Nurses' clinical reasoning concerning management of peripheral venous cannulae

• 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.

• Studien syftar till att beskriva sjuksköterskors kliniska resonemang vid skötsel av perifer venkateter. varje dag fattar sjuksköterskor en mängd beslut, bland annat om skötsel av PVK. En vanlig komplikation till PVK är tromboflebit, även om det också kan förekomma allvarligare komplikationer. Det finns kliniska riktlinjer om skötsel av PVK men dessa följs inte alltid. Tidigare studier om skötsel av PVK har inte genomförts i naturlig miljö. Därför designades en studie med kvalitativ metos som kombinerar observationer med intervjuer. Deltagande observation underlättade efterföljande öppna intervjuer om observationen, liksom de semistrukturerade intervjuerna om skötsel av PVK. texten analyserades med innehållsanalys. resultatet redovisas i tre huvudkategorier och ett tema. Temat visar att sjuksköterskorna balanserar mellan att minimera obehag för patienten och förebygga komplikationer från PVKn. Patientens välbefinnande övervägdes varje gång, även om det skedde med olika utgångspunkter t ex i form av den individuella patientsituationen, egen arbetsbelastning och egna erfarenheter av PVKskötsel. Denna typ av kunskap kan vara värdefull vid implementering av kliniska riktlinjer och också vid utbildning av sjuksköterskor.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Hälsovetenskap -- Omvårdnad (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Health Sciences -- Nursing (hsv//eng)

Nyckelord

cannulation

clinical reasoning

decision-making

nursing

decision-making

qualitative research

intravenous lines

critical-care

guidelines

adherence

catheters

Publikations- och innehållstyp

ref (ämneskategori)

art (ämneskategori)