The Use of Peripherally Inserted Central Venous Catheters - Case Study Example

Evidence Table

A1 Quantitative Article:

Background or Introduction

The purpose statement for the quantitative article by Panaglotounakou et al. states, "The use of peripherally inserted central venous catheters (PICC lines) has reduced the mortality and morbidity of premature newborns. The usual sites of insertion are the veins in the upper arms, but other locations are being used as well." This purpose statement is clearly stated, easy to understand and also identifies the primary purpose of the paper. The study, which investigates the frequency of complications of catheterization in newborns, based on the site of insertion. As a well-structured study, the article comprises of an abstract which identified the major sections of the paper that include, the objective, the study design, the result and the conclusion section. The abstract provides enough information about the topic and a summary of the information within each section of the study. The study also includes an introduction section, which also provides the background information on the topic and also a brief summary of the sections within the paper.

Review of the Literature

The authors of the study analyze seven articles evident in the introduction section. The reviewed articles are dated from 1997 providing sufficient information on the issue. The information provided in through the literature review covers specific topics which include

• Complications resulting from central and anon venous catheterization for newborns
• Comparison of the risks based on the different sites of catheterization
• Analysis of the rates of complication and reasons for these complications resulting from the different catheterization sites

Discussion of Methodology

The authors conducted the study through the use of quantitative methodology, which in turn used the randomized trial designs to arrive at the conclusions. As a quantitative study, the researchers used a randomized clinical trial design which included 62 preterm neonates which were later divided into two groups so as to the compilations resulting from two insertion sites. The authors then measured the outcomes including the complications related to PICC Line insertions, the reasons for catheter removal, and the impacts the duration of catheterization has on the individual patients.

Data Analysis

Data analysis was conducted through quantitative analysis method; data, in this case, was presented as standard deviation, mean values, and also extreme values. The tests used to analyses the normality of the variables were the Shapiro-Wilks and the Kolmogorov-Smirnoff tests. The associations between quantitative and categorical variables were tested through the use of t-tests, which in turn provided independent variables. The correlation between all the categorical variables, on the other hand, were analyzed with person's chi-square test. Other methods used for data analysis in this study included the SPSS version 13 which helped the authors in analyzing the data from the tests.

Researcher’s Conclusion

Based on the research topic the authors found that all premature neonates with axillary PICC lines had a 12 times probability of causing complications to patients. However, even with these all the complications were line related hence included inflammation, edema, blockage, and infection. The premature neonates also had higher full enteral nutrition achievements compared to other forms of insertions. These conclusions make sense as they identify a preferable site of insertion with lesser complications for premature newborn babies.

A2. Researcher’s Conclusion

Author's conclusion- The use of the axillary vein as a site of insertion of a PICC line was correlated with significantly fewer complications in premature newborns as opposed to the other sites of insertion.

Evidently, each section of the paper provides information which leads to the conclusions provided. In the beginning, the author's main focus is analyzing the different sites of insertions for premature newborns and identifying the complications resulting from each site of insertion. Even with this, however, the introduction identifies the possible conclusions from the study. This means that the study primarily focused on confirming a hypothesis made at the introduction of the levels of complications resulting from the different site for catheterization. The methods employed for the analysis of the statistical data gathered to some extent reflects the complexity of the data used for the study. Even with these, however, the different methods as identified represent the results used to arrive at the conclusions of the study. The conclusions are also guided by literature as identified in the discussion section where the authors argue that recent literature identifies that the use of PICC Line causes fewer complications as compared to other methods of catheterization

A3. Protection and Considerations

Even with the fact that the researchers used 62 neonates for the study, there is no actual mention of their origins, their parents, or even their identities. With this, there were no ethical considerations required and used for the study.

A4. Strengths and Limitations

The strengths of the study revolves around the number of neonates used, the way the authors grouped the neonates and the data analysis methods used for the study. The use of 62 neonates is an important element for the study as it was easier to generalize the results gathered to represent the population of premature newborns as well as the best method of catheterization. The combination of the specific data analysis methods, on the other hand, plays a crucial role in arriving at the most significant results. As evident each of the data analysis method used led to specific results all pillared in the conclusions made for the study

A5. Evidence Application

Catheterization complication presents a major challenge not only to infants but also to adults and the elderly. Through the provision of well-analyzed information on the most suitable site for premature newborn catheterization is an important element for all medical practitioners. This study, therefore, provides significant information, which could be used at specific levels of medical care provision in an attempt to prevent all the complications associated with newborn catheterization. This information is also important for future medical practices as well as future studies on newborn catheterization. This revolves around the fact that the article provides information on the most appropriate site and method for catheterization in premature newborns.

