Effectiveness of an Educational program on Nurses' Knowledge Regarding Care of Central Venous Catheter in AL-Nasiriyah cardiac center
Huda Alwan Khudair1 and Khalida Mohammed Khadur 2
1MSc Student, University of Baghdad, Collage of Nursing, Adult Nursing Department, and Academic Nurse in University of Misan, College of Nursing, Iraq ,Email
2 professor PhD, University of Baghdad, College of Nursing, Adult Nursing Department, Baghdad City, Iraq. ,Email: [email protected]
Abstract
A quasi experimental study design (study and control group) carried out through the period of 2020- 2021 to assess effectiveness of an educational program on nurses' knowledge regarding care of central venous catheter. The study carried out in in Al-Nasiriyah cardiac center in Al-Nasiriyah city, Iraq, sixty nurses (30 nurses in study group and 30 nurses in control group) in intensive care unit (ICU) and surgical ward were chosen by using of non-probability (purposive sample). The data were collected through three periods (pretest, posttest1 after one week of the implementation of educational program and posttest2 after two week of the implementation of educational program). The instrument reliable by using of coefficient reliability and valid by the panel of experts. The data analyzed by use of descriptive and inferential statistical data analysis. The study findings indicated that the nurses sample at age (≤ 25) years, most of participants were female, graduated from college of nursing for study group and nursing institute for control group, they had (1-5)years of experience in nursing and cardiac center, and they did notparticipants in training courses. nurses had low level of knowledge at pretest in both group more than three quarters of the participants in the study group 23(76.7%), and vast majority in control group 28(93.3%), with mean (0.29), and (0.26) respectively, at posttest1 mean score is (0.84) for study group and (0.26) in control group, at posttest2 the mean score of knowledge for study group was (0.85), while mean score of knowledge in control group was (0.29). The study concluded that the educational program has an effectiveness in improve the nurses’ knowledge regarding care of central venous catheter. The study recommended conducting research related to central venous catheter care in oncology and dialysis centers, and Providing an Arabic booklet on central venous catheter care to motivate nurses to develop and refine their knowledge.
Keywords: nurses’ Knowledge,care of central venous catheter.
1. Introduction
Central venous catheters (CVCs) are catheters which are positioned in a broad vein and may be inserting in the veins of the neck (the internal jugular vein), the chest (the subclavian vein), the groin (the
femoral vein) or the veins of the arms (Basilic, brachial, and cephalic veins). It is also referred to as a central venous line, central line or central venous access device (CVADs) (Ahmad, khan, & Beg, 2016; Gowhar, Manzoor, Jabeen, 2018; McKean, Ross, Dressler, Brotman, & Ginsburg, 2012).
CVCsare instruments that are implanted into the body via a vein to allow fluids, blood products, drugs, and other treatments to be delivered to the bloodstream. CVCs may be placed into the subclavian or jugular vein (implanted ports, and tunneled catheters) or into one of the upper extremity's peripheral veins, it is referred as (peripherally inserted central catheter (PICC)) (Ho, & Spry, 2017).
For several weeks, months, even years, some kinds of CVCs can remain. Furthermore, as long as the patient receives medication and so patients do not need to be tingling with a needle each time, which can effective to relive patients ' pain (Pesonen, 2017 as a cited in ElsadeqKhadrawi, 2019). Central line-associated blood stream infections (CLABSIs) are most common hospital acquired infections with record mortality of (12- 25%) the use of antibiotics and a strict aseptic procedure will minimize the rate of infection considerably (John, 2016).
Inadequate nursing awareness of routine CVCs treatment and maintenance is lead to poor patient outcomes, such as increased complications rates (e.g. CLABSIs and occlusions), increased morbidity and mortality, and prolonged hospital stay (Paquet, Boucher, Valenti, & Lindsay, 2017).
After the catheter is implanted, the nurse is responsible for CVCs care. Proper care provided by the nurse also effects on the rate of development of infections and other catheter-related complications (Aydoğdu,
& Akgün, 2020). Educational programs are the key pillar of prevention CVCs Complications, and a foundation for raising awareness among healthcare workers (HCWs) (Abdo, Ramadan, Tosson, & Al-Fadhil, 2020).
2. Methodology
2.1. Design of the Study:
The study design is a quasi-experimental (study and control group), that study carried out from the period of September 2020 to April ,2021 on nurses at ICU and surgical wards in AL-nasiriyah cardiac center, to evaluate the effectiveness of an educational program on their knowledge regarding central venous catheters care.
2.2. Ethical Considerations
Ethical approval was obtained from ethical committee of research in the Faculty of Nursing/University of Baghdad regarding confidentiality and anonymity of the participants. Also the nurses were fully acquainted of the current study and its aims and then a voluntary verbal consent was obtained in order to participate in the study.
2.3. Setting of the Study:
The study was carried out at ICU and surgical wards in AL-nasiriyah cardiac center.
2.4. Sample of the Study
The researchers sample includes (60) nurses, (30) nurses in study group and (30) nurses in control group in ICU and surgical wards. They are selected by using non probability sampling (purposive sample).
