UNIVERSITY OF THE PHILIPPINES, MANILA The Health Sciences Center COLLEGE OF NURSING Sotejo Hall, Pedro Gil St., Ermita, Manila SKILL RETENTION AND LEVEL OF KNOWLEDGE AND ATTITUDES ON INTRAVENOUS THERAPY AMONG SENIOR NURSING STUDENTS Submitted in partial fulfilment of the requirements in Introduction to Nursing Research (N 199) Second Semester, Academic Year 2012-2013 by Caballero, Izzah Mei C. Santos, Ma. Leoant B. Singson, Daniel Joshua M. Tan, Joyce Camille L. Tating, Dan Louie Renz P. Templonuevo, Lyzka Camille G. Trinidad, Lyka Eunice F. Tuazon, Patricia Louise L. Untalan, Axle Maria Rafaelle D. Vallejos, Anatole Gail P. Yanoria, Alexander T. Submitted to: Prof. Vanessa M. Manila, MA-HPS, RN
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UNIVERSITY OF THE PHILIPPINES, MANILA
The Health Sciences Center COLLEGE OF NURSING
Sotejo Hall, Pedro Gil St., Ermita, Manila
SKILL RETENTION AND LEVEL OF KNOWLEDGE AND ATTITUDES ON INTRAVENOUS THERAPY
AMONG SENIOR NURSING STUDENTS
Submitted in partial fulfilment of the requirements in
Introduction to Nursing Research (N 199) Second Semester, Academic Year 2012-2013
by
Caballero, Izzah Mei C. Santos, Ma. Leoant B.
Singson, Daniel Joshua M. Tan, Joyce Camille L.
Tating, Dan Louie Renz P. Templonuevo, Lyzka Camille G.
Trinidad, Lyka Eunice F. Tuazon, Patricia Louise L.
Untalan, Axle Maria Rafaelle D. Vallejos, Anatole Gail P. Yanoria, Alexander T.
Submitted to: Prof. Vanessa M. Manila, MA-HPS, RN
Skill Retention and Level of Knowledge and Attitudes on Intravenous Therapy among Senior Nursing Students
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ACKNOWLEDGEMENTS
The realization of this research paper would not have been possible if not for the
expertise, guidance, support and compassion of the people who assisted us on this endeavor.
The researchers would like to express their heartfelt gratitude to the following people who have
made the completion of this study possible:
To Prof. Lourdes Tejero, RN, PhD, head of the Research and Creative Writing
Program of UP College of Nursing, for reviewing our proposal and the ethical considerations,
and for giving approval to our research.
To all the evaluators for the validation of the research tools, namely: Ms. Cecille Pena,
RN, MAN; Mr. Normal Alviar, MD, MHPEd; Mrs. Josephine Cariaso, RN;Ms. Berling Coto,
RN;Mr. Kim Estella, RN;Ms. Jenniffer Paguio, RN; Ms. Judy Pangilinan, RN; and Ms.
Rebecca Tan, RN, MAN.
To Prof. Arnold Peralta, RN, MAN, Nursing Foundations II (N 11) faculty, for his efforts
in retrieving our subjects’ scores in the Intravenous Therapy skills portion of their grades.
To Ms. Cristina Jose, for her patience and understanding in accommodating the
researchers for their data collection.
To Prof. Vanessa M. Manila, MA-HPS, RN, Introduction to Nursing Research (N 199)
instructor and research adviser, for sharing with us the knowledge and skills essential in the
making of this research paper and for her continuous guidance and support.
To the researchers’ families and batchmates, for their undying support and
encouragement in all our undertakings.
And lastly, to the Almighty Father, for giving the group the strength and courage to
carry out this task. The accomplishment of this study would not have been possible without His
guidance.
Skill Retention and Level of Knowledge and Attitudes on Intravenous Therapy among Senior Nursing Students
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TABLE OF CONTENTS
Content Page
Abstract 8
CHAPTER 1: INTRODUCTION
Statement of the Problem 10
Goals and Objectives 10
Significance of the Study 10
Definition of Terms 11
Scope and Limitations 14
End Notes 15
CHAPTER 2: REVIEW OF RELATED LITERATURE
Intravenous Therapy (IVT) 18
Teaching IVT 25
Theories on Learning 28
Theories on Retention 35
Synthesis of Various Theories of Learning and Retention 38
Conceptual Framework 50
End Notes 50
CHAPTER 3: METHODOLOGY
Research Design 61
Setting 61
Sampling Procedures and Sample 62
Instrumentation and Procedures 63
Data Analysis 78
Ethical Considerations 85
End Notes 86
CHAPTER 4: RESULTS
Participants 89
Tool Validity and Reliability 90
Item Performance Review 92
Assessment of Level of Skills, Knowledge and Attitudes 96
Evaluation of Skill Retention 105
Factors Related to Retention of Skills and Level of SKA 106
Learning Framework 112
CHAPTER 5: DISCUSSION AND ANALYSIS
Skills 114
Knowledge 116
Attitudes 117
End Notes 123
CHAPTER 6: CONCLUSION AND RECOMMENDATIONS
Conclusion 127
Recommendations 127
BIBLIOGRAPHY 130
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APPENDICES
I. Research Schedule and Budget 137
II. Research Instruments Packet for Subjects 139
III. Research Instruments Packet for Validity and Reliability Testing 150
IV. Original UPCN Skills Laboratory Checklists 166
V. Initial Pool of Items (for IVT Knowledge Exam and IVT Attitudes Survey) 174
VI. Qualitative Analysis of Content Validity of the IVT Knowledge 180
Assessment Examination (Test Blueprint and N11 IVT Course Objectives)
VII. Data Tables from Validity and Reliability Testing 185
VIII. Data Tables and Statistical Printouts from Pre-testing 196
IX. Transcription of Focused Group Discussion 206
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LIST OF ACRONYMS
FGD – Focus Group Discussion
GWA – Grade Weighted Average
IV – Intravenous
IVF – Intravenous Fluid
IVT – Intravenous Therapy
KR-20 – Kuder-Richardson Formula 20
SBPR – Spearman-Brown Prophecy Formula
SKA – Skills, Knowledge, and Attitudes
SPSS – Statistical Package for the Social Sciences
UPCN – University of the Philippines Manila College of Nursing
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LIST OF TABLES
Table No. Title Page
Table 1 Number of items included in IVT Knowledge Assessment Exam according 69
to concept and test type
Table 2 Number of items included for each attitudinal domains/concepts for IVT 72
Attitudes Survey
Table 3 Measures of Central Tendency and Measures of Variation of General 90 Grade Weighted Average (GWA) of 4th year UPCN students Table 4 Measures of Central Tendency and Measures of Variation of knowledge 96
and skill scores of 4th year UPCN students Table 5 Independent t-test of knowledge scores of male and female 4th year 97
UPCN students Table 6 Independent t-test of skill scores of male and female 4th year UPCN 98 students Table 7 Classification of Nursing courses with the year and semester taken 98
Table 8 Cross tabulation of scores on setting up IV infusion and when skill was 99 emphasized and fully appreciated by 4th year UPCN students
Table 9 Cross tabulation of scores on changing an IV infusion and when skill was 100 emphasized and fully appreciated by 4th year UPCN students
Table 10 Cross tabulation of scores on discontinuing an IV Infusion and when skill 100 was emphasized and fully appreciated by 4th year UPCN students
Table 11 Cross tabulation of scores on administering medications through IV Push 101
and when skill was emphasized and fully appreciated by 4th year UPCN
students
Table 12 Cross tabulation of scores on administering medications through Heplock 102
and when skill was emphasized and fully appreciated by 4th year UPCN
students
Table 13 Cross tabulation of scores on incorporating medications in IV Fluid and 102
when skill was emphasized and fully appreciated by 4th year UPCN
students
Table 14 Cross tabulation of scores on incorporating medications into Soluset 103
and when skill was emphasized and fully appreciatedby 4th Year
UPCN Students
Table 15 Measures of Central Tendency and Measures of Variation of attitudinal 104 domain scores of 4th year UPCN students
Table 16 Measures of Central Tendency and Measures of Variation of percent 105 difference of Skill Score of 4th year UPCN students
Table 17 Paired t-test of Skill scores of 4th year UPCN students from sophomore 106 year and senior year
Table 18 Correlation Coefficients of Various Factors Perceived to be affecting skills 107
Skills and Knowledge on IVT of 4thUPCN Students
Table 19 Cross tabulation of learning style (according to Kolb) and Knowledge 108 scores of 4th year UPCN students
Table 20 Cross tabulation of learning style (according to Kolb) and skills scores 108 of 4th year UPCN students
Skill Retention and Level of Knowledge and Attitudes on Intravenous Therapy among Senior Nursing Students
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LIST OF FIGURES
Figure No. Title Page
Figure 1 IV regulation formula and drop factors 19 Figure 2 Conceptual Framework 50 Figure 3 Data collection and analysis algorithm 64
Figure 4 Learning Style profile 74
Figure 5 Instructions for IVT Skills Observation 77
Figure 6 Percentage distribution of sex of 4th year UPCN students 89
Figure 7 Percentage distribution of age of 4th year UPCN students 90
Figure 8 Frequency distribution of 4th year UPCN students who did not perform 93
important IVT procedures
Figure 9 Percentage distribution of the learner type (according to Kolb) of 4th year 105
UPCN students
Figure 10 Learning Framework (similar to Path Analysis) 112
Skill Retention and Level of Knowledge and Attitudes on Intravenous Therapy among Senior Nursing Students
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ABSTRACT
Intravenous Therapy competency is essential for any beginning nurse in matters of patient
safety. This retrospective cohort study aims to explore the level and factors related to retention
of Intravenous therapy skills, knowledge and attitudes. As a pilot investigation, ten senior
students were chosen by convenience sampling from the University of the Philippines College of
Nursing. Students were assessed using the IVT Skills Observation Checklist (Multi-rater
Kappa=0.86), IVT Knowledge Assessment Exam (CVI=0.978; Cronbach’s alpha=0.339), and
1. Good practice encourages contact between students and faculty.
Faculty and student contact, in and out of the learning setting, increases student
motivation and the student’s involvement in his or her learning. The concern of a teacher to
his or her student communicates support to the student and helps him or her do better.
Furthermore, as Astins’s Student Involvement Model presents, frequent interaction between
faculty and student is more strongly related to satisfaction of the student with college, than
any other type of instructional or student characteristic.
Consultation with professors outside of class hours and promoting interaction between
the student and the faculty in discussions and lectures are some of the ways by which
frequent faculty-student contact is exercised.
2. Good practice develops reciprocity and cooperation among students.
Working with peers and interacting with professors enhances learning and often
increases involvement in learning. Good learning is collaborative and social rather than
competitive and isolated. The products of interactions with other students and the faculty
improve thinking and deepen the understanding of the student. Also, involvement with other
students and the faculty is closely linked to student’s academic performance and satisfaction
with college.Study groups, group assignments and activities are examples of collaborative
leaning strategies.
3. Good practice encourages active learning.
In active learning, students and their learning needs are in focus. It requires the
engagement of the students in learning activities. The students are able to reflect on the
information that they are taught and in turn encouraged to express what and how they
understood the information. Activities such as group discussions, case studies, role playing
Skill Retention and Level of Knowledge and Attitudes on Intravenous Therapy among Senior Nursing Students
45
and journal writing are beneficial to the learner as these activities can improve critical
thinking skills, increase retention and transfer of information, increase motivation and
improve interpersonal skills (University of Minnesota, n.d).
4. Good practice involves giving prompt feedback.
Providing feedback enables the student to focus on his or her learning. Feedback helps
the student know in which areas of the subject matter he needs to improve. Learning is not
only facilitate on reflecting on what you have learned, what you already understand, but also
making efforts on understanding concepts which you need to know. Feedback also assists
students in how they might assess their performance in the future.
Utilizing rubrics for grading and assessment checklists can assist the student in
assessing what he or she knows about the subject matter and be guided with what areas he
or she needs to know or know more about.
5. Good practice emphasizes time on task.
When one desires to learn, a certain amount of energy and time is required. Effort
combined with a realistic amount of time allotted for a particular task facilitates effective
learning. Thus time management skills are very important for students, as well as
professionals. Time expectations can influence the performance of the student.
Establishing deadlines of projects and activities and estimating the appropriate amount
of time for each task are some possible applications of emphasizing time on task.
6. Good practice communicates high expectations.
High expectations are very important. It is especially needed by students, be they the
high-performing group or the unmotivated and poorly prepared. When the faculty expects
more from the students, they themselves are holding high expectations from themselves.
They put more effort in teaching the students and helping them learn. The high expectations
the faculty have set for the students will then be translated into reality.
Skill Retention and Level of Knowledge and Attitudes on Intravenous Therapy among Senior Nursing Students
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Providing with realistic expectations from the course utilizes this concept of expecting
more from the students.
7. Good practice respects diverse talents and ways of learning.
Even in the learning setting, the uniqueness of people is recognized. Students are
equipped with different talents and capabilities which they utilize to better grasp and
understand the things that they need to learn. They learn in ways that they are comfortable
with. To improve the ways by which they learn, the educational institution and the faculty
can introduce other methods of learning from which the students may gain new strategies
and techniques.
Examples of methods that can be introduced that may not be easily accessible to the
students include simulations and virtual experiences.
Environment and Instruction Characteristics
In a similar manner that he identified states for the various outcomes of learning, Gagne
also named several instructional events for each outcome It is sufficient to establish that the
events happening in the classroom, laboratory and clinical instruction affect learning
Instructional Methods
In a classroom setting, teachers are the main characters in facilitating learning and have
direct control in the implementation of the teaching-learning process. However, in determining
educational outcomes, studies have demonstrated that, instead of focusing on student’s
background or non-school factors, teacher practices when applied in the right context lead to
successful learning (Blair, 1988). These teacher practices are specifically referring to positive
and optimistic ways. It was also stated that that teachers may not have a direct control over the
student’s status in life or background or other environmental factors however, the teacher has a
direct control of face-to-face interactions with the students and the strategies and manners in
which the teacher utilize learning process and instructional time.
Skill Retention and Level of Knowledge and Attitudes on Intravenous Therapy among Senior Nursing Students
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Professors, instructors and clinicians are individuals who should have already acquired
the skills in performing safely the tasks intended for them, for instance, for a nurse to administer
IV medications properly and safely, for surgeon to perform an operation with knowledge and
skills to alleviate the disease of his or her client. Expertise of a certain field or subject requires
extensive focused education and sustained deliberate practice for a number of years which
gives the individual the experience so that sharing and providing his/her expertise to a group will
be much easier as he/she is knowledgeable about it. Students are not isolated in their own
learning, aside from it being a partnership; it is also an apprenticeship between the teacher and
the student as he quoted from Lave and Wenger. The students learn within a professional
context. As the teacher is knowledgeable about a certain field, the student learns from the
teacher and acquires skills, knowledge, and attitudes in the course of learning and experience
while the teacher or professor facilitates the learning experience (Kneebone, 2005). In addition,
Roberts, et al (2008) stated three factors that affect students’ lack of proficiency: (1) variation in
the rate and ease of student skill acquisition, (2) threatening learning environment created by
teachers, and (3) inconsistent teaching technique.
