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- Johansson, Maria Eiman, et al.
(author)
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Nurses' clinical reasoning concerning management of peripheral venous cannulae
- 2009
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In: Journal of Clinical Nursing. - : Blackwell. - 0962-1067 .- 1365-2702. ; 18:23, s. 3366-3375
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Journal article (peer-reviewed)abstract
- The aim was to describe nurses´clinical reasoning regarding peripheral venous cannulae management by focusing on the clinical information and circumstances considered during the decision-making process. On every shift nurses make several decisions, among others concerning the management of peripheral venous cannuae. Thrombophlebitis is a common complication associated with its use, although more severe complications can arise. There are clinical practice guidelines within the area, but they are not always adhered to. Previous studies have examined decisions related to the management of peripheral venous cannulae, but did not include observations in a naturalistic setting. A qualitative study combining observations and interviews was designed. Methods: Participant observation facilitated open interviews about the clinical reasoning behind decision-making in observed situations, as well as semi-structured interviews regarding clinical reasoning about the general management of peripheral venouscannulae. transcribed interview texts were analysed with content analysis. Three main categories describe clinical information and circumstances: the individual patient situation, the nurse´s work situation and experience of peripheral venous cannulae management. The overall theme of the interview texts was that the clinical reasoning was a balancing act between minimising patient discomfort and preventing complications from the peripheral venous cannulae. Conclusion: At all times the patients´well-being was considered, but the ways the nurses approached this differed depending on how they considered clinical information in the individual patient situation, circumstances in their own work situation and their experience of peripheral venous cannulae management. Relevance toclinical practice: Knowledge of the clinical information and circumstances considered in naturalistic settings, is valuable when implementing and adjusting clinical practice guidelines to local settings. This knowledge is also useful in nursing education as student nurses´and nurses´ability tobalance between preventing complications and avoiding discomfort is important for enhancing patient care.
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| 2. |
- Johansson, Maria Eiman, et al.
(author)
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Registered Nurses´Adherence to Clinical Guidelines Regarding Peripheral Venous Catheters : A Structured Observational Study
- 2008
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In: Worldviews on Evidence-Based Nursing. - : Blackwell. - 1545-102X .- 1741-6787. ; 5:3, s. 148-159
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Journal article (peer-reviewed)abstract
- peripheral catheterization is a common procedure, which affects numerous patients in health care today. having peripheral venous catheters in situ might lead to complications such as thrombophlebitis and sepsis, and clinical guidelines have been developed to assist nurses in their decisionmaking. Several reasons are given for clinicians not always adhering to clinical guidelines, although such adherence might lead to fewer complications. This papaer aims to describe registered nurses´adherence to national and local guidelines on peripheral venous catheters by focusing on time in situ, site, size, and documentation at the dressing. An additional aim is to describe the thrombophlebitis frequency associated with peripheral venous catheters in situ. Structured observational study of patients with peripheral venous catheters in situ, conducted from December 2004 to June 2005. data of 343 peripheral venous catheters were analyzed. Nurses partly adhered to national and local guidelines concerning size and site. Guideline adherence concerning documentation at the dressing was low. The results showed that non-adherence pertaining to time in situ varied between 5% and 26.3%. Differences between adherence to national or local guidelines were shown for size, site, and documentation at the dressing. Mild thrombophlebitis (Grades 1 and 2) was observed in 7.0%. Nurses partly adhered to clinical guidelines. Differences in guideline adherence were observed for wards with local or national guigelines, as well as for wards with different specialities. In accordance with clinical guidelines, the nurses seemed to replace or remove peripheral venous catheters before any severe complications arose. Adherence to clinical guidelines has an impact for preventing patient complications and thus it is essential that nurses are aware of their existence. Feedback and discussions of guideline adherence or of complication rates might influence nurses´clinical decision-making.
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