2.5.1. Demographic Data
This part consists of (6) items which include: nurses (sex, age, level of education, years of experience in nursing, years of experience in Al- Nasiriyah cardiac center, participated in training courses).
2.5.2. Questionnaire related nurses Knowledge regarding care of central venous catheter
This part is related to the questions that assess of the nurses knowledge for pre and post program. It is consisted of self-administered questionnaire and it is include three domain; first domain (nurses knowledge regarding central venous catheter. It was composed of (6) items), second domain (nurses knowledge regarding types of central venous catheter.It was composed of (6) items), and third domain (nurses knowledge regarding central venous catheter care. It was composed of (15) items) constructed for the purpose of an educational program.
2.6. Rating and Scoring of the Study Instrument:
The knowledge questionnaire have been scored and rated on two levels correct answer and incorrect answer, (1) points for correct answer and (0) point for incorrect answer which assessed by cutoff point (0.33) due to scores (1 and 0) respectively. Scores of responses are categorized according to the following level of nurses´ knowledge: (0 - 0.33) = deficit level of knowledge, (0.34 - 0.67) = moderate level of knowledge and (0.68 – 1.00) = good level of knowledge.
2.7. Data Collection Methods:
The process of gathering information was conducted from 21st December 2020 to March 1st 2021.
The study and the objectives were explained to the study sample by the researchers, the nurses´ verbal consent has been taken. The researchers gathered the general information about nurses participated in the study, and conducted the pretest about nurses´ knowledge regarding central venous catheter care.
2.8. Statistical Data Analysis:
The statistical analysis of the data of the study is done by using Microsoft office excel 2010 and SPSS package ver. 23. The following statistical data analysis approaches were used in order to analyze data and assess the results of the study. The researchers used descriptive and inferential statistical data analysis to obtain results.
3. Discussion of the Results
Part (1): Discussion of the distribution of the nurses by their demographic characteristics
The findings in the table (1) indicated that the age of nurses whom participate in the study (≤ 25) years in both study and control group. These findings will show the study samples of educational maturity, as well as their ability to acquire knowledge and change their behavior in terms of submitting up-to-date information. Shrestha, (2013) in their study (Impact of educational interventions on nurses' knowledge
regarding care of patient with central venous line) which reported that the majority of study group sample (72.5%) of nurses are at age group (≤ 25) years.
Sakshi et al., (2019) in their study (Effectiveness of education program regarding central venous catheter (CVC) care bundle in terms of knowledge and practice of nursing personnel) found that (63%) of study sample at age (21-30) years old.
Throughout the duration of the current study data analysis show, the finding present that 24(80%) in study group and 16(53.3%) in control group were females. Kumari, et al., (2016) in their study (A study of pre-and post-test knowledge score of nurses on care of patient with central venous access devices in selected oncology hospital of Bangalore) found that 40(80%) were females
Regarding to the nurses level of education the finding of the previous study indicated that 16(53.3%) in study group were graduated from college of nursing while control group 15(50%) were nursing institute. deshmukh and shinde, (2012) who reported that the majority of sample were (56.67%) are nursing institution. While Ahmed, et al., (2019) who indicated that the highest percentage of nurses (54%) were graduated from college of nursing.
The present study related to years of experience in nursing shows the findings of present study were in study group were 23(76.7) and control group were 24(80%) have (1-5) years of experience in nursing.
Shrestha, (2013) who indicated that the majority of study sample (85.5%) have (0-5) years of experience in nursing.
In related to the years of experience in Al- nasiriyah cardiac center, the results of the present study were 23(76.7%) in study group, 28(80%) in control group have (1-5) years of working in ICU and surgical wards. Ahmed, et al., (2019) which revealed that the highest percent (72%) of study sample have (1-5) years of experience in ICU. In relation to participation in training courses, the current study showed that 19(63.3%) in the study group and 26(86.7%) had no participation in training courses. Ahmed, et al., (2019) who presented (48%) of nurses had no participation in training courses.
Part (2): Distribution of nurses’ knowledge about central venous catheter care for the study and control groups at pre, post-1,and post-2 tests
Table (2) show that mean score of knowledge for study and control group were (M=0.29, M=0.26) respectively. According to this results nurses have deficit level of knowledge in pretest for both groups. This results agree with study done by (Ahmed et al., 2019) who mentioned that more than one half (54%) of nurses have fair level of knowledge. While mean score of posttest knowledge in study group increase after implemented of program (M=0.84). this is reflect the effectiveness of educational program on nurses’
knowledge in study group at posttest. This results agree with study done by Pushpakala and ravinath, (2014) who indicate that the mean score of knowledge was (X=9.80) after one week of self-instructional module on central venous catheter care. In posttest2 mean score of knowledge for study group was (X=0.85). This results agree with study done by El-Sol and Badawy, (2017) who indicate that mean score of knowledge in pretest of
study group was (X=5.09), after two week of implemented program the post test was (X=9.16).This is reflect the effectiveness of educational program on nurses’ knowledge in study group at posttests
Part (3): discussion the relationship between nurses knowledge and their demographic characteristics The findings in table (3) revealed there is no significant statistical difference between nurses knowledge at posttest and their demographic characteristics (age, gender, level of education, years of experience in nursing,years of experience in AL- nasiriyah cardiac center). This is agree with study done by (deshmukh & shinde,2012), which show there was no significant association of age and gender of staff nurses with knowledge regarding central venous access device care. Aydoğdu and Akgün, (2020) study, which mentioned that there was no significant association between nurses knowledge and their level of education.