With this, the instructor or teacher’s ability should be shaped according to the student’s
needs. According also to Roberts, et al, constant and appropriate teaching strategy is a very
important part on the student’s learning experience and retention skills. It was recommended in
that the teaching per se as well as the strategy should be based from research and evidence
(Morris, 2006). It was recommended that aside from nurse preceptors and clinical instructors, a
pharmacist should also be one of the professionals to teach medication administration because
they are the most knowledgeable when it comes to drugs.
To render holistic and efficient care to a patient, a nurse must be able to think critically
and consider the three key elements of this process, namely, skill, knowledge, and attitude as
identified by Watson and Glaser in 1980 (Bradshaw and Lowenstein, 2011). From these key
elements, teaching/learning strategies can be identified.
Skill Retention and Level of Knowledge and Attitudes on Intravenous Therapy among Senior Nursing Students
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According to Arthur, Bennett, Stanush and McNelly (1998), in conducting an inquiry on
long-term skill retention, the relationship between the initial acquisition of the skill and the
subsequent retention is of vital importance. The acquisition of the skill is carried out through the
use of different instructional strategies. In training contexts, instructional strategies used to
facilitate learning are referred to as training methods. Such methods are used to impart learning
to nursing students, making use of the classroom, laboratory and clinical settings as their
training grounds. However, extensive discussion on these instructional methods is outside the
scope of this research study. It is sufficient to note that there are many ways of teaching
knowledge to students.
Khan, Ali, Vazir, Barolia, and Rehan (2011), enumerated four teaching strategies,
namely demonstration, reflection, problem based learning, and concept map, were utilized
among nursing students. Each strategy was then assessed based on the students’ perceptions.
By using the reflection strategy, students believe that they are able to look back; thus, making
them see what they have done right, which they will continue to do, and those which they have
done wrong, which they will correct. In the problem based learning strategy, students found that
this greatly enhanced their communication, an important skill in nursing. They were able to listen
and speak to each other and give the necessary feedback. The concept map strategy enhanced
the students’ management skills since they were able to practice their organization and
prioritization skills. Though these strategies have been found to aid the students’ learning, it was
concluded that demonstration was the most effective as this strategy allows the students to not
only acquire the necessary knowledge and skills, but also apply them directly to the real clinical
situation. The students also believe that this strategy produces more long-lasting effects in their
minds.
Opportunity for Practice
Skill decay is defined by Arthur et al. (1998) as the progressive deterioration of
knowledge and skills when they are not used over extended periods of time. The more time
Skill Retention and Level of Knowledge and Attitudes on Intravenous Therapy among Senior Nursing Students
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passes, the more the skill deteriorates. It is often that nursing students are able to pass tests
measuring clinical skills in simulation laboratories at first however due to time passing without
any opportunity to perform those skills on an actual clinical setting they will lose proficiency in
doing those clinical skills. According to Hamilton (2005), even health professionals experience
skill deterioration when they have not performed a particular skill within 2 weeks and may need
to review how the procedure is done. If the skill is not done within 2 months, it may need to be
relearned (Roberts, Vignato & Moore, 2009). For nursing students who are learning about the
clinical skills for the first time, it is to be expected that their retention of skills will be much worse.
In an actual clinical setting, not all nursing student have the opportunity to perform all the
learned clinical skills as it will be dependent on the type of illness the patient assigned to him
has. Sometimes, a nursing student is not able to perform a clinical skill after the whole clinical
rotation, thus having to wait for the next semester to get a chance to do so.
Feedback: Reinforcement or Punishment
Feedback by the instructor or teacher about the examination provides opportunity for the
students to know and correct mistakes and to keep themselves on track as they are guided. It
can also lead to a higher student achievement and satisfaction. Motivation of the students is
another advantage of feedback especially an encouraging and constructive feedback
(Nicholson, 2010). Recent studies show no significant effect of immediate feedback timing as
compare to delayed feedback (Larsen, et al., 2008). However, it was stated in an article that an
immediate feedback of not only test questionnaires but also of skills is important and a crucial
component of learning as it will provide gradual improvement for the students but it should be
given clearly and without judicial remarks as it can be counterproductive for the student
(Kneebone, 2005).
From the behaviorist school of thought, practice provides an opportunity for making the
same response or learning in a wide variety of different situations (Lefrancois, 2000). Skinner’s
concept of reinforcement may also be a relevant environment characteristic. In Skinner’s
Skill Retention and Level of Knowledge and Attitudes on Intravenous Therapy among Senior Nursing Students
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system, the type of reinforcement is one independent variable. Reinforcement has two types:
positive and negative. Another concept, punishment, also two types: presentation and removal.
Positive reinforcement is equivalent to rewarding. Its opposite, penalizing, is removal
punishment. Castigation, an aversive consequence following a behavior, is termed presentation
punishment. The removal or relief of something resulting into a response occurring more often is
called negative reinforcement.
Conceptual Framework
Figure 2. Conceptual Framework.
Synthesized from Hull’s input-output framework (1940 in Gredler, 1997); Gagne’s conditions of learning and outcomes of learning(1977, 1984, 1985 in Gredler, 1997 and Lefrancois, 2000); behaviorist and cognitivist views(in
Lefrancois, 2000); Bandura’s observational learning (1977 in Gredler, 1997 and Lefrancois, 200), and Benner’s novice to expert model(1996 in Sana, 2010).
End Notes
Ally, M. (2008). Foundations of educational theory for online learning. In T. Anderson
(Ed.) Theory and practice of online learning (pp. 15-43). Retrieved February 5, 2013,
Skill Retention and Level of Knowledge and Attitudes on Intravenous Therapy among Senior Nursing Students
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CHAPTER IV
RESULTS
Participants
The target population for this research includes fourth year UP College of nursing
students currently enrolled in either N121.1 (Intensive Hospital-based Nursing Experience) or
N121.2 (Intensive Community-based Nursing Experience). Out of the 55 students, 10 (18.18%)
were included in the pilot study. Among which, 5 are males and 5 are females. Figure 6 shows
the age distribution of the sample.
All of the 10 students in the sample were regular. Two students shifted to the college of
nursing during their second year in the university. All of them entered UPCN at the year 2009.
One intervening variable in the study was the inherent intelligence of the students. This was
measured through the general grade weighted average of the students which ranged from 1.75
to 2.34. Table 3 on the next page shows the measures of central tendency and measures of
variability of the general grade weighted average of the students.
The range age of the sample of 10 fourth year students was 2 years and the mean was
20.1 years. Figure 7 on the next page shows the age distribution of the sample.
Male 50%
Female 50%
Figure 6. Percentage distribution of sex of 4th year UPCN students
Skill Retention and Level of Knowledge and Attitudes on Intravenous Therapy among Senior Nursing Students
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Table 3. Measures of Central Tendency and Measures of Variation of General Grade Weighted Average (GWA) of 4th year UPCN students
n Mean Median Mode Range
SD
General GWA 10 1.994 1.995 2.000 0.590 0.153
Tool Validity and Reliability
The instruments developed by the researchers include the IVT Skills Observation
Checklist, IVT Knowledge Assessment Exam, and IVT Attitudes Survey. The over-all Content
Validity Index (S-CVI/Ave) is 0.978 and 0.973, which are very excellent for the IVT Knowledge
Tool Assessment and IVT Attitudes Survey respectively. The IVT Skills Observation Checklist
was derived from the UPCN Skills Checklist used in the Nursing Interventions II course. Inter-
rater reliability was done by the 3 raters using the IVT Skills Observation Checklist and had a
multi-rater kappa of 0.86. This can be considered excellent. However, some items had a
reliability of less than 0.80. These items were clarified and discussed with the raters (see
Appendix VII)
In addition, in order to ensure that all items measure the same trait, the entire IVT
Knowledge Assessment Exam, and IVT Attitudes Survey subscales were tested for internal
19 y.o. 10%
20 y.o. 70%
21 y.o. 20%
Figure 7. Percentage distribution of age of 4th year UPCN students
Skill Retention and Level of Knowledge and Attitudes on Intravenous Therapy among Senior Nursing Students
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consistency. Two reliability measures were used for the final Attitudes Survey. The internal
consistency reliability of each sub-test was measured using the Kuder-Richardson Formula 20
(KR-20) to estimate the degree to which all of the items measure a common concept. SPSS
(Statistical Package for the Social Sciences) Version 20 was used to calculate Cronbach’s alpha
of the IVT Attitudes tool. This tool was a Likert scale with a total of 20 items. The Cronbach’s
alpha of each subscale was calculated as follows: (a) Learner satisfaction subscale was 0.838,
(b) Self-perception subscale was 0.801, (c) Educational Practices subscale was 0.419, and (d)
Motivation subscale was 0.912. The Attitude Assessment tool had an overall Cronbach’s alpha
of 0.912. This signified that the different subparts of the instrument were reliably measuring the
critical attribute accordingly. In addition to this, to estimate the reliability of the entire attitudes
survey, a split-half reliability was measured using Spearman-Brown Prophecy Formula (SBPR).
This was done because homogeneous content cannot be assumed across all items in the entire
exam, which limits the use of the KR-20 (Thorndike, 1997). The split half reliability was also
calculated using the same software. The even numbered items were compared to the odd
numbered items. It had a value of 0.846 indicating good internal consistency.
Because there was no function for the calculation of Cronbach’s alpha in SPSS for
dichotomous variable, a manual calculation was done for the Knowledge Assessment Exam.
The inter-item correlation of the items was calculated using Spearman Rho function because
dichotomous variables are in the nominal level of measurement. The average correlation
coefficient then calculated manually using Microsoft Excel 2010, thus the Cronbach’s alpha was
0.179 for the 14 multiple choice questions, 0.379 for the problem solving questions, and 0.379
for the 11 true or false questions. The average Cronbach’s alpha of the entire Knowledge
Assessment Tool was 0.339. This was low because several items were answered correctly by
all 10 students and because of low sample size.
Skill Retention and Level of Knowledge and Attitudes on Intravenous Therapy among Senior Nursing Students
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Item Performance Review
Skill Observational Checklist
There were several steps on the skills observational checklist wherein 3 or less of the
samples were able to remember to perform. None of the 10 students performed hand washing
while setting up an IV infusion, preparing and administering IV medications, and changing an
ongoing IV infusion. One out of 10 students (10%) performed hand washing before and after the
procedure while discontinuing an ongoing IV infusion. 3 out of 10 students (30%) checked the IV
site for signs of infiltration and inflammation before administering IV medications via the injection
port and using the heplock. During the preparation of IV medications in syringes, there were
only 3 out of 10 students (30%) who had checked for skin test of the drug for IV push, and 2 out
of 10 students (20%) who checked for drug-drug and drug-IV fluid incompatibility. While
incorporating medication into ongoing IV fluid, 3 out of the 10 students (30%) kinked the tubing
before removing the administration set from the bottle. While administering medications via IV
push using Heplock, 1 out of 10 students (10%) was able to fill the tuberculin syringe with the
correct amount of heparin solution. While incorporating and administering medications via
soluset, 2 out of 10 students (20%) checked the present IV fluid label, level and incorporated
into the soluset and placed an IV label tag on the soluset to indicate the drug administered.
While changing an ongoing IV infusion, 2 out of 10 students (20%) explained the procedure to
the patient and documented accordingly. 1 out of 10 students (10%) checked the sterility and
integrity of the IV. While discontinuing an ongoing IV infusion, 3 out of 10 students (30%)
inspected the IV catheter for completeness and performed documentation.
There were several steps on the skills observational checklist wherein all of the 10
students (100%) had performed. During preparation of IV medications in syringes, these steps
are counterchecking medication card against written orders, observing 10 Rs when preparing
medication, checking for dosage computation, preparing the necessary materials for the
procedure, and preparing the medications accordingly. During administration of medications via
Skill Retention and Level of Knowledge and Attitudes on Intravenous Therapy among Senior Nursing Students
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injection port, the steps included are kinking the tubing and pushing the IV drug slowly or as per
manufacturer’s instructions. During the administration of IV medications via push using Heplock
port, the step included is inserting medication into injection port, inject medication into vein and
timing the flow rate according to the doctor’s order. During the incorporation of medication into
soluset and administering medications via soluset, the step included is adding the desired IVF
diluent into soluset by opening the clamp on the bottle then closing the clamp after. During the
changing of an ongoing IV infusion, the step included is verifying the doctor’s order. During the
discontinuation of an ongoing IV infusion, the steps included are closing the IV clamp of the IV
tubing and getting a cotton ball with alcohol and then without applying pressure removed the IV
cannula.
Some important steps involved in IVT were not performed by the subjects. It can be
noted that some of the steps such as administration of heparin when administering medications
through Heplock, placement of IV label on the Soluset, and kinking the tubing before removing
the administration set are not done by the students in the actual hospital setting. Those notable
steps are indicated in Figure 8.
0
1
2
3
4
5
6
7
8
9
10
Figure 8. Frequency distribution of 4th year UPCN students who did not perform important IVT procedures
Hand washing Administration of Heparin
Checking of integrity of IVF
Checking of drug compatibility Checking of IVF label & level
Placement of IV label on soluset Explaining procedure to the patient
Documenting procedure
Checking for skin test Assessing IV site
Inspection of catheter for completeness
Kinking the tubing before removing the administration set
Skill Retention and Level of Knowledge and Attitudes on Intravenous Therapy among Senior Nursing Students
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Knowledge Assessment Exam Tool
There were several items in the knowledge tool wherein only half or less of the sample
was able to answer correctly. For the first item in the multiple choice section, 4 out of 10 (40%)
were able to get the correct answer. This item is about assessment and planning in fluid and
electrolyte imbalances. In the sixth item, which is about venipuncture sites, 4 out of 10 (40%)
were able to answer correctly. In the 11th, 12th, and 13th items, which are all about
troubleshooting IV therapy problems, there were 4 (40%), 3 (30%) and 5 (50%) out 10 students
respectively that were able to get the correct answers. It can be noted that most errors fall on
items related to troubleshooting IV therapy complications.
There were also several items in the multiple choice section that were all answered
correctly by the 10 students. These items were about monitoring of IV infusions and
complications, purposes of IV therapy, and troubleshooting IV therapy problems.
It is of note that there were 3 items on troubleshooting IV therapy problems that few
were able to answer correctly but another item on the same topic was answered correctly by all
the students. This might be because the situation presented in the latter item was a more
common occurrence during their clinical rotation thus they had to address this problem more
frequently and as such contributing to increased remembrance of what they do during those
times.
In the problem solving section, all the students were able to answer correctly the item on
calculating the appropriate drop rate according to the given time and amount of IV fluid.
In the true or false section, there were five items that were answered correctly by all the
students. Three items were on IV medication preparation, while the other two items were on IV
medication administration.
Attitudes Survey
The item performance review for the attitude survey is divided into the 4 domains
including learner satisfaction, self-perception, educational practices, and motivation.
