NRES

THE EXTENT OF KNOWLEDGE AND PARTICIPATION OF THE

STAFF NURSES ON THE VISUAL INFUSION PHLEBITIS PROGRAM OF

SAINT ANTHONY COLLEGE HOSPITAL

THE EXTENT OF KNOWLEDGE AND PARTICIPATION OF THE

STAFF NURSES ON THE VISUAL INFUSION PHLEBITIS PROGRAM OF

SAINT ANTHONY COLLEGE HOSPITAL

CHAPTER 1THE PROBLEM AND ITS BACKGROUNDTHE PROBLEM AND ITS BACKGROUND

Statement Statement of the of the

ProblemProblem

The main concern of this study is to determine the extent of knowledge and participation of the staff nurses towards visual infusion phlebitis at Saint. Anthony College Hospital during the year 2012.

Specifically, this Specifically, this study will seek to study will seek to

answer the following answer the following questions:questions:

1. What is the demographic profile of the staff nurses of St. Anthony Hospital in terms of age, sex, highest educational attainment, length of service, and position?

2. What is Visual Infusion Phlebitis Program?

3. What is the extent of knowledge of the staff nurses towards visual infusion phlebitis program?

4. What is the extent of participation of the staff nurses towards visual infusion phlebitis program?

5. Is there a significant difference in the extent of knowledge of the staff nurses towards visual infusion phlebitis program when grouped according to age, sex, highest educational attainment, length of service, and position?

6. Is there a significant difference in the extent of participation of the staff nurses towards visual infusion phlebitis program when grouped according to age, sex, highest educational attainment, length of service, and position?

7. Is there a significant relationship between the extent of knowledge and extent of participation of the staff nurses towards the visual infusion phlebitis program?

Hypotheses of the Study

A hypothesis is a specific statement of prediction. It describes in concrete (rather than theoretical) terms what you expect will happen in your study. Not all studies have hypotheses.

Sometimes a study is designed to be exploratory. There is no formal hypothesis, and perhaps the purpose of the study is to explore some area more thoroughly in order to develop some specific hypothesis or prediction that can be tested in future research.

A single study may have one

or many hypotheses.

1. There is no significant difference in the extent of knowledge of the staff nurses towards visual infusion phlebitis when grouped according to age, sex, highest educational attainment, length of service, and position.

2. There is no significant difference in the extent of participation of the staff nurses towards visual infusion phlebitis when grouped according to age, sex, highest educational attainment, length of service, and position.

3. There is no significant relationship between the extent of knowledge and extent of participation of the staff nurses towards the visual infusion program?

CHAPTER 2REVIEW OF RELATED

LITERATURE AND STUDIESREVIEW OF RELATED

LITERATURE AND STUDIES

This chapter consists of information culled from related legal basis, literature, studies and synthesis, from which this particular study is premised.  This will certainly help in giving the reader a better understanding of what visual infusion phlebitis program is.

Related Legal Basis

Good infection prevention and control are essential to ensure that people who use health and social care services receive safe and effective care. Effective prevention and control of infection must be part of everyday practice and be applied consistently by everyone.

Good management and organisational processes are crucial to make sure that high standards of infection prevention and control are developed and maintained.

This document sets out the Code of Practice on the prevention and control of infections, under The Health and Social Care Act 2008. It will apply to registered providers of all healthcare and adult social care in England. The Code of Practice (Part 2) sets out the 10 criteria against which the Care Quality Commission (CQC) will judge a registered provider on how it complies with the cleanliness and infection control requirement, which is set out in regulations.

1 Not all criteria will apply to every regulated activity but to ensure that consistently high levels of infection prevention and control are developed and maintained, it is essential that all providers of health and social care read and consider the whole document and not just selective parts.

1 Not all criteria will apply to every regulated activity but to ensure that consistently high levels of infection prevention and control are developed and maintained, it is essential that all providers of health and social care read and consider the whole document and not just selective parts.