Banks, et al., (2010) study show that there is no significant association between nurses' knowledge and their work setting.
4. Conclusion
The nurses’ knowledge in the study group increase after the educational program was implemented, but there was not any difference in the control group. And The findings showed that the educational program was effective regarding nurses knowledge toward central venous catheter care in study group.
5. Recommendations
The study recommended the necessity of activating conducting research related to central venous catheter care in oncology and dialysis centers, and Providing an Arabic booklet on central venous catheter care to motivate nurses to develop and refine their knowledge.
Table (1) Distribution of the nurses by their demographic characteristics
Variables
Characteristics
(n=60)
Study Group
Control Group C.S.
P-value
Freq.
%
Freq.
%
Age (years)
≤ 25 15 50.0 14 46.7
t-test p=0.742
NS
26-30 12 40.0 12 40.0
31-35 2 6.7 3 10.0
36-40 1 3.3 1 3.3
Gender
Male 6 20.0 14 46.7 FEPT
P=0.567
NS Female
24 80.0 16 53.3
Level of Education
Secondary Nursing 3 10.0 3 10.0 t-test
P=0.580
NS
Nursing institute 11 36.7 15 50.0
College of Nursing 16 53.3 12 40.0
Years of Experience in
Nursing
1-5 years 23 76.7 24 80.0
t-test p=0.585
NS
6-10 years 4 13.3 5 16.7
11-15 years 2 6.7 0 0.0
≥ 16 years 1 3.3 1 3.3
Years of 1-5 years 23 76.7 28 93.3 t-test
Experience in the Cardiac
Center
6-10 years 5 16.7 2 6.7 p=0.153
11-15 years 2 6.7 0 0.0 NS
Training courses
No 19 63.3 26 86.7 FEPT
P=0.569
NS
Yes 11 36.7 4 13.3
Total 30 100.0 30 100.0
n=sample size, Freq.=Frequency, %=Percentages, C.S. : Comparison Significant, ∓ .=Arithmetic Mean and Std.
Dev.=Standard deviation, P=P-value, FEPT=Fisher Exact Probability Test N.S.= Non-Significant , ≤ = less than or Equal
Table (2): Distribution of nurses’ knowledge regarding central venous catheter care for the study and control groups at pre, pre-1,and post-2 tests
Test Period
Levels of Evaluation
Pre-Test
Post-1 Test Post-2 Test .
Freq % Freq. % Freq. %
Study Group
Deficit ( 0 - 0.33 ) : 1
23 76.7
0
0.0
0
0.0
Moderate (0.34 – 0.67) : 2 7
23.3
0
0.0
0
0.0 Good (0.68 – 1.00) : 3
0
0.0 30 100.0 30 100.0
Total
30 100.0 30 100.0 30 100.0
0.29 ∓ .
0.84 ∓ 0.046 0.85 ∓ 0.049
Control Group
Deficit ( 0 - 0.33 ) : 1
28
93.3
28
93.3
24
80.0
Moderate (0.34 – 0.67) : 2 2 6.7 2 6.7 6 20.0 Good (0.68 – 1.00) : 3
0
0.0
0
0.0
0
0.0
Total
30 100.0 30 100.0 30 100.0
∓ . .
0.26 ∓ 0.064 0.26 ∓ 0.064 0.29 ∓ 0.064
F= Frequencies; %= Percentages; Arithmetic Mean ( ) and Std. Dev.= Standard. Deviation; Levels of Evaluation = Deficit ( 0 - 0.33 ) : 1; Moderate (0.34 – 0.67) : 2; Good (0.68 – 1.00) : 3
Table (3) relationship between nurses’ Knowledge at posttest and demographic characteristics
variable Period
ANOVA
F d.f Sig.(p)
Age (years)
Pretest 0.975 26 0.420
Posttest1 0.920 26 0.445
Posttest2 1.197 26 0.331
Gender
Pretest 1.537 28 0.410
Posttest1 0.455 28 0.126
Posttest2 3.327 28 0.128
Level of Education Pretest 1.060 27 0.361
Posttest1 0.147 27 0.864
Posttest2 0.210 27 0.812
Years of Experience in
Nursing
Pretest 1.118 26 0.360
Posttest1 0.958 26 0.427
Posttest2 1.346 26 0.281
Years of Experience in the
Cardiac Center
Pretest 1.238 27 0.306
Posttest1 1.328 27 0.282
Posttest2 1.658 26 0.209
ANOVA: Analysis of variance; F = F-test, d.f = degree of freedom, P = probability value; NS: Non-Significant at ( P > 0.05); S:
Significant at ( P < 0.05); HS: High Significant at ( P< 0.01).
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