Skill Retention and Level of Knowledge and Attitudes on Intravenous Therapy among Senior Nursing Students
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Learner Satisfaction
The participants displayed satisfaction with regards to teaching methods, learning
materials used and instructional designs applied in the curriculum of the university in teaching IV
therapy knowledge and skills. Among the five items for learner satisfaction, the item #1 (The
teaching methods used in teaching IV therapy skills are helpful) scored the highest median of
4.5 indicating that the participants perceive teaching methods in IV therapy helpful or effective.
However, item #5 (The way IV therapy skills is taught is consistent with the way I like to
learn)had a median score of 4.0. Although the value can still be considered high, there were 2
participants who disagreed with the statement indicating that the way IV therapy skills is taught
is not consistent with the way they like to learn the said skill. This is consistent with the findings
in the Focused Group Discussion (FGD) which will be discussed in the later portion of this
chapter. The participants in the FGD stated that the practice of IV therapy in the actual setting
during their clinical rotations is inconsistent with the ideal practices which are taught in the
classroom or laboratory sessions.
Self-perception
The highest median score of 4.5 was recorded for item #7 (I am confident that I am
developing the practical skills needed to become a good health professional). This may be due
to their increased clinical exposure and increased opportunities for practicing IV therapy skills,
as well as troubleshooting possible complications. In general, the students have high self-
efficacy and self-esteem in their knowledge and skills towards IV therapy.
Educational Practices
Item # 13 (I like to collaborate with my classmates during learning) showed the highest
median score of 4.5 for the educational practices dimension revealing that collaboration among
student nurses is highly favored during learning activities such as in clinical rotations or in
classroom. Educational practices such as active learning, feedback system, collaboration
Skill Retention and Level of Knowledge and Attitudes on Intravenous Therapy among Senior Nursing Students
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among members of a team, and using various learning methods and time management are
generally beneficial to learning IV therapy.
Motivation
Among the given items for motivation, items # 18 (It is important for me to learn IV
therapy) and # 20 (I think it is useful for me to learn IV therapy) scored the highest median of 5.0
indicating that what motivates the students in learning IV therapy is its importance and
usefulness in their chosen career. In general, the participants demonstrated high motivation in
learning IV therapy taking into account experiences of setbacks, having pride in one’s work and
interest in IV therapy.
Assessment of Level of SKA of 4th year Students
Skill and Knowledge
Assessment of the current level of skills, knowledge, and attitudes of fourth year nursing
students was done through the use of the instruments developed by the researchers. The
sample had a mean skill score of 50.00 (61.73%) out of 81. The skill scores ranged from 43
(53.09%) out of 81 to 65 (80.25%) out of 81. The knowledge scores ranged from 21 (70.00%)
out of 30 to 28 (93.33%) out of 30. It had a mean value of 23.90 (79.67%) out of 30 and a
standard deviation of 1.79. Table 4 shows a summary of the measures of central tendency and
measures of variation of the knowledge and skills score of the fourth year students.
Table 4. Measures of Central Tendency and Measures of Variation of knowledge
and skill scores of 4th year UPCN students
n Range Mode Median Mean Std. Deviation
Skill Score 10 22.00 48.00 49.00 50.00 5.91
Knowledge Score 10 7.00 24.00 24.00 23.90 1.79
Skill Retention and Level of Knowledge and Attitudes on Intravenous Therapy among Senior Nursing Students
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Other possible variables were also looked into by the researchers. The sex of the
students was also analyzed with the skill scores and knowledge scores. Two T-tests of
independent means were done. The first t-test t (df=6.785, α = 0.05) = 2.306 was performed and
the calculated test statistic was -1.765. Given the following hypotheses:
Ho: There is no significant difference between the mean knowledge scores of fourth year
UPCN female and male students
Ha: There is a significant difference between the mean knowledge scores of fourth year
UPCN female and male students
The mean of the knowledge score of female students, 24.800 (82.667%), is higher than
the knowledge scores of male students, 23.000 (76.667%) as shown in Table 5. However, the
standard deviation of the knowledge scores of female students (1.924) is also higher than those
of the male students (1.225). The level of knowledge of females is relatively higher but is more
varied.
Because the calculated p-value (.122) is not less than .05, the null hypothesis is
accepted. Therefore, there is no significant difference between the mean knowledge scores of
fourth year UPCN female and male students. A copy of the statistical printout from SPSS is
attached in Appendix VIII.
Table 5. Independent t-test of knowledge scores of male and female 4th year UPCN students
n Mean Std. Deviation p-value* Test statistic
Male 5 23.000 1.225 .122 t=-1.765 Female 5 24.800 1.924
* 2-tailed independent t-test; α=0.05
Another t-test of independent means t (df=4.617, α = 0.05) = 2.306 was also performed
and the calculated test statistic was -.730. Given the following hypotheses:
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Ho: There is no significant difference between the mean skill scores of fourth year UPCN
female and male students
Ha: There is a significant difference between the mean skill scores of fourth year UPCN
female and male students
The mean of the skill score of female students, 51.40 (63.46%), is higher than the skill
scores of male students, 48.60 (60.0%) as shown in Table 6. However, the standard deviation
of the knowledge scores of female students (8.26) is also higher than those of the male students
(2.30). The level of skill of females is relatively higher but is more varied.
Because the calculated p-value (.501) is not less than .05, the null hypothesis is
accepted. Therefore, there is no significant difference between the mean skill scores of fourth
year UPCN female and male students.
Table 6. Independent t-test of skill scores of male and female 4th year UPCN students
n Mean Std. Deviation p-value* Test statistic
Male 5 48.60 2.30 .501 t=-.730 Female 5 51.40 8.26
* 2-tailed independent t-test; α=0.05
The subjects were also asked to indicate what course the different IVT procedures were
given emphasis and when it was fully appreciated in practice. The different courses are further
classified as show in the table below.
Table 7. Classification of Nursing courses with the year and semester taken
Course Year Taken Semester Taken
Nursing Foundations N 11
2nd year
2nd semester
Nursing Interventions N105 N107 N109.1
3rd year 3rd year 4th year
1st semester 2nd semester 1st semester
Intensive Clinical Experience N121.1
4th year
2nd semester
Skill Retention and Level of Knowledge and Attitudes on Intravenous Therapy among Senior Nursing Students
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The different skills include (a) Setting-up IV Infusion, (b) Changing an IV Infusion, (c)
Discontinuing an IV Infusion, (d) Administering medications through IV Push, (e) Administering
medications through Heplock, (f) Incorporating medications into IV Fluid, and (g) Incorporating
medications into Soluset. The scores for each skill are classified as either low score or high
scoredepending on the total number of items. Scores around 60% are classified as high. These
will be further discussed in the subsections below.
Setting-up IV Infusion
This skill has a total of 15 steps. Raw scores of at least 10 (67%) are classified as high
scores. Half of the students were classified under high scores. All of the students classified
under high scores in setting up IV infusion part came from students who perceived that this skill
was emphasized during the clinical rotation from the Interventions courses. These students
perceived that they fully appreciated this skill during their clinical rotations in the interventions
courses and in the intensive clinical experience. The scores of the students are high because
they fully appreciated the skill in courses recently taken.
Table 8. Cross tabulation of scores on setting up IV infusion and when skill was emphasized and fully appreciated by 4th year UPCN students
Low Scores High Scores Emphasis
n Full Appreciation
n Emphasis
n Full Appreciation
n
Foundations Course
4 (40%) 2 (20%) 0 (0%) 0 (0%)
Interventions Courses
1 (10%) 2 (20%) 5 (50%) 3 (30%)
Intensive Clinical Experience Course
0 (%) 1 (10%) 0 (0%) 2 (20%)
Total 5 (50%) 5 (50%)
Changing IV Infusion
This skill has a total of 15 items. Because only one student had a score greater than 9
out of 15 (60%), raw scores of at least 8 (53%) are classified as high scores. 4 out of the 10
(40%) students had high scores. Most of the students who had high scores perceive that this
Skill Retention and Level of Knowledge and Attitudes on Intravenous Therapy among Senior Nursing Students
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skill was given emphasis during their interventions courses. 2 out of the 4 students who had
high scores perceived that the skill was fully appreciated during their Intensive Clinical
Experience Course which was the last course that they took.
Table 9. Cross tabulation of scores on changing an IV infusion and when skill
was emphasized and fully appreciated by 4th year UPCN students
Low Scores High Scores Emphasis
n Full Appreciation
n Emphasis
n Full Appreciation
n
Foundations Course
4 (40%) 2 (20%) 1 (10%) 1 (0%)
Interventions Courses
2 (20%) 4 (40%) 3 (30%) 1 (10%)
Intensive Clinical Experience Course
0 (%) 0 (0%) 0 (0%) 2 (20%)
Total 6 (60%) 4 (40%)
Discontinuing an IV Infusion
This has a total of 12 items. 4 (40%) students who had scores of at least 8 (67%) are
classified as high scores. All of the students who have high scores for the discontinuing IV
infusion part perceived that this skill was given emphasis during the interventions courses.
These students perceived that they fully appreciated this skill during their clinical rotations in
their Intensive Clinical Experience and Interventions Courses.
Table 10. Cross tabulation of scores on discontinuing an IV Infusion and when skill was
emphasized and fully appreciated by 4th year UPCN students
Low Scores High Scores Emphasis
n Full Appreciation
n Emphasis
n Full Appreciation
n
Foundations Course
4 (40%) 2 (20%) 0 (0%) 0 (0%)
Interventions Courses
2 (20%) 4 (40%) 4 (40%) 2 (20%)
Intensive Clinical Experience Course
0 (%) 0 (0%) 0 (0%) 2 (20%)
Total 6 (60%) 4 (40%)
Skill Retention and Level of Knowledge and Attitudes on Intravenous Therapy among Senior Nursing Students
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Administering Medications through IV Push
This skill had a total of 5 steps. 8 students (80%) students with scores of at least 4 (80%)
are classified as high scores. 5 out of the 7 (71%) students classified under high scores fully
appreciated this skill in their interventions courses. Similar to the results of the previous steps
discussed, students who had high scores appreciated administering medications through IV
push in the courses taken during their 3rd year and 4th year level.
Table 11. Cross tabulation of scores on administering medications through IV Push and when
skill was emphasized and fully appreciated by 4th year UPCN students
Low Scores High Scores Emphasis
n Full Appreciation
n Emphasis
n Full Appreciation
n
Foundations Course
1 (10%) 1 (10%) 4 (40%) 2 (20%)
Interventions Courses
1 (10%) 1 (10%) 4 (40%) 5 (50%)
Intensive Clinical Experience Course
0 (%) 0 (00%) 0 (0%) 1 (10%)
Total 2 (20%) 8 (80%)
Administering Medications through Heplock
Administering medications through heplock had a total of 9 steps. High scores are
defined as scores of at least 6 (67%). 7 (70%) students were classified as high scores. 5 out of
the 7 (71%) students classified as high scores and all of the students classified as low scores
perceived that administering medications through heplock was given emphasis in their
interventions courses. 4 out of these 7 (57%) students also perceived that this skill was fully
appreciated in the intervention courses. 2 out of the 3 (67%) of the students who had low scores
perceived that administering medications through heplock was emphasized during their
foundations courses. In contrast with the students who had high scores, none of the students
who had low scores perceived that this skill was fully appreciated in the intensive clinical
experience course.
Skill Retention and Level of Knowledge and Attitudes on Intravenous Therapy among Senior Nursing Students
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Table 12. Cross tabulation of scores on administering medications through Heplock and when skill was emphasized and fully appreciated by 4th year UPCN students
Low Scores High Scores Emphasis
n Full Appreciation
n Emphasis
n Full Appreciation
n
Foundations Course
2 (20%) 0 (0%) 2 (20%) 2 (20%)
Interventions Courses
1 (10%) 3 (30%) 5 (50%) 4 (40%)
Intensive Clinical Experience Course
0 (%) 0 (0%) 0 (0%) 1 (10%)
Total 3 (30%) 7 (70%)
Incorporating Medications in IV Fluid
This part had a total of 6 steps. Half of the students had a score of at least 4 (67%) and
are classified as high scores. Similar to all the other IVT skills, none of the students perceived
that emphasis of IV Therapy skills is first perceived in their intensive clinical course. 4 out of the
5 (80%) students who had low scores and 2 out of 5 (40%) students who had high scores
perceived that this skill emphasized in their interventions courses. 2 out of the 5 (40%) students
who had low scores and 3 out of 5 (60%) students who had high scores perceived that this skill
was fully appreciated also in their interventions courses. Unlike the results of the previous skills
discussed, there is no particular pattern for the perceived emphasis and appreciation of the
students.
Table 13. Cross tabulation of scores on incorporating medications in IV fluid and when skill was emphasized and fully appreciated by 4th year UPCN students
Low Scores High Scores Emphasis
n Full Appreciation
n Emphasis
n Full Appreciation
n
Foundations Course
1 (10%) 1 (10%) 3 (30%) 1 (10%)
Interventions Courses
4 (40%) 2 (20%) 2 (20%) 3 (30%)
Intensive Clinical Experience Course
0 (0%) 2 (20%) 0 (0%) 1 (10%)
Total 5 (50%) 5 (50%)
Skill Retention and Level of Knowledge and Attitudes on Intravenous Therapy among Senior Nursing Students
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Incorporating Medications into Soluset
This skill had a total of 8 steps and scores of at least 5 (63%) are classified as high
scores. 5 out of the 6 (83%) students who had high scores perceived that incorporating
medications into soluset was fully appreciated in their interventions course. None of the
students perceived that full appreciation of the skill was made during their sophomore year. In
addition, most of the students who had high scores perceived that this skill was emphasized
also during their interventions courses.
Table 14. Cross tabulation of scores on incorporating medications into Soluset and when
skill was emphasized and fully appreciated by 4th year UPCN students
Low Scores High Scores Emphasis
n Full Appreciation
n Emphasis
n Full Appreciation
n
Foundations Course
2 (20%) 1 (10%) 2 (20%) 0 (0%)
Interventions Courses
2 (20%) 2 (20%) 4 (40%) 5 (50%)
Intensive Clinical Experience Course
0 (%) 1 (10%) 0 (0%) 1 (10%)
Total 4 (40%) 6 (60%)
In summary, all of the students perceived that IVT skills are emphasized during their
foundations and interventions courses. This reflects that clinical instructors in the college ensure
that the students’ competency in the said skills is developed starting from their sophomore year.
Most students who had high scores perceived that they fully appreciated various IVT skills
during their clinical rotations in the interventions and intensive clinical experience courses. The
scores of these students are high because they fully appreciated the skills in courses which
were recently taken. In contrast with the students who had high scores, very few of the students
who had low scores perceived that this skill was fully appreciated in the intensive clinical
experience course.
Skill Retention and Level of Knowledge and Attitudes on Intravenous Therapy among Senior Nursing Students
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Attitude
The attitude score of each student were divided into 4 subsections namely learner
satisfaction, self-perception, educational practices, and motivation. The table below shows the
mode, median and range for the different attitudes. The highest possible score for each domain
was 25.
