of ,4 total
deviations!.n the primary study, there ere 4@- nurses involved in
deviations of managing central lines! Several months after the
primary study as completed and nurses ere reeducated and data
collected during - randomly selected ee%s from June *+,46#ugust
*+,4, there ere ,, nurses involved in deviations of nurses managing
central lines! The primary study indicated there ere ,-+ nurses ith
feer than * years of e9perience involved in central line deviations
or >+A of 4@- total nurses! There ere *>4 nurses ith *6-
years of e9perience involved in central line deviations or 4?!CA of
4@- total nurses! There ere ,,, nurses ith greater than - years of
e9perience involved in central line deviations or **!4A!Results of
the secondary study indicated there ere to nurses ith less than *
years of e9perience involved in central line deviations or ,2!,A of
,, total nurses! There ere si9 nurses ith *6- years of e9perience
involved in central line deviations or -4!-A of ,, total nurses!
There ere three nurses ith greater than - years of e9perience
involved in central line deviations or *?!*A ;Table >4 nurses
ere given to this researcher! 0urses ith feer than * years of
tenure involved in line deviations as ,-, or >+!>A, nurses
ith * to - years of tenure as *>C or 4?!*A, and nurse ith
greater than - years tenure as ,,> or **!4A! 0urses ith * to -
years of tenure at this Southestern $lorida health system had the
greatest number of deviations in managing central lines! The tenure
of nurses is for this system onlyE the nurse could have many more
years of e9perience in their professionE but, for the purpose of
this study, only the years of tenure in this system as
calculated!The result of the secondary study . performed found
reeducating nurses as effective as noted by a decrease in
deviations recorded on the :#0 audits and data displayed in
frequency and percentages! . chose to find the tenure of nurses ho
have the greatest deviations!Reeducating staff nurses in the
management of central lines decreased deviations in the
documentation and guidelines adherence! $indings for the second
ob5ective determined there is a greater number of tenured nurses
ith * to - years of tenure identified, as compared to staff ith a
lesser amount of e9perience or greater amount of e9perience that
are deviating from the guidelines standard for managing central
lines! This is a difference from the study8s ob5ective stating that
the e9pected deviations ould be greater in nurses ith longer
tenure! . e9pected the longer tenured nurses to have more
deviations due to the length of time from originally being educated
on the guidelines of managing central lines!"ata concluded after
the primary study as concluded that documentation as the most
frequent deviation folloed by tubing and then dressing deviations!
#lthough >- this remained the same at the conclusion of the
secondary study, the frequency of the occurrences had decreased!
0urses ith *6- years of tenure had the highest frequency of being
involved in deviations on managing central lines after the study as
completed!Discussion of &indings in the &rame'or( 1ein8s
;*+,>< theory of change supports this study! #fter the nurses
ere reeducated on managing central lines there as a decrease in
deviations! The three6stage model %non as the
unfree=ing6change6refree=e model ;1ein, *+,>< involves prior
learning to be re5ected and replaced! There is a direct application
to this study as the staff has released previously learned
behavior, understand the e9pectation of them, and continue ith that
ne learned behavior hen managing central lines and completing
relevant documentation ;1ein, *+,>C C1#3S.s are the most common
cause of H#.s! #n estimated 2+,+++ catheter6related bloodstream
infections found in the United States are caused from central
venous catheters ;C"C, *+,,,+++ infections ere noted from patients
in outpatient areas ;C"C, *+,,?,+++ across the country! C1#3S.s
lead to longer lengths of hospital stay and one in four patients
die from this infection every year ;C"C, *+,,W6 > West 4006 4
0orth 0aples -006 - 0orth 0aples C006 C 0orth 0aples >S 6 >
South 4S 6 4 South -S 6 - South CS 6 C South >0 6 > 0orth 40
6 4 0orth -0 6 - 0orth 7:S 6 7ulf :ie Suites .CU6 .ntensive Care
Unit C:RU 6 Cardio6:ascular Recovery Unit S.CU Q Surgical .ntensive
Care Unit 4- Table > Audit (ata )rimary study )ro5ect study
0ursing units audited,2,2 Wee%s audited,C- Total 0umber of
1inesC*?4, Total number of deviationsC*,,4 0umber of dressing
deviations ;A of total deviations!?A