Parts 3 and 4 of this document will help registered providers interpret the criteria and develop their own risk assessments. The appendices provide examples of how a proportionate approach could be applied to the criteria in all sectors and it is important to read the examples given in the appendices, alongside the guidance under each criterion in Part 3 of this document. The bibliography lists a range of supporting national guidance.

Parts 3 and 4 of this document will help registered providers interpret the criteria and develop their own risk assessments. The appendices provide examples of how a proportionate approach could be applied to the criteria in all sectors and it is important to read the examples given in the appendices, alongside the guidance under each criterion in Part 3 of this document. The bibliography lists a range of supporting national guidance.

Synthesis of the Study

Of 300 patients, 145 (48.3%) were male and 155 (51.7%) were female. Mean (± standard deviation) age of patients was 51.8 (± 22.5) years. 56.3% were younger than 60 years old. Catheters were inserted for reasons such as administration of fluids, intravenous drugs and blood products.

Catheter gauge size was 20 in 190 patients, 18 in 109 patients, and 22 in one patient. 287catheters were inserted in the upper extremities and 13in the lower extremities. Catheter insertion was urgent in 140 patients and elective in 160 patients. Phlebitis occurred in 26% (95% CI 21–31).

There was no significant relationship between age, size of catheter, trauma and phlebitis (Table Ι). The incidence of phlebitis in females and males was 31% and 20.7%, respectively. 57.7% of diabetic patients and 7.4% of non-diabetics developed phlebitis. Independent risk factors associated with phlebitis were gender, site and type of catheter insertion, diabetes mellitus, infectious diseases and burns.

The control group and 33 in the case group were included in the evaluation. Twelve patients in the control group out of 48 (25%) and 11 out of the 44 (25%)patients in the case group were excluded because their IV cannula were removed in less than 24 hours or the patients were discharged before the investigator was able to assess the IV site.

. Subject characteristics for both groups were similar with respect to sex although there in terms of age, there were more subjects in the 1 to 12 months age group among the control. For both control and case group, the locations of the IV insertions had almost similar distribution and most were done in the hand. Final result had shown that 8 out of the 36 (22%) subjects in the control group developed phlebitis as compared to the case group in whom 4 out of the 33 (12%) subjects had phlebitis.

Dwell time, The average dwell time for subjects in the control group is 62.9 hours (SD 30.3 hours) as compared to the case group with average dwell time of 62.8 hours (SD 30.4). If subjects whom IV cannula were electively removed or those whom cannulation where removed because they were no longer need for were excluded,the average dwell time became 62.7 hours (SD 29.9) forthe control and 65 hours (SD 27.6) for the case group.

Of the total of 12 patients who had phlebitis, 5 had their cannula in place for 24-48 hours, 3 of them for 49-72 hours, 2 for 73-96 hours while 2 had their cannula in place for 145-168 hours. Of the 12 patients in the control group who developed phlebitis, 8 were given IV fluids while 4 had heparin lock.

Eight were given IV antibiotics while 3 were given blood products. There could be several attempts in IV insertion in a subject and a cannula could be used several times by the intern or the residents before a successful cannulation. Majority of IV insertion fortunately was successful on first . Seven out of 51 of those who developed phlebitis had the IV cannula used only once in an attempt.

There were 2 subjects whose cannula was used 4 times but did not developed phlebitis. Type of Personnel performing the cannulation, in PGH pediatric wards and emergency room, the interns were the first in line who should perform the IV insertion, thus 70% (36/53) of the IV insertion were performed by the interns while the rest were done by the residents. Seven out of the 36 insertions done by the interns developed phlebitis while 4 out of the 18 insertions done by the residents had phlebitis.

CHAPTER IIIRESEARCH DESIGN

AND METHODOLOGYRESEARCH DESIGN

AND METHODOLOGY

This chapter deals with the research design, research locale, respondents of the study, research instruments, validity of the questionnaire, reliability of the questionnaire, statistical analysis of data, statistical tool.

Research Design

The Descriptive research design will be employed in this study. According to David (2005), this particular design is appropriate for collecting descriptive information about a population or subjects of the study. According to Travers (1984), this research design describes the present existing conditions. It involves the collection of data in order to test hypotheses or to answer questions concerning the current status of the subjects under study.

