Nurses’ clinical reasoning concerning management of peripheral venous cannulae

Abstract

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 to balance between preventing complications and avoiding discomfort is important for enhancing patient care.

Factors Influencing Nurses' Decision-Making Process on Leaving in the Peripheral Intravascular Catheter After 96 Hours

“…9 For each category that emerged in the original qualitative study, 9 researchers decided the significance to give in accordance with the aim of this study. Then, sample answers obtained from the participants were appropriately included in the categories to explain each unequivocally (Table 1).…”

“…Then, sample answers obtained from the participants were appropriately included in the categories to explain each unequivocally (Table 1). 9 To avoid personal bias, this process was first conducted by 3 researchers, who worked independently: each answer collected was included in 1 or more categories according to the framework established by Johansson and colleagues. 9 Later, another researcher compared each categorization made by the previous researchers and prepared a final file highlighting the discordances between the categories.…”

“…9 To avoid personal bias, this process was first conducted by 3 researchers, who worked independently: each answer collected was included in 1 or more categories according to the framework established by Johansson and colleagues. 9 Later, another researcher compared each categorization made by the previous researchers and prepared a final file highlighting the discordances between the categories. These discrepancies were discussed and agreed on by all the researchers, and all of the responses were then categorized in their final location appropriately.…”

“…Notwithstanding the contents of the guideline, 1 the length of stay in situ is still debated. Recent literature [3][4][5][6][7][8] and clinical practice data 9 show the tendency to maintain the catheter over the prescribed 96 hours. This lack of guideline adherence seems to be supported by several factors: (a) for nurses, it is difficult to explain to and argue with the patients about the need to replace a properly functioning PIV catheter 4,9 ; (b) the replacement may have a negative impact, such as discomfort and pain, on patients 4 ; (c) the replacement might also increase the risk of infection, because each time skin integrity is breached, a potential portal for pathogens is provided 4 ; and (d) the recent systematic review made by Webster and colleagues 5 found no conclusive evidence in the need for catheter replacement every 72 to 96 hours.…”

“…This decision is made on the basis of clinical information and circumstances as stated by Johansson and colleagues, 9 who have described under a qualitative study design combining observations and interviews, the decision-making process adopted by 43 nurses in their natural setting. Exploring the factors involved in the decision-making process affecting the PIV catheter's length of stay in situ and capturing the variability and richness of the nurses' clinical decision making in practice was the general aim of this study.…”