Among the 4 attitudinal domains, motivation had the highest median score of 23.5 (94%)
while learner satisfaction had the lowest median score of 20.0 (80%). In addition, the motivation
domain also had the lowest range and the highest mode. It can be said that the fourth year
UPCN students are highly motivated to learn IVT. Learner satisfaction had the highest range of
9. Satisfactions among samples are most varied compared to the other 3 domains of attitude.
Table 15. Measures of Central Tendency and Measures of Variation of
attitudinal domain scores of 4th year UPCN students
n Minimum Maximum Range Mode Median
Satisfaction 10 16 25 9 20 20.0
Self-perception 10 18 25 7 20 20.5
Educational Practices 10 19 24 7 21 21.5
Motivation 10 20 25 5 25 23.5
The second part of the attitudes survey was taken from Learning Style Inventory which
was derived from Kolb’s experiential theory and model of learning. The tool was taken as is and
was not revised. It was used to classify the subjects into 4 types of learner namely divergent,
accommodative, convergent, and assimilative. 5 out of the 10 students were convergent
learners, 3 out of 10 were accommodative learners, 1 out of 10 was a divergent learner, and 1
out of 10 was an assimilative learner. The classifications of the subjects are shown in the figure
located on the next page.
Skill Retention and Level of Knowledge and Attitudes on Intravenous Therapy among Senior Nursing Students
105
Evaluation of Skill Retention
All of the 10 students had a negative percent difference of skill score. The mean percent
difference of skill score was -49.85 and the variation of the scores was low at standard deviation
14.78. The measures of central tendency and measures of variation are shown in the table
below.
Table 16. Measures of Central Tendency and Measures of Variation of percent difference of skill score of 4th year UPCN students
n Mean Median Mode Range SD
Percent Difference
of Skill Score 10 -49.85 -50.37 -52.08 58.66 14.78
Two-tailed T-test of paired means t (df=9, α = 0.05) = 2.262 was performed and the
calculated test statistic was 13.065. Given the following hypotheses:
Ho: There is no significant difference between the mean skill scores of fourth year UPCN
students from their sophomore year and their current mean skill score.
Divergent 10%
Accomodative 30%
Convergent 50%
Assimilative 10%
Figure 9. Percentage distribution of the learner type (according to Kolb) of 4th year UPCN students
Skill Retention and Level of Knowledge and Attitudes on Intravenous Therapy among Senior Nursing Students
106
Ha: There is a significant difference between the mean skill scores of fourth year UPCN
students from their sophomore year and their current mean skill score.
The mean skills score of 4th year nursing students was higher during their sophomore
year (74.196 or 91.6%) compared to their skill score from the IVT Observational Checklist
(50.000 or 61.7%). Their current skill scores are more varied compared to their skill scores
during their sophomore year as shown in the table below.
Table 17. Paired t-test of skill scores of 4th year UPCN students from
sophomore year and senior year
n Mean Std. Deviation p-value* Test statistic
Sophomore year 10 74.196 2.837 .000 t=13.065 Senior year 10 50.000 5.907
* 2 tailed paired t-test; α=0.05
Because the p value (.000) is less than .05, the null hypothesis is rejected and the
alternative hypothesis is accepted. There is a significant difference between the mean skill
scores of fourth year UPCN students from their sophomore year and senior year.
From the results of the t-test and the percent difference of skill score, it can be said that
there was no relative retention of IVT skills among fourth year UPCN students. This direction
may change if sample size is increased because of possible sampling error. This may also be
affected by confounders such as student’s temperament or disposition during the data
collection.
Factors Related to Retention of Skills and Level of SKA
Learner Attitudes
Several factors, as discussed in the previous chapters, are thought to affect the retention
of skills and the level of knowledge in IVT of students. Learner attitude as a factor has 4
domains namely learner satisfaction, self-perception, educational practices, motivation, and
Skill Retention and Level of Knowledge and Attitudes on Intravenous Therapy among Senior Nursing Students
107
learning style. Pearson product moment correlation and Spearman rho were done depending on
the level of measure of the said variables. Table 18 shows correlation coefficients of these
factors in relation to the skill score, skill decay, knowledge score, and among the said factors.
As seen from the table, none of the 4 domains of learner attitude had a statistically
significant correlation with the knowledge score, skill score, and skill decay. The domains of
learner attitude including learner satisfaction (rs=-.309, α=0.05), self-perception (rs=-.158,
α=0.05), educational practices (rs=-.256, α=0.05), and motivation (rs=-.309, α=0.05) had
negative correlation with skill decay. This indicates that skill decay is higher when these learner
attitude domains are lower. However, the correlation is weak and is statistically insignificant.
Table 18. Correlation coefficients of various factors perceived to be affecting
skills and knowledge on IVT of 4th year UPCN students
Skill Decay
%Skill Score
%Knowledge Score
Learner Satisfaction
Self-Perception
Educational Practices
Motivation Learning Style
Skill Decay 1.0 %Skill Score -.929
** 1.0
%Knowledge Score
.195 .031 1.0
Learner Satisfaction
-.309 .229 -.396 1.0
Self-Perception
-.158 .176 -.549 .677* 1.0
Educational Practices
-.256 .084 -.253 .372 .259 1.0
Motivation -.309 .228 -.452 .566 .821**
.423 1.0 Learning Style
.178 -.402 .130 .126 .127 -.356 -.277 1.0
*. Correlation is significant at the 0.05 level (2-tailed). **. Correlation is significant at the 0.01 level (2-tailed).
It can also be seen that several domains of learner attitudes affect each other. Self-
perception had a significant correlation with learner satisfaction (rs=0.667, α=0.05) and
motivation had a significant correlation with self-perception (rs=0.821, α=0.01).
Two significant findings were noted for the type of learner and its effect on the
knowledge and skill scores of the subjects. The knowledge assessment examination had a total
of 30 items. Scores of at least 24 (80%) are classified as high scores. 6 (60%) students are
Skill Retention and Level of Knowledge and Attitudes on Intravenous Therapy among Senior Nursing Students
108
classified as high scorers. Students who had low scores fell on all 4 categories of learning style.
It can be noted from the table below that 2 (20%) got a high score from the accommodative
learning style and 4 from the convergent learning style (40%). This may indicate that most
nursing students who has a good knowledge about IV therapy must have come from these two
learning styles, accommodative and convergent.
Table 19. Cross tabulation of learning style (according to Kolb) and knowledge scores of 4th year UPCN students
Skill Retention and Level of Knowledge and Attitudes on Intravenous Therapy among Senior Nursing Students
136
Thorndike, R. M. (1997). Measurement and evaluation in psychology and education (6th Ed.).
New Jersey: Merrill, Prentice Hall.
University of Maryland. The Rosenberg Self-Esteem Scale. Retrieved from
http://www.bsos.umd.edu/socy/research/rosenberg.htm on January 28, 2013.
University of the Philippine Manila College of Nursing (2006). Competency-based BSN
curriculum: a model (Vol. 1). Ermita, Manila: The College of Nursing University of the
Philippines Manila.
White, R. T., & Mayer, R. E., (1980). Understanding intellectual skills. Instructional Science 9,
101-127. doi: 10.1007/BF00120858
Williams, D.J.P. (2007). Medication errors. Journal of the Royal College of Physicians of
Edinburgh, 37:343–346. Retrieved from http://www.rcpe.ac.uk/journal/issue/journal_
37_4/Williams.pdf
Yahaya, M. (n.d.).Self concepts and motivation to learn among students.
Yu, J. (2008). A study of the influence of instructional innovation on learning satisfaction and
study achievement. The Journal of Human Resource and Adult learning, 4(2). 43-54.
Retrieved from http://www.hraljournal.com/Page/6%20Yu-Je%20Lee.pdf
Skill Retention and Level of Knowledge and Attitudes on Intravenous Therapy among Senior Nursing Students
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APPENDIX I
Research Schedule (GANTT Chart) and Budget Allocation
Skill Retention and Level of Knowledge and Attitudes on Intravenous Therapy among Senior Nursing Students
138
Gantt Chart
Research Budget Allocation
NOVEMBER DECEMBER JANUARY FEBRUARY MARCH
ACTIVITY 12
- 1
6
19
- 2
3
26
- 3
0
3-
7
10
- 1
4
17
- 2
1
24
- 3
1
1 -
4
7 -
11
14
- 1
8
21
- 2
5
28
- 3
1
1
4 -
8
11
- 1
5
18
- 2
2
25
- 2
8
1
4 -
8
11
- 1
5
18
- 2
2
25
- 2
9
Research Topic Proposal
Conceptual Framework
Chapter 1
Chapter 2
Chapter 3
Tool/Instrument
Validity and Reliability Testing
Sampling
Data Collection
Data Collation
Data Analysis
Interpretation of Data
Submission
Presentation of Research
ITEM AMOUNT
Direct Expenses on Research - Reproduction of tools and letters ₱ 150.00 - Printing of proposals and packets of research instruments ₱ 300.00 - Printing and production of final research paper ₱ 800.00 - Poster and tarpaulin ₱ 200.00 - Medical supplies for IVT ₱ 200.00 - Token gifts for experts (for validity and reliability testing) ₱ 300.00 - Token for FGD participants ₱ 200.00
Personnel and Travel Expenses ₱ 0.00 TOTAL ₱ 2,150.00
Skill Retention and Level of Knowledge and Attitudes on Intravenous Therapy among Senior Nursing Students
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APPENDIX II
Research Instruments Packet for Subjects Informed Consent
Skill Retention and Level of Knowledge and Attitudes on Intravenous Therapy among Senior Nursing Students
140
University of the Philippines Manila The Health Sciences Center
COLLEGE OF NURSING Sotejo Hall, Pedro Gil Street, Ermita, City of Manila
Informed Consent
This informed consent form is for the senior nursing students enrolled in N121.1 (Intensive Hospital-based Nursing Experience) or N121.2 (Intensive Community-based Nursing Experience), and whom we are inviting to participate in our group’s research “Retention of Skills, Knowledge and Attitudes on Intravenous Therapy among Senior Nursing Students”. This informed consent form has two parts: (1) information sheet to share information about our study with you, and (2) certificate of consent for signatures if you choose to participate.
We are from Group V, currently enrolled in N199 course (Introduction to Nursing Research). We are undertaking a study about Intravenous Therapy (IVT), which is a competency highly expected from a nurse. We are going to give you information and invite you to be part of this research. This consent form may contain words that you do not understand. Please ask us to stop as we go through the information and we will take time to explain. If you have questions later, you can ask them to us or of another researcher.
We want to determine the current level of skills, knowledge and attitudes (SKA) of senior nursing students on IVT. We believe that you can help us by responding to our questionnaires, joining in our return demonstrations and participating in our focused group discussion. These will also help us evaluate the level of retention and describe the factors that are perceived and experienced by senior nursing students. Your experiences from second year to fourth year can contribute much to our understanding of retention of SKA on IVT among senior nursing students.
This research will involve your participation for about one and a half hour, and a fifteen-minute focused group discussion. We will ask you and others in the group not to talk to people outside the group about what was said in the group.
Your participation in this research is entirely voluntary. It is your choice whether to participate or not. The choice that you make will have no bearing on your status as a student or on any academically-related evaluations or reports. You may change your mind later and stop participating even if you agreed earlier. There will be no compensation on your participation in our study.
We will not be sharing information about you to anyone outside of the research team. The information that we collect from this research project will be kept private. Any information about you will have a code number on it instead of your name. Only the researchers will know what your number is. It will not be shared with or given to anyone.
If you have any questions, you can ask them now or later. If you wish to ask questions later, you may contact any of the following: 09273901505 or [email protected]. Respectfully yours, Noted by: Dan Louie Renz Tating, SN Prof. Vanessa M. Manila, MA-HPS, RN Leader, N199 Group V Research Adviser and Course Coordinator, N199
Certificate of Consent
I have read the foregoing information, or it has been read to me. I have had the opportunity to ask questions about it and any questions I have been asked have been answered to my satisfaction. I consent voluntarily to be a participant in this study.
Printed Name of Participant ___________________________________ Signature of Participant ___________________________________ Date (MM/DD/YY) ________________
Skill Retention and Level of Knowledge and Attitudes on Intravenous Therapy among Senior Nursing Students
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COMPREHENSIVE INTRAVENOUS THERAPY SKILLS OBSERVATION CHECKLIST Condensed Version with Skills on Setting-up IV Infusion, Preparing and Administering IV Medications,
Changing an ongoing IV Infusion, and Discontinuing an ongoing IV Infusion
* adapted from UPCN Clinical Skills Checklist
Name (optional): ___________________________________________ Control Number: ____________ Please check the column that best corresponds to the performance of the student in each of the following steps.
Steps Performed Not
Performed
SETTING-UP AN IV INFUSION
1 Verify doctor’s order. Make I.V. label (patient’s name, room number, solution, drug incorporation, bottle sequence and duration)
2 Explain procedure to patient and/or significant others. Secure consent if necessary.
3 Wash hands and maintain asepsis throughout the preparation and during the therapy.
4 Prepare necessary materials (IV tray with IV solution, administration set, IV cannula, antiseptic solution, cotton balls with alcohol, plaster, tourniquet, gloves, splint and IV stand).
5 Check the sterility and integrity of the IV solution and IV set and other devices.
6 Place IV label on IV bottle.
7 Open the seal of the IV solution. Disinfect port with cotton balls with alcohol.
8 Open administration set aseptically (IV set). Close the clamp.
9 Spike the container aseptically.
10 Fill drip chamber to at least half and prime the tubing aseptically.
11 Remove air bubbles if any and put back the cover of the distal end of the IV tubing.
PREPARING AND ADMINISTERING IV MEDICATIONS Preparing IV Medications in Syringes
12 Countercheck medication card against the written doctor’s orders.
13
Observe 10 R's when preparing medication (selected “rights”*): Right Medication Right Client * other rights not selected because either they are incorporated in other steps (ex: right dose, right documentation, right assessment), or they are not applicable (ex: right time, right route, right client education, right to refuse, right evaluation)
14 Wash hands before and after the procedure.
15
Check for skin test of drug for IV push. Check for drug-drug and drug-IV fluid incompatibility. Check for dosage computations.
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Steps Performed Not
Performed
16 Prepare the necessary material for the procedure such as: right drug, right diluents needed IV injection tray, syringes, and needles.
Prepare the medications accordingly.
Administering via Injection Port
17 Check IV site (if infiltrated or out of vein; if there are signs of swelling, redness, phlebitis, do not give the drug).
18
Disinfect the Y-injection port of the IV administration set; pierce through the bull’s eyed rubber port.
Kink the tubing. Push IV drug slowly as ordered or as per manufacturer’s instructions.
19 Flush IV tubing after drug administration with IV fluid (aspirate IV fluid using same syringe and push IV fluid slowly).
Incorporating medications into Ongoing IV Fluid
20
Put down the bottle. Kink the tubing. Remove the administration set from the bottle aseptically. Disinfect the bottle’s rubber stopper: incorporate the right drug to the IVF bottle. Return the administration set to IVF bottle aseptically. Swirl bottle to mix the drug with the IVG and regulate the flow rate as ordered.
