The effect of the training program based on participation on the knowledge and performance of nurses in the care of central venous catheters in special care departments of teaching hospitals affiliated to Zanjan University of Medical Sciences in 2013

Master's Thesis of Special Care Nursing

Abstract

Context and purpose: Improving the quality of care of central venous catheters requires raising the level of awareness of nurses about the standard guidelines for catheter care and research results in this field.  In this regard, the present study was conducted with the aim of determining the effect of a training program based on participation on the performance of nurses in relation to the care of central venous catheters in the intensive care units of the teaching hospitals of Zanjan University of Medical Sciences. Methodology: This semi-experimental study with a pre-test-post-test design of two groups (test and control) on 46 nurses working in intensive care units in two Ayat hospitals. Mousavi and Waliasr, which were divided into two groups of control (18 nurses) and intervention (28 nurses) in a non-random way. Before conducting the intervention, using the observational checklist made by the researcher and the awareness questionnaire developed by Labeau et al. Then, in the test group, a training program based on participation was implemented for one month, and in the control group, a routine intervention (giving a speech) was implemented. Three months after the intervention, the nurses' knowledge and performance were again evaluated by a questionnaire and a performance observation checklist by a research colleague. The data was analyzed by spss statistical software version 16 using chi-square, Fisher, one-way analysis of variance, independent t-test and paired t-test. Results: The findings show that in the pre-test stage, there was no statistically significant difference between the test and control groups in terms of knowledge score (P>0.691) and performance score (P>0.817). However, after the educational intervention, there was a significant difference in the knowledge (p<0.004) and performance (p<0.001) of nurses in the care of central venous catheters in both the control and intervention groups.

Conclusion: The results of the present study indicate that the educational intervention based on participation in dialogue with the usual methods in improving the knowledge level of nurses and improving their performance in caring for central venous catheters. It is more effective and nursing education planners can use this educational approach in the training of nurses.

Key words: participation-based education, nurses' awareness, nurses' performance, central venous catheter, special care department

1-1) Background and importance of the research

Today, the establishment of hospitals equipped with intensive care units [1] (ICU) has led to the treatment and recovery of patients who were sentenced to death in the past (1). Prolonged hospitalization of patients in the intensive care unit and the use of invasive equipment has led to a high prevalence of hospital infections [2]. Hospital infection is defined as an infection that is limited or diffuse, caused by pathogenic reactions related to the infectious agent itself or its toxins in the patient. This infection must develop at least 48 to 72 hours after the patient is admitted to the hospital and must not be in its incubation period at the time of hospitalization (1, 2, and 3). Meanwhile, in developing countries, this figure increases to about 25%. According to the report of the World Health Organization, more than 1.4 million people in the world get hospital infections every year. There have been no comprehensive studies on the prevalence of hospital infections in Iran. The information related to nosocomial infections obtained sporadically from the hospitals of Mashhad shows that there were 798 known cases of nosocomial infections in Rasul Akram (PBUH) hospital in 2013 and 849 cases in 2014 (3). In a study conducted by Ajal Luian et al. (2006) in the special care department of Khatam Al Anbia Hospital in Tehran, the incidence rate of nosocomial infection was estimated to be 18.7 cases of infection per one thousand people (4).Published statistics show that about 25 to 50% of all hospital infections occur in the intensive care unit (1). The relatively higher prevalence of this complication among patients hospitalized in the intensive care unit may be due to the severity of the underlying problem or more aggressive services such as tracheal intubation and central venous catheters and urinary catheters that these patients receive (5). Hospital infections are one of the important causes of death and increase in treatment costs (6). Studies show that the duration of hospitalization in people suffering from these types of infections increases between 2.5 to 19.2 days (7 and 8).

Any part of the human body can get infected in the hospital. The most important types of infections reported include urinary tract infection (42%), lower respiratory tract infection (pneumonia) 15-20%, surgical wound infection 24%, and circulatory system infection 10-20%. Pneumonia and blood infection are the most important causes of death from hospital infections (1, 3). Although blood infection is less frequent compared to other hospital infections such as respiratory infection, urinary infection and wound infection (5.8 cases per 1000 catheter days), but due to the high mortality rate, the increase in treatment costs and the resulting complications are of particular importance (9).

One ??of the most important causes of blood infections is the use of central venous catheters. A central venous catheter is a catheter placed in a large central vein such as the subclavian vein or the femoral vein. This catheter is routinely used to inject drugs and serum with high concentration and volume, measure central venous pressure, take blood samples, and operate cardiac pacemakers (10). Central venous catheterization is sometimes associated with unpleasant complications. Statistics show that more than 15% of patients who undergo central venous catheterization experience complications. Complications caused by central venous catheters are divided into three main groups: infectious, mechanical, and thrombotic. In the studies conducted in connection with central venous catheter complications, the incidence of mechanical complications is 15-19%, thrombotic complications 2-26%, and infectious complications 5-26% have been reported (11). The results of the study by Yoshida[3] et al. can cause a significant increase in the risk of blood infection and also the duration of hospitalization (12). The quality of central venous catheters caring requires the improvement of knowledge level of nurses from standard guidelines and manuals of catheter care and the findings of the studies in this field. In this line, this study aimed to assess the effect of participation-based training program on nurses' knowledge and performance with regards to providing care for Central venous catheters in Intensive Care Units in teaching hospitals of Zanjan's University of Medical Sciences.

Method: A quasi-experimental pretest-posttest design with two experimental and control groups was carried out on 46 nurses who were working in intensive care units. , in two Ayatollah Mousavi and Vali-e Asr hospitals, and were non-randomly allocated to experimental group (n=28) and control group (n=18). Before conducting intervention, performance and knowledge of the nurses regarding central venous catheter care were assessed by using researcher made observational checklist and questionnaire developed by Labio et al. (2008). Then, in the experimental group for the period of 1 month a participation-based training program was conducted. For the control group also routine intervention (provision of a seminar) was carried out.  Three months after intervention, the knowledge questionnaires were completed by nurses, and the checklist by the researcher's colleague for the second time.