The Literacy in Professional Nursing in Peripheral Venous Catheterization Procedures: A Systematic Review

Introduction: Peripheral intravenous catheterization is a common practice in the hospital context and implies a set of nursing diagnoses and actions with clear therapeutic goals. As invasive procedure, manipulation of peripheral intravenous catheters (PIC) constitutes an increased risk for infection. Nursing care provided to users with PIC should be grounded in scientifically based practice, with a view to production trend of current knowledge. The guidelines presented by the Center for Disease Control and Prevention give clear indications for this procedure. Constant updates of knowledge are fundamental to the safety of the user, in order to optimize and standardize practices, increasing the quality and excellence with regard to the care to the patient with PIC. The concept of literacy translates the capacity to mobilize the skills (taught and learned) in reading, writing and calculation. It can also be defined as the information processing capabilities written in everyday life where the focus is assigned to the mobilization and use of expertise and not the formal level of education that the person may have. Thus, seeks to recognize and systematize the scientific evidence about reality and knowledge, attitudes and health practices (literacy) of nursing professionals on the peripheral intravenous catheterization procedure.

Methodology: The preparation of the systematic review based on Cochrane Handbook, taking as its starting point the research question: in nursing professionals, which is them literacy relative to the procedure peripheral intravenous catheterization with repercussions in the nursing care?

The research was limited by PICOD shape, taking into account predetermined inclusion and exclusion criteria. The survey was conducted in April 2014, in the electronic database EBSCOhost and online Portuguese and international institutional repositories, with a time limit acceded to scientific research results published between 2009 and 2014 were used in the English language, such as search keywords: * guidelines *, * knowledge, nurs * and peripheral intravenous catheter *. Data collection was conducted in accordance with three research strategies, resulting 7 investigations included in the analysis.

Results: From the research carried out it appears that only a few empirical studies evaluate the quality of nursing care to clients with PIC’s focusing on the relationship between knowledge of national and international recommendations and their applicability in providing nursing care. In fact there are few specific data on the literacy of nurses in relation to peripheral intravenous catheterization. With regard to knowledge of nursing professionals on the scientific evidence in this procedure and its membership in the provision of nursing care, the literature refers that nurses should not be confined to the formation of 'base' or take on a complicating role of applicability of evidence most up to date in the provision of nursing care. Thus, it is the responsibility of the nursing professional look, constantly in the literature, to update their knowledge and answer some questions. Of course nurses should guide their practice under protocols established by national or international studies, for guidelines. But, in this context, nurses should recognize the importance of constant training, since both the guidelines and theoretical knowledge are undergoing changes. As the expertise of nurses in this procedure, it was found in the investigations that most of the knowledge, though revealed by nurses, were not according to their clinical practice and, although informed of the guidelines, nurses do not always adhere to them. On the other hand, it is also mentioned that the nursing understanding of current guidelines was limited, with some barriers to the provision of evidence-based in nursing care with some lack of knowledge, with some low skills and negative attitudes, with organizational and structural factors underlying, which shows the importance of peer group and professional user interaction in a more targeted and efficient way. Although not always check a practical adherence to guidelines in peripheral intravenous catheterization procedure, it is known that an adequate and effective adhesion to recommendations an Guidelines are crucial issues related to the quality of health care, particularly in the art, which represents a important procedure nursing.

The procedure of cleaning hands is considered essential for the prevention of complications, however the investigations shows that the performance of nurses would often be more appropriate. In one study it was found that hand hygiene insertion occurred in 96.7% of PIC’s, as opposed to 3.7% of the cases in which it was not documented. In another study, when established training interventions after a first observation and before a second point, there was a significant increase in adherence to hand hygiene, increasing to a rate of 46.3% in the endoscopy unit (82 observations) and 65.2% in the dermatology unit (23 observations). Other authors corroborate saying that, after observation, there was a low adherence to hand washing (non-adherence of 74.8%), and add non-adherence to the use of gloves (non-adherence of 69.4%) and use of antiseptic solution of alcohol-based service available (not 100% adherence). For example, when it is asked about the need of use gloves in the introduction / placement of PIC’s, 89.7% of nurses said as needed, but only 30.5% of the observed nurses used gloves, and not always exchanged between users.

On the other hand, also the recommendations on disinfection of the puncture site, the concern of professionals is evident, for the preparation of the skin to puncture, even before the intervention at around 100% adherence to recommendations. In what concerns the non palpation of the puncture site after disinfection percentages, on the accession of health professionals, down to 25.7% and 62.5%, respectively in the endoscopy and dermatology units, before the intervention. After the training, the percentage rose to 63.4% and 69.6% in the respective services.

For the PIC call time, although it is found that most nurses had the knowledge, but 13.8% of PIC's were remained for more than 72 hours, that is, not mobilized for the recommendations for good practice in nursing care, and that most of the cases depended on making some wrong decision by nurses.

In an investigation they study the type of dressing/noun selection. It was analyzed the procedures by nurses before and after the implementation of protocols and it was observable behavior changes in the type of dressing selection recommended. After the adoption of a new protocol, the risk of inappropriate use fastening material decreased from 57.89% to 37.91%.

As regards the maintenance of the permeability of PIC during medication administration was observed that 89.4% of the PIC’s were not salinized.

Thus, the realization and implementation, by a multidisciplinary team, of policies that standardize clinical practice and promote the adoption of a harmonious and coherent conduct of health professionals in the peripheral intravenous catheterization procedure, should be measures to take to improve better literacy in the nurses and so a better quality of care. In fact, educational programs should not only focus on learning contents, but should also focus on the importance of following the recommendations for user safety.

Conclusion: Responding to the research question formulated in this review 'in nursing professionals, which is them literacy relative to the procedure peripheral intravenous catheterization with repercussions in the nursing care?', It appears that the literature points out that the vast majority nurses have knowledge of the peripheral intravenous catheterization procedure, however, not always mobilize them knowledge for the provision of nursing care, and not shown to possess a good literacy in this procedure. There are authors who claim that knowledge of nurses is sometimes insufficient, such phenomena demonstrate an impact on the quality of care because the nurse plays a key role in the prevention and reduction of complications associated with peripheral intravenous catheterization. In this sense, the mobilization of knowledge, based on evidence, for the provision of nursing care, is also crucial to the safety of the user, because only they can prevent complications and, consequently, changes in their behavior with desired impact in the nursing care of patients with PICs.

In order to overcome this barrier to quality of care, the investigations identifies as important the continuing and more focus education of nursing professionals on the national and international protocols, in particular, on the 2011 CDC guidelines and, above all, on ensure their implementation for the provision of quality nursing care. It is evident as soon as educational activities of nurses are done often, allowing reflective moments for your update, designing objective changes in some routine behaviors.

We therefore consider that the results of this review may contribute to the encouragement of debate for achieving future research on the relationship between the knowledge that nursing professionals have on the peripheral intravenous catheterization procedure and their effective mobilization in nursing care (Literacy), with good and natural consequences of that applicability in the quality of health care.

In a final appointment, we recognize that this is an important area of nursing knowledge and it is necessary more contributions sustained in new researches, because the scientific production in this area is still reduced.