Administering via IV Push using Heplock port
21 Check IV site (if infiltrated or out of vein; if there are signs of swelling, redness, phlebitis, do not give the drug).
22 Fill a tuberculin syringe with Heparin solution. (0.1 cc heparin plus 0.9 cc normal saline)
23 Fill the 2 2.5 cc syringes with isotonic solution or normal saline 1 cc each.
24 Swab injection port with alcohol or iodophor swab. Insert saline syringe into port. Saline syringe is also used to check the patient of the infusion set. If so. Administer saline via IV Push.
25 Insert medication into injection port. Inject medication into the vein, timing the flow rate according to doctor’s order.
26 Insert the saline syringe and flush the line.
27 Insert heparin syringe; to prevent the formation of clot in the catheter
28 Remove syringe and return the cover of the injection port aseptically
Incorporating medications into Soluset and administering medications via Soluset
29 Check IV site (if infiltrated or out of vein; if there are signs of swelling, redness, phlebitis, do not give the drug)
30 Check present IV fluid label, level, and incorporated medicine in the soluset or IV bottle.
31
Add desired IVF diluent into soluset by opening the clamp on the bottle then close the clamp after.
Disinfect rubber injection port of the soluset. Incorporate the drug. Mix gently.
32 Open the clamp of the airway at the soluset.
33 Regulate flow rate of IVF infusion (if to run for 30 min or 1 hour).
34 Place IV label on soluset indicating drug administered.
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Steps Performed Not
Performed
After administering medications: 35 Dispose sharps and other waste according to HICU guidelines.
36 Document procedure in the patient’s chart.
CHANGING AN ONGOING IV INFUSION
37 Verify written doctor’s order. Countercheck IV label, bottle number or bottle sequence, type, amount, additives (if any), duration of infusion.
38 Explain the procedure to the patient. Assess the IV site for redness, swelling and pain.
39 Wash hands before and after procedure.
40 Prepare necessary materials (IV solution, IV label, disinfectant, IV tray).
41 Check the sterility and integrity of the IV.
42 Calibrate new IV bottle according to the duration of the infusion.
43 Open rubber port of IV solution to follow. Disinfect rubber port of IV solution.
44 Close the clamp or kink tubing. Spike the container aseptically.
45 Regulate the flow rate based on duration of infusion. Remove air bubbles (if any).
46 Discard all waste material according to HICU guidelines.
47 Document accordingly and endorse to incoming shift.
DISCONTINUING AN ONGOING IV INFUSION 48 Verify written doctor’s order to discontinue IV including IV medicines.
49 Assess and inform the patient of the order.
50 Prepare necessary materials: IV trays or injection tray, cotton balls with alcohol, plaster, antiseptic solution.
51 Wash hands before and after procedure.
52 Don gloves.
53 Close IV clamp of the IV tubing.
54 Moisten adhesive tapes around the IV catheter using cotton balls with alcohol. Remove plaster gently.
55 Get cotton ball with alcohol and without applying pressure remove IV cannula. Apply pressure using dry cotton ball or then apply plaster.
56 Inspect IV catheter for completeness.
57 Discard all waste material including the IV cannula according to HICU guidelines.
58 Document time or removal, status of insertion site and integrity of IV catheter and endorse to incoming shift.
Thank you for evaluating the subject! - The Researchers
Name (optional): ___________________________________________ Control Number: ____________
Please underline the letter of your answer. 1. What is the priority goal/s of a nurse treating a patient with fluid and electrolyte imbalance?
A. fluid balance B. oxygenation C. risk prevention D. all of the above 2. Which of the following pairs of intravenous solutions and their classification are mismatched?
A. 0.9% NaCl – Isotonic B. 5% dextrose in 0.45% NaCl – Isotonic C. 0.45% NaCl – Hypotonic D. 5% dextrose in normal saline – Hypertonic
3. Which of the following intravenous solutions provide free water and treat cellular dehydration? A. isotonic solutions B. hypotonic solutions C. hypertonic solutions D. volume expanders
4. Which of the following intravenous solutions expand vascular volume by drawing fluid out of the intracellular compartment into the vascular compartment?
A. isotonic solutions B. hypotonic solutions C. hypertonic solutions D. volume expanders 5. Which of the following are useful guidelines in selecting a vein for venipucture?
I. use proximal veins of the arm first II. use client’s dominant arm whenever possible III. vein selected must be easily palpated and soft and full IV. avoid veins in areas of flexion such as the antecubital fossa A. I and II B. II and III C. III and IV D. none
6. Which of the following statements is incorrect regarding the initiation of IV Therapy? I. avoid hand veins, they must be a last choice II. use the smallest gauge cannula for the therapy III. dangle the arm to encourage deep vein filling IV. stabilize the client’s arm with your non-dominant arm A. I and II B. II and III C. III and IV D. none
7. Which of the following causes phlebitis? A. vein irritation from catheter B. chemical irritation from medicines C. infection from improper aseptic technique D. all of the above
8. What may happen when a foreign object is not removed in the IV tubing? A. circulatory overload B. pulmonary embolism C. speed shock D. pulmonary edema
9. Which of the following IV Therapy complication may possibly lead to the other? I. air embolism II.circulatory overload III.speed shock IV. pulmonary edema A. I and II B. I and III C. II and IV D. III and IV
10. Which of the following are the goals of parenteral fluid therapy? A. provide water, electrolytes and nutrients to meet daily requirements B. replace water and correct electrolyte deficits C. administer medications and blood products D. all of the above
11. All of the following interventions should be done when there is infiltration except for? A. elevate the affected extremity B. discontinue IV infusion C. apply cold compress D. none of the above
12. Which of the following should be done in case pulmonary edema occurs? A. place the patient in a flat position B. regulate the IV to keep vein open C. discontinue the IV infusion D. secure tourniquet above the venipuncture site
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13. You are regulating the IV fluid of your patient when you notice that there was about 5mL of air trapped in the tubing. Which of the following statements can be done? A. tap the tubing until the bubbles rise into the drip chamber B. withdraw the air from the accessory port using a syringe C. both A and B D. none of the above
14. You noticed that blood backed up at the IV tubing upon ambulation of the patient .What should be done? A. increase the height of the pole during ambulation B. elevate the extremity of the patient C. discontinue the ongoing IV infusion D. refer to the physician
Please write your answer on the blanks below.
1. What is the flow rate of an intravenous solution of 3 L infused in 24 hours? Express your answer in mL/h. ___________________________
2. What is the flow rate if a liter of intravenous solution is to be infused in 8 hours using an administration set with drip factor of 20 drops/ml? Express in drops/min. ___________________________
3. An IV solution of 1000mL of D5W NaCl is to infuse over 8 hours. The IV set drop factor is 15 gtts/mL. How many drops per minute should the client receive? ___________________________
4. A 3 and a half year old male patient with a weight of 15kg is to be given 300 mg Cefuroxime. Does the dose ordered fall within the recommended range? Answer with yes or no. (Recommended dose range for 2 to 12 years is 10 – 30mg/kg). If yes, how many mL of the reconstituted solution should be withdrawn? (Preparation: Powder which when reconstituted with 1.8ml water for injection, gives a solution of 250mg in 2ml.) ___________________________
5. A 4 month old infant with a weight of 6.5kg is to be given 7.5 mg Furosemide IV. Does the dose ordered fall within the recommended range? Answer with yes or no. (Recommended dose range age 1 month to 2 years is 1 – 2mg/kg bd) If yes, how many mL of the medication should be withdrawn? (Preparation: Ampoules containing 20mg in 2ml.) ___________________________
Indicate whether the following statements are True or False. Write your answer on the blanks below.
1. Hands washing should be performed before preparation of IV antibiotic solution. __________ 2. It is not necessary to check expiry date for a medication that is recently indented from pharmacy.
__________ 3. ‘cc’ or ‘ml’ is the dosage expression for IV insulin. __________ 4. Preparation of IV Hydrocortisone solution does not require hands hygiene. __________ 5. Any reconstituted IV medications can still be used if it is less than 48 hours from the date of reconstitution
or preparation. __________ 6. Patient’s armband and IV catheter should be inspected for phlebitis or extravasations during
administration of IV cytotoxic drugs. __________ 7. Medication administered intramuscularly acts rapidly than if administered intravenously. __________ 8. KCl injection should be administered as slow bolus injection over 3 minutes during emergency such as
ventricular fibrillation. __________ 9. IV Ceftriaxone can be administered simultaneously with solution containing Calcium Gluconate via a Y-
site, at a slower rate of 5mg/min. __________ 10. Medications that are classified as High Alert Medication include Noradrenaline and Insulin. __________ 11. When an emergency happens such as hypocalcaemia tetany, 10% CaCl 210 ml should be administered in
1– 2 minutes. __________
Thank you for taking time to answer this examination! - The Researchers
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INTRAVENOUS THERAPY ATTITUDES SURVEY
Name (optional): ___________________________________________ Control Number: ____________ Please check the column that best describes your agreement or disagreement with the following statements below. Example: Statement: IV Therapy is being taught to students of UP College of Nursing. Your Rating: Strongly Agree (check column under “Strongly Agree”)
Statements Strongly Disagree
Disagree Neutral Agree Strongly
Agree
1 The teaching methods used in teaching IV therapy skills are helpful
2 the class on IV therapy skills provides a variety of learning materials
3 I enjoy the format in which the class on IV therapy skills is offered
4 the teaching materials in the class on IV therapy skills motivate me to study on IV Therapy
5 the way IV therapy skills is taught is consistent with the way I like to learn
6 I am confident that I am developing the knowledge needed to become a competent health professional
7 I am confident that I am developing the practical skills needed to become a good health professional
8 I did well on the tests in this class on IV therapy skills
9 I take a positive attitude in performing intravenous therapy on patients.
10 I am satisfied with how I perform intravenous therapy.
11 I am an active learner
12 I rely on feedbacks given to me
13 I like to collaborate with my classmates during learning
14 I prefer more diverse ways of learning
15 The time dedicated on a task usually affects my performance
16 When working on my goals, I put forth my best effort and work even harder if I’ve encountered a setback.
17 I tend to put my best effort so that I feel proud of my work.
18 It is important for me to learn IV therapy.
19 I am very interested in learning what IV therapy is all about.
20 I think it is useful for me to learn IV therapy.
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Look at the four statements in each row. Decide and rank them (1 to 4) according to how they refer to you. Below each word, write 4 if it describes your learning style appropriately, or 1 if it describes you the least. Please do not make ties in each row. Example: Statements in each row: Competent, Caring, Compassionate, Careless Ranking (in decreasing order): Caring, Competent, Compassionate, Careless Rating: 4 under the word “Caring”, 3 under the word “Competent”,
2 under the word “Compassionate”, and 1 under the word “Careless”
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FOCUSED GROUP DISCUSSION GUIDE INSTRUCTIONAL METHODS:
What is your general impression or assessment to the instruction or teaching style employed in IV Therapy?
What methods were employed in teaching IV Therapy? Do you think they were effective? Why?
What do you best appreciate in these methods or styles? OPPORTUNITY FOR PRACTICE:
How were you able to practice IV Therapy?
Do you think it was sufficient? Why?
What are your perceived barriers and enabling opportunities in learning IV Therapy?
FEEDBACK:
How was your performance on IV Therapy given feedback?
How did it help?
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APPENDIX III
Research Instruments Packet for Validity and Reliability Testing Cover Letters
Content Validity Forms
Inter-rater Reliability Form
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University of the Philippines Manila
The Health Sciences Center COLLEGE OF NURSING
Sotejo Hall, Pedro Gil Street, Ermita, City of Manila February 8, 2013 <Name of Evaluator-Expert> <Position or Designation> <Name of Institution> University of the Philippines Manila <Address of Institution> <Name of Evaluator-Expert>: Good day! Our group is currently enrolled in N199: Introductory Nursing Research in the UP College of Nursing. The title of our research study is "Retention of Intravenous Therapy Knowledge, Skills and Attitudes among Senior Nursing Students." In order to accomplish our research goals, a validity testing of the instruments for gathering necessary information should be accomplished. In this regard, our group would like to request your expertise and assistance in testing the validity of our research instruments. Attached are the copies of the said instruments and the forms that will be needed to be filled up in the validity testing process. There are instructions in each form that will guide you through the process. Our group is expected to submit the results of the validity testing at the end of February. In the event that you decide to assist us in our study, our group shall coordinate with you in order to provide you the most convenient schedule. If you wish to learn of the results of our research, we may send you a summary of our findings once they have been completed. For any inquiries, please do not hesitate to contact us at 09273901505 or at [email protected] The information that you will provide us will be kept private and confidential. Our findings shall be used only for academic and research purposes. Thank you very much for your favorable response regarding this request. Respectfully yours, Noted by: Dan Louie Renz Tating, SN Prof. Vanessa M. Manila, MA-HPS, RN Leader, N199 Group V Research Adviser and Course Coordinator, N199
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University of the Philippines Manila
The Health Sciences Center COLLEGE OF NURSING
Sotejo Hall, Pedro Gil Street, Ermita, City of Manila March11, 2013 <Name of Evaluator-Expert> <Position or Designation> <Name of Institution> University of the Philippines Manila <Address of Institution> <Name of Evaluator-Expert>: Good day! We would like express our gratitude for your cooperation in the validity testing of our instruments for
our research entitled "Retention of Intravenous Therapy Knowledge, Skills and Attitudes in Senior
Nursing Students" in our course N199: Introductory Nursing Research in the UP College of Nursing.
In this regard, we would like to request foryour assistance and expertise in IV therapy in the second
round of testing the validity of our research instruments. Attached are the copies of the said
instruments and the forms that were revised based on the suggestions given by all the experts we
consulted.Our group is expected to submit the results of the validity testing by the third week of March.
If you wish to learn of the results of our research, we may send you a summary of our findings once they
have been completed. For any inquiries, please do not hesitate to contact us at 09273901505 or at
The information that you will provide us will be kept private and confidential. Our findings shall be used
only for academic and research purposes.
We hope for your favourable response regarding this request. Thank you very much!
Respectfully yours, Noted by: Dan Louie Renz Tating, SN Prof. Vanessa M. Manila, MA-HPS, RN Leader, N199 Group V Research Adviser and Course Coordinator, N199
Skill Retention and Level of Knowledge and Attitudes on Intravenous Therapy among Senior Nursing Students
Instructions: Please review each item carefully, taking into consideration the highlighted dimensions of
the construct “Intravenous Therapy Knowledge”. Write Y or N under the column “Clarity of Wording” to
measure that dimension of the item. Rate the “Relevance” of each item to the specified dimension by
checking the appropriate column: 4 for relevant, 3 for moderately relevant, 2 for somewhat relevant or
1 for not relevant. For the last column “General Recommendation”, please indicate Ret to retain the
item exactly as worded, Rev to make major/minor revisions to the item, or Drop to discard the item
entirely from the pool. You may also write your Remarks about the item appropriateness, etc. in the
same column.