This research design is deemed appropriate for this particular study because the main concern was to determine the extent of knowledge and participation of the staff nurses towards visual infusion phlebitis at St. Anthony College Hospital.

Research Locale

The study was conducted at Saint Anthony College (Hospital) at San Roque Ext., Roxas City, Capiz, Philippines. The study covered 171 staff nurses as respondents during the year 2012-2013. 

Respondents of the Study

This study will utilize 171 staff nurses of St. Anthony College Hospital as respondents. This is a population study.

The distribution of the staff nurses-respondents is presented in table 1.

Ward Population Percent

Immaculate Heart Of Mary 18 10.52

St. Catherine Laboure 13 7.5

Rosalie Rendu 1313 7.57.5

Surgical 77 4.094.09

Service 77 4.094.09

St. Joseph 1313 7.57.5

Mother Baby Friendly 44 2.332.33

Nino De Praga 88 4.674.67

Medical 1313 7.57.5

Emergency Room 1212 7.017.01

Intensive Care Unit 2424 14.0314.03

Operating Room /Delivery Room 2020 11.611.6

Neonatal Intensive Care Unit 99 5.265.26

Dialysis 44 2.332.33

Dots 11 0.580.58

Opd 11 0.580.58

Floater 44 2.332.33

Special Care 11 0.580.58

TOTAL 171171 100%100%

Table 1.Respondents of the Study

Research Instrument

The data needed for the study will be gathered with the use of the Self-administered nurse-respondents questionnaire. The questionnaire for the respondents will be made up of three parts.

Part I is on the demographic profile of the respondents, part II is on the extent of knowledge of the staff nurses towards visual infusion phlebitis, and part III is on the extent of participation of the staff nurses towards visual infusion phlebitis. The part II and III of the questionnaire will be made up of 25 statements each.

The research instrument will be subjected to the content validity and reliability testing. This will be subjected to pivotal or trial run to thirty (30) staff nurses of Capiz Doctor’s Hospital to check flaws in the items and in the instructions. The pretest respondents will not be included in the actual survey.

Validity of the Questionnaire

The questionnaire will be subjected to face validation zeroing on its content. The validators are members of the faculty of Saint Anthony College of Roxas City who are considered experts. 

Reliability of the Questionnaire

To test the reliability of the questionnaire, this will be subjected to a pre-test. It will be administered to thirty (30) staff nurses of Capiz Doctor’s Hospital who will be chosen at convenience and will not participate in the actual survey. Only thirty (30) staff nurses will be used in the reliability testing because according to Garrett, this number is adequate enough.

Data from the pre-test will be tabulated and the reliability coefficient will be computed using the split-half method. The items in every part of the questionnaire will be split into odd and even numbers. The results of the odd-numbered items are correlated with that of the even-numbered items.

The Spearman Rank The Spearman Rank Correlation Coefficient Correlation Coefficient will be used to determine will be used to determine the reliability coefficient the reliability coefficient of one half of the of one half of the questionnaire: (Downie, questionnaire: (Downie, 1984)1984)

= 1-6 ΣD2

N (N2-1)

Where: =

ΣD2 = sum of the squares of the differenceN = number of paired scorer

Is the reliability coefficient of

one-half of the questionnaire

To get the reliability coefficient of the whole questionnaire, the Spearman Brown Prophecy formula will be used: (Garrett, 1971)

2 r ½ 1/11

1 + r ½ 1/11rll =

Where:

½ 1/11 = reliability coefficient of one-half of the

questionnaire

rll = reliability coefficient of the whole

questionnairer

As recommended by our statistician, to counter-check the reliability of the questionnaire, the reliability coefficient will again be computed using the Cronbach Alpha. Cronbach Alpha measures how well a set of items or variables measures a single unidimensional latent construct.

When data have a multidimensional structure, Cronbach Alpha is usually low. Technically, Cronbach Alpha is a coefficient of reliability or consistency. (SPSS FAQ, http://www.ats.ucla.edu/stat/spss/modules/default.htm).