B1 Qualitative Article:

Roberts, S., Mclnnes, E., Wallis, M., Bucknail, T., Banks, M., & Chaboyer, W. (2016). Nurses’ perceptions of a pressure ulcer prevention care bundle: a qualitative descriptive study. BMC Nursing.

Background or Introduction

The purpose statement for the study states, "Nurses' perceptions of a pressure ulcer prevention care bundle." This statement provides the main purpose of the study, which revolves around the different perceptions nurses have on the prevention of pressure ulcer. The article by Roberts et al. comprises of a well-structured analysis of the issue which is divided into the background the methodology section, the result section and the conclusion section. The paper also comprises of an abstract which provides the problem statement and a brief summary of the information from each section of the paper. The authors in the study include an introduction section which provides the background information on the issue as well as a summary of the information from the study. This information from the abstract and the introduction focuses on providing the reader with the information from the paper and also introduce the reader to the topic.

Review of the Literature

As evident in the study is the review of 17 scholarly articles all dated between 2003 and 2016. The articles provide the relevant information needed for the study. This information provided covers a specific topic, which develops the guiding concepts of the study. These topics include

• Definition of Pressure Ulcers
• Impacts of patient and nurse participation in prevention of pressure ulcers
• Nurses perceptions on Pressure ulcers

Discussion of Methodology

The study uses a qualitative design methodology through which the researchers used semi-structured interviews with nurses working inwards with pressure ulcer prevention bundle. 18 Nurses from four acute care hospital are used for the study; these four acute care hospitals, in this case, are represented as the sites for the study. Purposive sampling was then used to recruit the participants based on the sites. These participants were later mixed differently in terms of gender, the area of specialty, and the years of experience. The researchers in order to gather their data, sample 4-5 participants from each of the sites. These participants are interviewed so as to provide the most relevant information about their individual perceptions on PUPCB.

Data Analysis

The authors used thematic analysis so as to arrive at the results of the study. The information from the semi-structured interviews was then read, reread, and coded based on the verbatim statements from the participants. The coded data was then collated into themes and subthemes, which were all based on the commonality of the data. The trustworthiness of the data gathered was enhanced through discussions of the findings from the study, and the use of purposive sampling so as to ensure that the data represents the perceptions of the nurses.

Researcher’s Conclusion

The conclusion from the study was based on the purpose statement and was governed by the data collected from the semi-structured interviews. From the five themes of the study, the conclusions identified revolved around the acceptability levels of the PUPCB in which the participants showed that they found the care bundle to be acceptable and feasible. This feasibility and acceptance revolved around the number of benefits identified by the participants, which included an improved system of communication, increased awareness, and also active participation among the staff and the patients. According to the study, however, the nurses identified that the system was not effective for all the patients, for example, those impaired cognitively. Some of the perceived enablers included strong leadership and simplicity of the care bundle.

B2. Researcher’s Conclusion

Author's conclusions- the care bundle, is both feasible and acceptable, as it has several benefits such as improved communication, increase in participation and increased awareness

This conclusion is supported by the different sections of the study, including the introduction the result section, the discussion and the conclusion section. Evidently, the nurses have different perceptions on PUPCB, an element that is important for the prevention of pressure ulcer. Also evident is the supporting factor in the sections of the study, with each section supporting the conclusion made. As evident in the introduction, there are benefits towards the use of the system; an element also supported in the different sections of the study.

B3. Protection and Considerations

The fact that the study involved actual participants, there is need to follow specific ethical standards in the gathering of data. As evident in the methodology section, the involved participants provided informed consents from all those that agreed to participate. Even with the anonymity existing in the study, it was still necessary to follow all the necessary ethical considerations and standards.

B4. Strengths and Limitations

The strength of the study revolves around the way the information from the study beginning with the purpose statement, to the introduction up to the conclusion is presented. The information is presented in a simple well-structured manner, which transitions from one section to another leading to the conclusions made. The involvement of actual medical practitioners also presents another strength of the study as it helps provide the necessary information related to the purpose of the study. The presentation of the discussion and the conclusion sections also present another strength as they provide information supported by the introduction and background sections.

A limitation of the study, however, revolves around the fact that it is location-based and may not present information from the other hospitals across the globe with similar programs.

B5. Evidence Application

As one of the most important processes in healthcare re sector, it is important for the medical practitioners to understand the importance of specific programs. The study, in this case, provides information important information necessary for care both currently and in the future. The duty to care is the core principle of the nursing process, programs that can enhance the process, therefore, are necessary for the process of proving healthcare. The benefits of the bundle also identify the importance of the program in the prevention of pressure ulcer.