Item Clarity of Wording (Y or N)
Relevance to Dimension of Construct General Recommendation (Ret, Rev, Drop)
and Remarks
4 Relevant
3 Moderately
relevant
2 Somewhat
relevant
1 Not
relevant
MULTIPLE CHOICE QUESTIONS
The following questions are about Fluid and Electrolyte Imbalances.
1
Mrs. Simpson lost large amounts of water from excessive urination last week. Looking at her serum test results, the osmolality was increased. What kind of fluid imbalance is this in relation to water? A. isotonic loss B. isotonic gain C. hyperosmolar loss D. hypo-osmolar loss
2
Which of the following laboratory data indicate an electrolyte imbalance? A. Na = 140 mEq/L B. K = 3.0
mEq/L C. Ca = 9.0 mg/dL
D. Cl = 100 mEq/L
The following question is about Assessment and Planning in Fluid and Electrolyte Imbalances.
3
What is the priority goal/s of a nurse treating a patient with fluid and electrolyte imbalance? A. fluid balance B. oxygenation C. risk prevention D. all of the above
The following questions are about IV Solutions.
4
Which of the following pairs of intravenous solutions and their classification are mismatched? A. 0.9% NaCl – Isotonic B. 5% dextrose in 0.45% NaCl – Isotonic C. 0.45% NaCl – Hypotonic D. 5% dextrose in normal saline – Hypertonic
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Item Clarity of Wording (Y or N)
Relevance to Dimension of Construct General Recommendation (Ret, Rev, Drop)
and Remarks
4 Relevant
3 Moderately
relevant
2 Somewhat
relevant
1 Not
relevant
5
Which type of intravenous solution is indicated to increase blood volume following severe loss of blood or plasma? A. isotonic solutions B. hypotonic solutions C. hypertonic solutions D. volume expanders
6
Which of the following intravenous solutions provide free water and treat cellular dehydration? A. isotonic solutions B. hypotonic solutions C. hypertonic solutions D. volume expanders
7
Which of the following intravenous solutions expand vascular volume by drawing fluid out of the intracellular compartment into the vascular compartment? A. isotonic solutions B. hypotonic solutions C. hypertonic solutions D. volume expanders
The following items are about Venipuncture Sites.
8
Which of the following are useful guidelines in selecting a vein for venipucture? I. use proximal veins of the arm first II. use client’s dominant arm whenever possible III. vein selected must be easily palpated, soft and full IV. avoid veins in areas of flexion such as the antecubital fossa A. I and II B. II and III C. III and IV D. none
9
Which of the following are incorrect regarding the initiation of IV therapy? I. Avoid hand veins, they must be a last choice II. Use the smallest possible gauge cannula III. Dangle the arm to encourage
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Item Clarity of Wording (Y or N)
Relevance to Dimension of Construct General Recommendation (Ret, Rev, Drop)
and Remarks
4 Relevant
3 Moderately
relevant
2 Somewhat
relevant
1 Not
relevant
deep vein filling IV. Stabilize the client’s arm with your non-dominant arm A. I and II B. II and III C. III and IV D. none
The following questions are about IV Equipment.
10
A standard IV administration set contains all of the following, except: A. butterfly needle B. roller clamps C. spike connector for fluid containerD. IV tubing
11
Which of the following pairs of intravenous equipment and its use are mismatched? A. insertion spike – inserted into fluid bag B. drip chamber – predicts fluid amount delivery C. roller clamp – controls the rate of flow D. injection ports – ensures sterility of the line
The following questions are about Monitoring of IV infusions and Complications.
12
Which of the following does not affect flow rate of an intravenous fluid? A. forearm position B. height of IV bottle C. infiltration D. temperature
13
Which of the following causes phlebitis? A. vein irritation from catheter B. chemical irritation from medicines C. infection from improper aseptic technique D. all of the above
14
Which of the following pairs of terminologies and its definition are mismatched? A. septicemia – systemic infection B. infiltration – leakage of IV solution into tissue C. extravasation – leakage of chemical to vein D. phlebitis – vein inflammation
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Item Clarity of Wording (Y or N)
Relevance to Dimension of Construct General Recommendation (Ret, Rev, Drop)
and Remarks
4 Relevant
3 Moderately
relevant
2 Somewhat
relevant
1 Not
relevant
15
What may happen when a foreign object is not removed in the IV tubing? A. circulatory overload B. pulmonary embolism C. speed shock D. pulmonary edema
16
Which of the following IV therapy complication may possibly lead to the other? I. air embolism II. circulatory overload III. speed shock IV. pulmonary congestion
A. I and II B. I and III C. II and IV D. III and IV
The following questions are about the Purposes of IVT.
17
Which of the following are the goals of parenteral fluid therapy? A. provide water, electrolytes and nutrients to meet daily requirements B. replace water and correct electrolyte deficits C. administer medications and blood products D. all of the above
The following questions are about Troubleshooting IVT Problems.
18
All of the following interventions should be done when there is infiltration except for? a. Elevate the affected extremity b. Discontinue IV infusion c. Apply cold compress d. None of the above
19
Which of the following should be done in case pulmonary edema occurs? a. Place the patient in a flat position b. Regulate the IV to keep vein open c. Discontinue the IV infusion d. Secure tourniquet above the venipuncture site
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Item Clarity of Wording (Y or N)
Relevance to Dimension of Construct General Recommendation (Ret, Rev, Drop)
and Remarks
4 Relevant
3 Moderately
relevant
2 Somewhat
relevant
1 Not
relevant
20
You are regulating the IV fluid of your patient when you notice that there was about 5mL of air trapped in the tubing. Which of the following statements can be done? a. Tap the tubing until the bubbles rise into the drip chamber b. Withdraw the air from the accessory port using a syringe c. Both a and b d. None of the above
21
You noticed that blood backed up at the IV tubing upon ambulation of the patient .What should be done? a. Increase the height of the pole during ambulation b. Elevate the extremity of the patient c. Discontinue the ongoing IV infusion d. Refer to the physician
PROBLEM SOLVING
The following problems are about IV Medications and Fluid Regulation Calculation.
1
What is the flow rate of an intravenous solution of 3 L infused in 24 hours? Express your answer in mL/h. (125mL/hr)
2
What is the flow rate if a liter of intravenous solution is to be infused in 8 hours using an administration set with drip factor of 20 drops/ml? Express in drops/min. (42drops/min)
3
An IV solution of 1000mL of D5W NaCl is to infuse over 8 hours. The IV set drop factor is 15 gtts/mL. How many drops per minute should the client receive? (31-32drops/min)
4
A 3 and a half year old male patient with a weight of 15kg is to be given 300 mg Cefuroxime. Does the dose ordered fall within the recommended range? Answer with yes or no. (Recommended
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Item Clarity of Wording (Y or N)
Relevance to Dimension of Construct General Recommendation (Ret, Rev, Drop)
and Remarks
4 Relevant
3 Moderately
relevant
2 Somewhat
relevant
1 Not
relevant
dose range for 2 to 12 years is 10 – 30mg/kg.) If yes, how many mL of the reconstituted solution should be withdrawn? (Preparation: Powder which when reconstituted with 1.8ml water for injection, gives a solution of 250mg in 2ml.) (Yes; 2.4mL)
5
A 4 month old infant with a weight of 6.5kg is to be given 7.5 mg Furosemide IV. Does the dose ordered fall within the recommended range? Answer with yes or no. (Recommended dose range age 1 month to 2 years is 1 – 2mg/kg bd) If yes, how many mL of the medication should be withdrawn? (Preparation: Ampoules containing 20mg in 2ml.) (Yes; 0.7mL)
TRUE OR FALSE
The following statements are about IV Medication Preparation
1 Hands washing should be performed before preparation of IV antibiotic solution. (True)
2
It is not necessary to check expiry date for a medication that is recently brought from the pharmacy. (False)
3 ‘cc’ or ‘ml’ is the dosage expression for insulin delivered via IV drip. (False)
4 Preparation of IV Hydrocortisone solution does not require hand hygiene (False)
5
Any reconstituted IV medications can still be used if it is less than 48 hours from the date of reconstitution or preparation. (False)
The following statements are about IV Medication Administration.
6
Patient’s armband and IV catheter should be inspected for phlebitis or extravasations during administration of IV cytotoxic drugs. (True)
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Item Clarity of Wording (Y or N)
Relevance to Dimension of Construct General Recommendation (Ret, Rev, Drop)
and Remarks
4 Relevant
3 Moderately
relevant
2 Somewhat
relevant
1 Not
relevant
7
Medication administered intramuscularly acts rapidly than if administered intravenously. (False)
8
KCl injection should be administered as slow bolus injection over 3 minutes during emergency such as ventricular fibrillation. (False)
9
IV Ceftriaxone can be administered simultaneously with solution containing Calcium Gluconate via a Y-site, at a slower rate of 5mg/min. (False)
10 Medications that are classified as High Alert Medication include Noradrenaline and Insulin. (True)
11
When an emergency happens such as hypocalcaemia tetany, 10% CaCl 210 ml should be administered in 1– 2 minutes. (False)
Thank you for taking time to review our IVT Knowledge Assessment Examination!
- The Researchers
Evaluated by: _______________________________________ Date: _____________________ Name of Evaluator-Expert over Signature
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INTRAVENOUS THERAPY ATTITUDES SURVEY
Instructions:Please review each item carefully, taking into consideration the highlighted dimensions of the construct “Intravenous Therapy Attitudes”. Rate the “Relevance” of each item to the specified dimension by checking the appropriate column: 5 for being a “for” the attitude statement, 3 for being a “neutral” statement towards the attitude, 1 for being an “against” for the attitude statement or 4 or 2 for moderate degrees of being “for” or “against” the attitude, respectively. For the last column “General Recommendation”, please indicate Ret to retain the item exactly as worded, Rev to make major/minor revisions to the item, or Drop to discard the item entirely from the pool. You may also write your Remarks about the item clarity, appropriateness, etc. in the same column.
Statements
Relevance to Dimension of Construct General Recommendation
(Ret, Rev, Drop) and Remarks
5 “For”
4 3
“Neutral” 2
1 “Against”
The following items will be rated by the subjects using a 5-step Likert Scale.
The following statements are about Learner Satisfaction.
1 The teaching methods used in teaching IV therapy skills are helpful
2 the class on IV therapy skills provides a variety of learning materials
3 I enjoy the format in which the class on IV therapy skills is offered
4 the teaching materials in the class on IV therapy skills motivate me to study on IV Therapy
5 the way IV therapy skills is taught is consistent with the way I like to learn
The following statements are about Self-efficacy, Self-reliance, and Self-esteem.
6 I am confident that I am developing the knowledge needed to become a competent health professional
7 I did well on the tests in this class on IV therapy skills
8 I know how to get help when I do not understand class material
9 I know how to use the class material effectively for learning the IV venipuncture content
10 I am able to perform intravenous therapy as well as most other student nurses
11 I take a positive attitude in performing intravenous therapy on patients.
12 I am satisfied with how I perform intravenous therapy.
The following statements are about Educational Practices and Learning Styles.
13 I am an active learner
14 I rely on feedbacks given to me
15 I like to collaborate with my classmates
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Statements
Relevance to Dimension of Construct General Recommendation
(Ret, Rev, Drop) and Remarks
5 “For”
4 3
“Neutral” 2
1 “Against”
during learning
16 I prefer more diverse ways of learning
17 The time dedicated on a task usually affects my performance
The following items are about Motivation.
18 I experience pleasure and satisfaction while learning new concepts.
19 The most satisfying thing for me in classes is trying to understand the content as thoroughly as possible.
20 I prefer course material that really challenges me so that I can learn new things.
21 When working on my goals, I put forth my best effort and work even harder if I’ve encountered a setback.
22 I tend to put my best effort so that I feel proud of my work.
23 I think I will be able to use what I learn in IV therapy in settings other than nursing.
24 It is important for me to learn IV therapy.
25 I am very interested in learning what IV therapy is all about.
26 I think it is useful for me to learn IV therapy.
27 Understanding IV therapy is very important to me.
Thank you for taking time to review our IVT Attitudes Survey!
- The Researchers
Evaluated by: _______________________________________ Date: _____________________ Name of Evaluator-Expert over Signature
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FOCUSED GROUP DISCUSSION GUIDE Instructions: Please review each item carefully. Write Y or N under the column “Clarity of Wording” to
describe the factor related to the item. Rate the “Relevance” of each item to the factor by checking the
appropriate column: 4 for relevant, 3 for moderately relevant, 2 for somewhat relevant or 1 for not
relevant. For the last column “General Recommendation”, please indicate Ret to retain the item exactly
as worded, Rev to make major/minor revisions to the item, or Drop to discard the item entirely from the
pool. You may also write your Remarks about the item clarity, appropriateness, etc. in the same column.
Item
Relevance to the Factor General Recommendation (Ret, Rev, Drop)
and Remarks
4 Relevant
3 Moderately
relevant
2 Somewhat
relevant
1 Not
relevant
The following items are about Instructional Characteristics.
1
INSTRUCTIONAL METHODS: What is your general impression or assessment to the instruction or teaching style employed in IV Therapy?
2 What methods were employed in teaching IV Therapy? Do you think they were effective? Why?
3 What do you best appreciate in these methods or styles?
4 OPPORTUNITY FOR PRACTICE: How were you able to practice IV Therapy?
5 Do you think it was sufficient? Why?
6 What are your perceived barriers and enabling opportunities in learning IV Therapy?
7 FEEDBACK: How was your performance on IV Therapy given feedback?
8 How did it help?
Thank you for taking time to review our Focused Group Discussion Guide!
- The Researchers
Evaluated by: _______________________________________ Date: _____________________ Name of Evaluator-Expert over Signature
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COMPREHENSIVE INTRAVENOUS THERAPY SKILLS OBSERVATION CHECKLIST Condensed Version with Skills on Setting-up IV Infusion, Preparing and Administering IV Medications,
Changing an ongoing IV Infusion, and Discontinuing an ongoing IV Infusion
* adapted from UPCN Clinical Skills Checklist
Name (optional): ___________________________________________ Control Number: ____________ Please check the column that best corresponds to the performance of the student in each of the following steps.
Steps Performed Not
Performed
SETTING-UP AN IV INFUSION
1 Verify doctor’s order. Make I.V. label (patient’s name, room number, solution, drug incorporation, bottle sequence and duration)
2 Explain procedure to patient and/or significant others. Secure consent if necessary.
3 Wash hands and maintain asepsis throughout the preparation and during the therapy.
4 Prepare necessary materials (IV tray with IV solution, administration set, IV cannula, antiseptic solution, cotton balls with alcohol, plaster, tourniquet, gloves, splint and IV stand.)
5 Check the sterility and integrity of the IV solution and IV set and other devices.
6 Place IV label on IV bottle.
7 Open the seal of the IV solution. Disinfect port with cotton balls with alcohol.
8 Open administration set aseptically (IV set). Close the clamp.
9 Spike the container aseptically.
10 Fill drip chamber to at least half and prime the tubing aseptically.
11 Remove air bubbles if any and put back the cover of the distal end of the IV tubing.
PREPARING AND ADMINISTERING IV MEDICATIONS Preparing IV Medications in Syringes
12 Countercheck medication card against the written doctor’s orders.
13
Observe 10 R's when preparing medication (selected “rights”*): Right Medication Right Client * other rights not selected because either they are incorporated in other steps (ex: right dose, right documentation, right assessment), or they are not applicable (ex: right time, right route, right client education, right to refuse, right evaluation)
14 Wash hands before and after the procedure.
15
Check for skin test of drug for IV push. Check for drug-drug and drug-IV fluid incompatibility. Check for dosage computations.