Cronbach Alpha can be written as a function of the number of test items and the average inter-correlation among the items:

N . r

1 + ( N – 1 ) . ra =

Where:

N = number of items

r = average inter-item correlation among the items.

According to Milton Smith, a reliability coefficient of 0.80 or more but not more than 1.0 is

necessary for the whole questionnaire to be reliable.

Statistical Statistical Analysis of Analysis of

DataData

The data gathered will be processed manually because its bulk is manually manageable. To facilitate analysis, the raw data will be scored using the following scoring guide as basis:

The items in the instrument on the extent of knowledge and participation of the staff nurses towards visual infusion phlebitis will be scored as follows:

Extent of Knowledge:

Response Category

PositiveItem

NegativeItem

ScoreInterval

VerbalInterpretation

Strongly agree5.00

5 1 4.45 – Very Knowledgeable

Agree4.44

4 2 3.45 – Knowledgeable

Uncertain3.44

3 3 2.45 – Moderately Knowledgeable

Disagree2.44

2 4 1.45 – Least Knowledgeable

Strongly Disagree 1 5 1.0 – 1.44 NotKnowledgeable

Extent of Participation:

Response Positive Negative Score Verbal

Category Item Item Interval Interpretation

Strongly agree 5 1 4.45 – 5.00 Very

Knowledgeable

Agree 4 2 3.45 – 4.44 Knowledgeable

Uncertain 3 3 2.45 – 3.44 Moderately

Knowledgeable

Disagree 2 4 1.45 – 2.44 Least

Knowledgeable

Strongly

Disagree1 5 1.0 – 1.44 Not

Knowledgeable

Statistical Tools

The gathered data will be analyzed with the use of the following statistical tools: frequency count, mean, percentage, t-test, F-test, and pearson product-moment correlation coefficient.

The researchers will use the frequency count and the mean to know the extent of knowledge and participation of the staff nurses towards visual infusion phlebitis. The mean formula is: (Downie, 1984)

XNX =

Where:

X = is is the meanX = sum sum of scoresN= number number of respondents

To find out whether or not there is a significant difference in the extent of knowledge and participation of the staff nurses towards visual infusion phlebitis when grouped according to sex, the t-test will be used. The formula is: (Downie, 1984)

t = X1 - X2

S.E.D.X

Where:t = is the t-valueX1 1 = mean mean of the first

variableX2 2 = meanmean of the

secondvariableS.E.D.X = standard standard error of

the difference between raw means

To determine whether or not there is significant difference in the extent of knowledge and participation of the staff nurses towards visual infusion phlebitis when grouped according to age, highest educational attainment, length of service, and position, the F-test will be used. The formula is: (Downie, 1984)

Mean square between

Mean square withinF=

To determine the significant relationship between the extent of knowledge and extent of participation of the staff nurses towards the visual infusion program, the researchers used the Pearson Product – Moment Correlation Coefficient. The formula is: (Downie, 1984)

r =S1

2 + S22 - Sd

2

2 √ S12 √ S2

2

where :

r -

Pearson - r valueS1

2 = variance of the first variable

S22= variance of the second variable

Sd2 = variance of the difference

between two variables

Result of the computation will be interpreted using the following scales with their corresponding Interpretations:

0.00 to + 0.20 denotes indifferent or negligible relationship;+ 0.20 to + 0.40 denotes low relationship presents but slight;+ 0.40 to + 0.70 denotes marked or substantial relationship;+ 0.70 to + 1.00 denotes high to very high relationship.

The significance of the relationship will be determined by comparing the computed value of “ “ with the tabular value of ” “ for N-2 degrees of freedom and 5 percent level of significance.

The significance of the relationship will be determined by comparing the computed value of “ “ with the tabular value of ” “ for N-2 degrees of freedom and 5 percent level of significance.

r r

END….

By:

ARIENNE A. ASTROLOGIA

DISYME D. AZURES

AERIEL FAYE V.

BERGANTINOS

WINGIE D. BUDAY