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Steps Performed Not
Performed
16 Prepare the necessary material for the procedure such as: right drug, right diluents needed IV injection tray, syringes, and needles.
Prepare the medications accordingly.
Administering via Injection Port
17 Check IV site (if infiltrated or out of vein; if there are signs of swelling, redness, phlebitis, do not give the drug).
18
Disinfect the Y-injection port of the IV administration set; pierce through the bull’s eyed rubber port.
Kink the tubing. Push IV drug slowly as ordered or as per manufacturer’s instructions.
19 Flush IV tubing after drug administration with IV fluid (aspirate IV fluid using same syringe and push IV fluid slowly).
Incorporating medications into Ongoing IV Fluid
20
Put down the bottle. Kink the tubing. Remove the administration set from the bottle aseptically. Disinfect the bottle’s rubber stopper: incorporate the right drug to the IVF bottle. Return the administration set to IVF bottle aseptically. Swirl bottle to mix the drug with the IVG and regulate the flow rate as ordered.
Administering via IV Push using Heplock port
21 Check IV site (if infiltrated or out of vein; if there are signs of swelling, redness, phlebitis, do not give the drug).
22 Fill a tuberculin syringe with Heparin solution. (0.1 cc heparin plus 0.9 cc normal saline)
23 Fill the 2 2.5 cc syringes with isotonic solution or normal saline 1 cc each.
24 Swab injection port with alcohol or iodophor swab. Insert saline syringe into port. Saline syringe is also used to check the patient of the infusion set. If so. Administer saline via IV Push.
25 Insert medication into injection port. Inject medication into the vein, timing the flow rate according to doctor’s order.
26 Insert the saline syringe and flush the line.
27 Insert heparin syringe; to prevent the formation of clot in the catheter
28 Remove syringe and return the cover of the injection port aseptically
Incorporating medications into Soluset and administering medications via Soluset
29 Check IV site (if infiltrated or out of vein; if there are signs of swelling, redness, phlebitis, do not give the drug)
30 Check present IV fluid label, level, and incorporated medicine in the soluset or IV bottle.
31
Add desired IVF diluent into soluset by opening the clamp on the bottle then close the clamp after.
Disinfect rubber injection port of the soluset. Incorporate the drug. Mix gently.
32 Open the clamp of the airway at the soluset.
33 Regulate flow rate of IVF infusion (if to run for 30 min or 1 hour).
34 Place IV label on soluset indicating drug administered.
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Steps Performed Not
Performed
After administering medications: 35 Dispose sharps and other waste according to HICU guidelines.
36 Document procedure in the patient’s chart.
CHANGING AN ONGOING IV INFUSION
37 Verify written doctor’s order. Countercheck IV label, bottle number or bottle sequence, type, amount, additives (if any), duration of infusion.
38 Explain the procedure to the patient. Assess the IV site for redness, swelling and pain.
39 Wash hands before and after procedure.
40 Prepare necessary materials (IV solution, IV label, disinfectant, IV tray).
41 Check the sterility and integrity of the IV.
42 Calibrate new IV bottle according to the duration of the infusion.
43 Open rubber port of IV solution to follow. Disinfect rubber port of IV solution.
44 Close the clamp or kink tubing. Spike the container aseptically.
45 Regulate the flow rate based on duration of infusion. Remove air bubbles (if any).
46 Discard all waste material according to HICU guidelines.
47 Document accordingly and endorse to incoming shift.
DISCONTINUING AN ONGOING IV INFUSION 48 Verify written doctor’s order to discontinue IV including IV medicines.
49 Assess and inform the patient of the order.
50 Prepare necessary materials: IV trays or injection tray, cotton balls with alcohol, plaster, antiseptic solution.
51 Wash hands before and after procedure.
52 Don gloves.
53 Close IV clamp of the IV tubing.
54 Moisten adhesive tapes around the IV catheter using cotton balls with alcohol. Remove plaster gently.
55 Get cotton ball with alcohol and without applying pressure remove IV cannula. Apply pressure using dry cotton ball or then apply plaster.
56 Inspect IV catheter for completeness.
57 Discard all waste material including the IV cannula according to HICU guidelines.
58 Document time or removal, status of insertion site and integrity of IV catheter and endorse to incoming shift.
Thank you for evaluating the subject! - The Researchers
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APPENDIX IV
Original UPCN Skills Laboratory Checklists Setting-up an Intravenous Infusion
Changing an ongoing Intravenous Infusion Discontinuing an ongoing Intravenous Infusion
Administering medications via IV Push using injection port Administering medications via IV Push using heplock port
Incorporating medications into Intravenous Fluid Incorporating medications into Soluset
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INTRAVENOUS THERAPY SKILLS OBSERVATION CHECKLIST Setting-up an Intravenous Infusion
Name (optional): ___________________________________________ Control Number: ____________ Please check the column that best corresponds to the performance of the student in each of the following steps.
Steps Performed Not Performed
1 Verify doctor’s order and make I.V. label
2
Explain procedure to patient and/or significant others and asses patient’s
vein; choose appropriate vein; location, size, condition, secure consent if
necessary.
3 Washes hands and maintains asepsis throughout the preparation and during
the therapy.
4
Prepare necessary materials (IV tray with IV solution, administration set, IV
cannula, antiseptic solution, cotton balls with alcohol, plaster, tourniquet,
gloves, splint and IV stand.)
5 Check the sterility and integrity of the IV solution and IV set and other
devices
6 Place IV label on IV bottle (patient’s name, room number, solution, drug
incorporation, bottle sequence and duration)
7 Open the seal of the IV solution and disinfect port with cotton balls with
alcohol
8 Open administration set aseptically (IV set) and close the clamp
9 Spike the container aseptically
10 Fill drip chamber to at least half and prime the tubing aseptically
11 Remove air bubbles if any and put back the cover of the distal end of the IV
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INTRAVENOUS THERAPY SKILLS OBSERVATION CHECKLIST Changing an ongoing Intravenous Infusion
Name (optional): ___________________________________________ Control Number: ____________ Please check the column that best corresponds to the performance of the student in each of the following steps.
Steps Performed Not Performed
1 Verify written doctor’s order; countercheck IV label, bottle number or bottle
sequence, type, amount, additives (if any), duration of infusion
2 Explain the procedure to the patient and asses the IV site for redness, swelling
and pain.
3 Wash hands before and after procedure
4 Prepare necessary materials (IV solution, IV label, disinfectant, IV tray)
5 Check the sterility and integrity of the IV
6 Calibrate new IV bottle according to the duration of the infusion
7 Open and disinfect rubber port of IV solution to follow
8 Close the clamp or kink tubing and spike the container aseptically
9 Regulate the flow rate based on duration of infusion. Remove air bubbles (if
any)
10 Discard all waste material according to HICU guidelines
11 Document accordingly and endorse to incoming shift
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INTRAVENOUS THERAPY SKILLS OBSERVATION CHECKLIST Discontinuing an ongoing Intravenous Infusion
Name (optional): ___________________________________________ Control Number: ____________ Please check the column that best corresponds to the performance of the student in each of the following steps.
Steps Performed Not Performed
1 Verify written doctor’s order to discontinue IV including IV medicines
2 Assess and inform the patient of the order.
3 Prepare necessary materials: IV trays or injection tray, cotton balls with alcohol,
plaster, antiseptic solution
4 Wash hands before and after procedure
5 Don gloves (optional)
6 Close IV clamp of the IV tubing
7 Moisten adhesive tapes around the IV catheter using cotton balls with alcohol.
Remove plaster gently.
8 Get cotton ball with alcohol and without applying pressure remove IV cannula
then apply pressure using dry cotton ball or dressing then apply plaster
9 Inspect IV catheter for completeness
10 Discard all waste material including the IV cannula according to HICU guidelines
11 Reassure patient.
12 Document time or removal, status of insertion site and integrity of IV catheter
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INTRAVENOUS THERAPY SKILLS OBSERVATION CHECKLIST Administering medications via IV Push using injection port
Name (optional): ___________________________________________ Control Number: ____________ Please check the column that best corresponds to the performance of the student in each of the following steps.
Steps Performed Not Performed
1 Countercheck medication card against the written doctor’s orders
2 Observe 10 Rs when preparing and administering medication
3 Explain procedure to patient ( the name of medicine and action interaction
of medication to patient care) before administering.
4 Wash hands before and after the procedure (use gloves especially for
chemotherapeutic drugs)
5 Check IV site (if infiltrated or out of vein; if there are signs of swelling,
redness, phlebitis, do not give the drug)
6 Check for skin test of drug for IV push, drug-drug, drug- IV fluid
incompatibility, dosage (computation)
7 Prepare the necessary material for the procedure such as: right drug, right
diluents needed IV injection tray, syringes, and needles.
8
Disinfect the injection port of the diluent (if in vial) and the drug. Aspirate
the right amount of diluents and dilute the drug (if the drug needs to be
diluted)
9
Aspirate the right drug dose, disinfect the Y-injection port of the IV
administration set; pierce through the bull’s eyed rubber port; kink the
tubing; push IV drug slowly as ordered or as per manufacturer’s instructions.
Observe precautionary measures during drug administration
10 Flush IV tubing after drug administration with IV fluid (aspirate IV fluid using
same syringe and push IV fluid slowly).
11 Regulate IV fluid infusion as ordered (if needed)
12 Discard sharps and other waste according to HICU guidelines
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INTRAVENOUS THERAPY SKILLS OBSERVATION CHECKLIST Administering medications via IV Push using heplock port
Name (optional): ___________________________________________ Control Number: ____________ Please check the column that best corresponds to the performance of the student in each of the following steps.
Steps Performed Not Performed
1 Counter check medication card against the written doctor’s order
2 Observe 10 Rs when preparing and administering medication
3 Explain procedure to patient ( the name of medicine and action interaction o
medication to patient care) before administration
4 Wash hands before and after the procedure ( use gloves especially for
chemotherapeutic drugs)
5 Gather equipment such as IV tray, Heparin solution, Normal saline diluents,
3 pieces 2.5 cc syringes
6 Prepare medication to be administered e.g. antibiotic, and draw it up into a
syringe
7 Fill a tuberculin syringe with Heparin solution. Heparin solution is usually
prepared with 0.1 cc heparin plus 0.9 cc normal saline
8 Fill the 2 2.5 cc syringes with isotonic solution or normal saline 1 cc each
9
Swab injection port with alcohol or iodophor swab. Insert saline syringe into
port. Take not: some drugs are incompatible with heparin. Saline syringe is
also used to check the patient of the infusion set. If so. Draw 2 syringes with
2 2.5 cc saline solution and use one syringe at a time.
10 Insert medication into injection port. Inject medication into the vein, timing
the flow rate according to doctor’s order or drug manufacturer’s instruction
11 Insert the saline syringe and flush the line
12 Observe patient for any adverse reactions
13 Insert heparin syringe; Rationale: Heparin should prevent the formation of
clot in the catheter
14 Remove syringe and return the cover of the injection port aseptically
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INTRAVENOUS THERAPY SKILLS OBSERVATION CHECKLIST Incorporating medications into Intravenous Fluid
Name (optional): ___________________________________________ Control Number: ____________ Please check the column that best corresponds to the performance of the student in each of the following steps.
Steps Performed Not Performed
1 Countercheck medication card against the written doctor’s orders
2 Observe 10 Rs when preparing and administering medication
3 Explain procedure to patient ( the name of medicine and action
interaction of medication to patient care) before administration
4 Wash hands before and after the procedure (use glove especially for
chemotherapeutic drugs.)
5 Check IV site ( if infiltrated or out of vein; if there are signs of welling,
redness, phlebitis , do not give the drug
6 Check for skin test of drug for IV push, drug-drug, drug- IV fluid
incompatibility, dosage (computation)
7 Prepare the necessary materials for the procedure such as: injection tray,
syringes needed right drug to be incorporated either vial or ampule
8 Disinfect injection port of the vial and aspirate the drug aseptically
9
Put down the bottle, kink the tubing remove. Remove the administration
set from the bottle aseptically. Disinfect the bottle’s rubber stopper:
incorporate the right drug to the IVF bottle; return the administration set
to IVF bottle aseptically; swirl bottle to mix the drug with the IVG and
regulate the flow rate as ordered
10 Observe and reassure the patient
11 Document in the patient’s chart
12 Disposed sharps and other waste according to HICU guidelines
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INTRAVENOUS THERAPY SKILLS OBSERVATION CHECKLIST Incorporating medications into Soluset
Name (optional): ___________________________________________ Control Number: ____________ Please check the column that best corresponds to the performance of the student in each of the following steps.
Steps Performed Not Performed
1 Countercheck medication card against the written doctor’s orders
2 Observe 10 Rs when preparing and administering medication
3 Explain procedure to patient ( the name of medicine and action
interaction of medication to patient care) before administration
4 Wash hands before and after the procedure (use glove especially for
chemotherapeutic drugs.)
5 Check IV site ( if infiltrated or out of vein; if there are signs of welling,
redness, phlebitis , do not give the drug
6 Check for skin test of drug for IV push, drug-drug, drug- IV fluid
incompatibility, dosage (computation)
7 Prepare the necessary material for the procedure such as: right drug,
right diluents needed IV injection tray, syringes, and needles.
8
Check present IV fluid label, level, and incorporated medicine in the
soluset or IV bottle. If with incorporate medicine, check for drug-drug
incompatibility. If the ongoing IV fluid in the soluset it is be consumed in
6-8 hours ask from the doctor and order for IVF to be used solely for
drug administration.
9
Aspirate prepared right drug with correct dose; add desired IVF diluent
into soluset by opening the clamp on the bottle then close the clamp
after, disinfect rubber injection port of the soluset and incorporate the
drug. Mix gently
10 Open the clamp o f the airway at the soluset
11 Regulate flow rate of IVF infusion ( if to run for 30 min) or 1 hour
12 Place IV label on soluset indicating drug administered
13 Document in patient’s chart the drug administered
14 If incorporated medicine is consumed, clamp airway of soluset; add IVF
and regulate flow rate of IVF as ordered. Remove IV labels from soluset
15 Document in patient’s chart and Kardex ( of changes in IV rate/time due)
Coverage and severity of IVT complications 1 item (#9)
Apply (37%)
Priority goal setting 1 item (# 1)
Guidelines for selecting veins Key concepts in starting IVT 2 items (#5, 6)
Interventions for infiltration Interventions for an air trapped in an IV tubing Actions on backflow of blood in IV tubing 3 items (# 11, 13, 14)
Synthesis (3%)
Complications of IVT 1 item (#12)
No. of items 1 3 2 7
Total time for test: 30 minutes
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CLASSIFICATION OF QUESTION
CONTENT AREAS Total
E. Purposes of IVT (3%)
F. Calculations (17%)
G. IV Medication Preparation (17%)
H. IV Medication Administration (20%)
Recall (10%)
Dosage expression 1 item: True or False (#3)
Examples of high alert medications 1 item True or False (#10)
3
Understand (30%)
Goals of parenteral fluid therapy 1 item (#10)
Importance of handwashing/hand hygiene Importance of checking expiry date 3 items True or False (#1, 2, 4)
Administration of cytotoxic drugs Comparison of IV & IM Infusion Rate Administration of CaCl 2 items True or False (#6, 7)
9
Analysis (20%)
Reconstituted IV medications 1 item True or False (# 5)
Use of slow bolus injection Administration: Y site Emergency IV drugs 3 items True or False(#8, 9, 11)
6
Apply (37%)
Flow Rate computation IV regulation Pedia Dose computation 5 items (Write answer on the blank) (#1-5)
11
Synthesis (3%)
1
No. of items 1 5 5 6 30
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OBJECTIVES OF NURSING FOUNDATIONS II COURSE FOCUSING ON INTRAVENOUS THERAPY
OBJECTIVES ITEMS
SKA Analysis of Professional Responsibilities: Assesses with client their conditions to identify existing and potential nursing problems (Skills) 1. Common manifestations of general physiologic problems/alterations in fluid and electrolyte balance 2. Factors related to problems/alterations in fluid and electrolyte balance Plans and Implements with clients appropriate nursing interventions for nursing diagnoses (Skills) 1. Implements planned interventions for individual client (other nursing interventions appropriate for general physiologic problems) (Knowledge) 1. Nursing interventions for meeting clients’ needs for fluid and electrolyte balance (specifically setting up IV systems, calculating/regulating flow of IVF/ terminating IV systems)
Test I: #1 Test I: #1-4, 10; Test II: #1-5; Test III: #1-11 Test I: #5-10; Test II: #1-5; Test III: #1-11 Test 1: #10; Test II: #1-5; Test III: #1-11
Professional Competencies; Terminal Competencies Given a client in stress/crisis situation with specific problems in fluid and electrolyte balance 1. Assesses the client’s problems (fluid and electrolyte balance) based on: - Physical Assessment 2. Implements planned interventions for individual client (other nursing interventions appropriate for general physiologic problems)
Test I: #1, 6-9 Test I: #5-10; Test II: #1-5; Test III: #1-11
Instruction Design Given relevant questions related to administration of medicine 1. Identifies the components of a legal medication order 2. Computes for the correct dosage of drug (IV) 3. Describes the steps in preparing the drug (IV) 4. Demonstrates administration of medication (IV) in terms of: - purpose - route and site of administration
Test II: #4-5 Test II: #1-4 Test III: #1-5 Test I: #1, 5-10; Test III: #6-11
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- standard procedure - precautions to be observed before, during and after Given simulated situations 1. Demonstrates the correct procedures of administering parenteral fluids/medications (including IV Therapy
and blood transfusions) Given a selected client with specific health needs in fluid and electrolytes 1. Takes a thorough physical assessment 2. Describes the general manifestations specific to fluids and electrolytes 3. Demonstrates the following procedures on fluids and electrolytes: - Calculating and regulating the flow of intravenous fluids - Preparing IV infusion set-up - Assisting in IV insertion - Starting and discontinuing IVF
Test I: #1-14; Test II: 1-5; Test III: #1-11 Test I: #1, 5, 10 Test I: #1 Test II: #1-5; Test III: #1-11
RECORDS AND REPORTS Given clinical records 1. Utilizes a record system to document patient data on appropriate forms and according to institutional policies (e.g. problem-oriented record): - therapeutic sheet - nurses’ notes
Found in skills checklist.
* Most objectives are also addressed using the skills checklist utilized in the study.
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APPENDIX VII
Data Tables from Validity and Reliability Testing Inter-rater Reliability for IVT Skills Observation Checklist
First Round of Content Validity IVT Knowledge and Attitudes Tools Second Round of Content Validity for IVT Knowledge and Attitudes Tools
Skill Retention and Level of Knowledge and Attitudes on Intravenous Therapy among Senior Nursing Students
* These steps had inter-rater reliability values less than 80%. These were clarified and discussed further with the raters.
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FIRST ROUND OF CONTENT VALIDITY (KNOWLEDGE TOOL)
ITEMS
RESULTS
CLARITY AVE
>80%? RELEVANCE
AVE RANKING RET REV DROP
MC: MULTIPLE CHOICE
1 0.66667 N 3.5 33 4 2 0
2 0.66667 N 3.166666667 43 4 2 0
3 0.83333 Y 3.666666667 17 5 0 1
4 0.66667 N 3.166666667 42 4 1 1
5 0.66667 N 2.833333333 48 3 2 1
6 0.83333 Y 3.333333333 39 4 2 0
7 0.83333 Y 3.333333333 39 5 1 0
8 1 Y 3.666666667 18 5 1 0
9 0.66667 N 3.2 38 4 2 0
10 1 Y 3.666666667 17 5 1 0
11 0.5 N 3.5 29 1 1 0
12 1 Y 3.833333333 5 6 0 0
13 0.83333 Y 3.833333333 6 5 1 0
14 0.5 N 2.833333333 40 2 1 2
15 0.83333 Y 3.166666667 34 4 2 0
16 0.5 N 3.166666667 34 3 2 1
17 1 Y 3.833333333 6 6 0 0
18 0.83333 Y 3.666666667 16 4 2 0
19 0.6 N 3 34 2 3 0
20 0.5 N 3.5 25 3 3 0
21 1 Y 3.5 25 2 2 0
22 1 Y 3.666666667 15 5 0 1
23 1 Y 3.833333333 6 6 0 0
24 0.83333 Y 3.5 24 5 0 1
25 1 Y 3.833333333 6 6 0 0
26 0.8 N 3.75 12 3 1 1
27 0.66667 N 3.4 25 4 2 0
28 1 Y 3 27 5 0 1
29 0.5 N 2.75 28 3 2 1
30 1 Y 4 1 6 0 0
31 0.83333 Y 3 26 5 0 1
PS: PROBLEM SOLVING
1 1 Y 4 1 6 0 0
2 1 Y 4 1 6 0 0
3 0.83333 Y 3.6 15 5 1 0
4 0.83333 Y 3.4 21 5 1 0
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ITEMS
RESULTS
CLARITY AVE
>80%? RELEVANCE
AVE RANKING RET REV DROP
5 0.66667 N 3.6 15 4 2 0
6 0.66667 N 3.6 15 4 2 0
7 0.83333 Y 3.833333333 3 5 1 0
8 0.5 N 3.8 6 3 3 0
9 0.5 N 3.8 6 3 3 0
TF: TRUE OR FALSE
1 0.83333 Y 3.833333333 3 5 1 0
2 0.83333 Y 3.833333333 3 4 1 1
3 0.83333 Y 3.666666667 5 5 0 1
4 1 Y 3.5 10 5 1 0
5 0.66667 N 3.666666667 5 4 2 0
6 1 Y 3.666666667 5 6 0 0
7 1 Y 3.5 8 6 0 0
8 0.83333 Y 3.6 7 4 1 0
9 1 Y 4 1 6 0 0
10 1 Y 3.666666667 4 6 0 0
11 1 Y 4 1 6 0 0
12 1 Y 3.666666667 3 6 0 0
13 1 Y 3.5 3 6 0 0
14 1 Y 3.833333333 1 6 0 0
15 1 Y 3.8 1 5 0 0
16 0.83333 Y 3.166666667 1 5 0 1
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FIRST ROUND OF CONTENT VALIDITY (ATTITUDES TOOL)
ITEMS RESULTS
RELEVANCE MEDIAN RESULT? RET REV DROP
LS: LEARNER SATISFACTION
1 4.5 FOR 6 0 0
2 4.5 FOR 5 0 2
3 4.5 FOR 5 0 1
4 4.5 FOR 6 0 2
5 5 FOR 5 0 1
SELF-PERCEPTION
6 5 FOR 5 0 0
7 5 FOR 6 0 0
8 3 NEUTRAL 3 0 3
9 4 FOR 5 0 1
10 4 FOR 3 0 0
11 4 FOR 4 0 1
12 3 NEUTRAL 1 0 3
13 1 AGAINST 2 0 0
14 3.5 NEUTRAL 3 0 2
15 4 FOR 4 0 1
16 5 FOR 5 0 1
17 5 FOR 5 0 0
EDUC: EDUCATIONAL PRACTICES AND LEARNING STYLES
18 5 FOR 6 0 0
19 4 FOR 5 0 1
20 3 NEUTRAL 2 0 2
21 4 FOR 5 0 1
22 3 NEUTRAL 3 0 4
23 5 FOR 5 0 0
24 4.5 FOR 5 0 0
MOTIV: MOTIVATION
25 4.5 FOR 4 0 0
26 4 FOR 4 0 0
27 4 FOR 5 0 1
28 5 FOR 5 0 0
29 5 FOR 5 0 0
30 5 FOR 4 0 0
31 5 FOR 6 0 0
32 5 FOR 6 0 0
33 5 FOR 6 0 0
34 3.5 NEUTRAL 5 0 2
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ITEMS RESULTS
RELEVANCE MEDIAN RESULT? RET REV DROP
35 5 FOR 5 0 1
36 3 NEUTRAL 4 0 3
37 3 NEUTRAL 3 0 2
RANK: RANKING ACCORDING TO IMPORTANCE
1 5 FOR 3 0 0
2 5 FOR 3 0 1
3 5 FOR 3 0 1
4 4 FOR 3 0 0
5 4 FOR 3 0 1
6 4 FOR 3 0 1
7 5 FOR 3 0 0
LEARN: MODE OR STYLE OF LEARNING
1 5 FOR 1 0 0
2 5 FOR 1 0 0
3 5 FOR 1 0 0
4 5 FOR 1 0 0
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SECOND ROUND OF CONTENT VALIDATION (KNOWLEDGE TOOL)
ITEMS
RESULTS
CLARITY AVE
>80%? RELEVANCE
AVE RET REV DROP
MC: MULTIPLE CHOICE
1 * 1 Y 3.857142857 6 1 0
2 * 1 Y 4 7 0 0
3 0.71429 N 4 5 2 0
4 1 Y 4 6 1 0
5 * 0.85714 Y 4 6 1 0
6 0.85714 Y 4 6 1 0
7 1 Y 4 7 0 0
8 0.85714 Y 4 6 1 0
9 0.85714 Y 4 6 1 0
10 * 0.85714 Y 3.571428571 6 1 0
11 * 0.85714 Y 3.857142857 5 2 0
12 * 1 Y 4 6 1 0
13 1 Y 4 6 1 0
14 * 1 Y 4 6 1 0
15 1 Y 4 7 0 0
16 0.85714 Y 3.857142857 6 1 0
17 1 Y 3.714285714 6 1 0
18 0.85714 Y 4 6 1 0
19 1 Y 4 6 0 1
20 1 Y 4 6 1 0
21 0.85714 Y 4 6 1 0
PS: PROBLEM SOLVING
1 1 Y 4 7 0 0
2 1 Y 4 7 0 0
3 1 Y 4 7 0 0
4 1 Y 4 7 0 0
5 1 Y 4 7 0 0
TRUE OR FALSE
1 1 Y 4 6 1 0
2 0.85714 Y 4 6 1 0
3 1 Y 4 6 1 0
4 1 Y 3.714285714 6 0 1
5 1 Y 4 7 0 0
6 0.85714 Y 4 6 1 0
7 1 Y 4 7 0 0
8 1 Y 4 7 0 0
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ITEMS
RESULTS
CLARITY AVE
>80%? RELEVANCE
AVE RET REV DROP
9 1 Y 4 7 0 0
10 1 Y 4 7 0 0
11 0.85714 Y 4 6 1 0
* These items were omitted from the final IVT knowledge assessment examination administered to the subjects on the bases of their relevance average rating and the number of experts suggesting to drop these items. ** The relevance average of each item was ranked and the top of 14 multiple choice items, top 5 problem solving items, and top 11 true or false items were taken and was included in the final IVT Knowledge Assessment Exam. The average Content Validity Index for the tool was 0.978
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SECOND ROUND OF CONTENT VALIDATION (ATTITUDES TOOL)
ITEMS RESULTS
RELEVANCE MEDIAN
RESULT? RET REV DROP
LS: LEARNER SATISFACTION
1 5 FOR 7 0 0
2 5 FOR 7 0 0
3 5 FOR 7 0 0
4 5 FOR 6 1 0
5 5 FOR 7 0 0
SELF-: SELF-ESTEEM, SELF RELIANCE, SELF-EFFICACY
6 ** 5 FOR 7 0 0
7 5 FOR 7 0 0
8 * 5 FOR 7 0 0
9 * 5 FOR 6 1 0
10 * 5 FOR 7 0 0
11 5 FOR 6 0 1
12 5 FOR 7 0 0
EDUC: EDUCATIONAL PRACTICES AND LEARNING STYLES
13 5 FOR 7 0 0
14 5 FOR 6 0 1
15 5 FOR 7 0 0
16 5 FOR 7 0 0
17 5 FOR 7 0 0
MOTIV: MOTIVATION
18 * 5 FOR 6 1 0
19 * 5 FOR 7 0 0
20 * 5 FOR 7 0 0
21 5 FOR 7 0 0
22 5 FOR 7 0 0
23 * 5 FOR 6 0 1
24 5 FOR 7 0 0
25 5 FOR 7 0 0
26 5 FOR 7 0 0
27 * 5 FOR 7 0 0
* These items were omitted from the final IVT attitudes survey administered to the subjects on the bases of their relevance rating and the number of experts suggesting to drop these items. ** This item was re-used to become another item by revising the statement from knowledge to “practical skills”. ***The top 5 items for each domain were taken to be part of the final IVT Attitudes Survey. The average Content Validity Index for the tool was 0.973
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APPENDIX VIII
Data Tables and Statistical Printouts from Pre-testing Socio-demographic Profile of Subjects
Results of IVT Skills Observation Results of IVT Knowledge Assessment
Results of Attitudes Survey Statistical Printout of the Computation of T-test of paired means
Statistical Printout of the Computation of T-test of independent means
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SOCIO-DEMOGRAPHIC PROFILE OF SUBJECTS
NO.
Sex (1-male;
2- female) Age GWA
N11 Skills Score
(over 25)
Year Entered UPCN
Status (1-regular;
2- irregular)
1 1 20 2.00 23 2009 1
2 1 21 2.10 23 2009 1
3 2 20 1.99 24 2009 1
4 2 19 2.34 24 2009 1
5 2 20 1.75 23 2009 1
6 1 20 1.91 23 2009 1
7 1 20 1.97 21 2009 1
8 2 20 2.00 23 2009 1
9 1 21 2.00 22 2009 1
10 2 20 1.88 23 2009 1
Skill Retention and Level of Knowledge and Attitudes on Intravenous Therapy among Senior Nursing Students