The central venous access (CVAD) are insert to provide a wide range of intravenous treatments. Although important improvments have been done to reduce blood flow infections (CRBSI) during the insertion of these devices, the risk of complications is important. These complications are principally caused by health professionals, who usually forget or don’t precisely apply for the recommendations for the prevension of infections. To reduce the morbility, the health professionals have to be well behaved about potential complications and strategies necessary to reduce them. CDC suggests that implementation of education and programmes of development for health professionals can reduce the infections acquiered in hospital. The decision of write this thesis is born from the idea to examine the most efficient modalities to reduce the morbility and the mortality in carrier patients of CVAD, studying how professionals are informed about potential complicances and ways to reduce them. Object:The object is to analyse the application of Evidence Based Practise in the management of CVAD from nurses after specific trainings and planned a training event Continuing medical education (CME)– Field Training (audit). Methods:A retrospective observational study was conducted. The study was carried out at the University Hospital "Ospedali Riuniti" in Ancona. In the academic year 2018/2019, has been studied the carrying out of CME events of tutoring held by the PICC Unit to the nurse working in the Department of Internal Medicine. Not probabilistic sampling with convenience strategy was used. To investigate the compliance with the course, questionnaires are distributed to each SOD who participated in the above-mentioned training events for a total of 360 questionnaires, from July to September 2019. The data were analyzed using common methods of descriptive and inferential statistics. In view of the results of the previous study, In the academic year 2019/2020, an CME course was designed for department nurses whose results of the questionnaire given the previous year provided the best and worst results regarding venous access management (Haematology clinic and general surgical clinic department). The type of course CME organized is field training, through improvement groups of clinical audit. Results:The study was performed in the period from July to September 2019, on a sample of 83 subjects.The results show that the training has been successful in the groups observed but the results cannot be generalised to the entire population that has attended the training courses, as statistically not significant.The correctness of the answers given to the questionnaire varies depending on the setting in which the nurses work. The audit activity articulated in the academic year 2019/2020 was defined in the product format. Discussion:The results show that those who participated in the study do not have more knowledge and skills in the management, care and monitoring of Cvads. In this research work, it is also very important to belong to SOD specifications: there are in fact important differences in the percentages of correct answers between the different SOD observed and their statistical significance (p 0,05). With regard to the percentages of correct answers, it can be observed that departments that make more frequent use of CVAD are more informed and more up to date than those where the frequency of use is lower. On the basis of these results, an audit training event (Field Training) was devised in which nurses reflected on clinical practice.Conclusion:The course proved to be ineffective on learning as, there were no significant changes and improvements in knowledge from nurses. An audit mode was designed to study the effective change and improvement of behaviour in the management of Avcs.
Gli accessi venosi centrali (CVAD) vengono inseriti per fornire un'ampia gamma di terapie intravenose. Sebbene siano stati fatti progressi per ridurre le infezioni del flusso sanguigno (CRBSI) durante il posizionamento dei dispositivi, il rischio di complicanze è rimasto evidente.Queste sono prevalentemente causate dall’agire del personale sanitario, che spesso, dimentica o non applica correttamente le raccomandazioni per la prevenzione delle infezioni.I professionisti devono essere ben educati su potenziali complicazioni e le strategie necessarie per ridurle.La CDC suggerisce che l'implementazione di programmi di formazione possono diminuire le infezioni acquisite in ospedale.La decisione di effettuare questo elaborato è nata dall'idea di indagare le modalità per poter ridurre la morbilità e la mortalità nei pazienti portatori di CVAD, studiando come i professionisti che gestiscono questi dispositivi siano informati sulle potenziali complicanze e le strategie necessarie per ridurle.Obbiettivo:Analizzare l’applicazione dell’Evidence Based Practise nella gestione dei CVAD da parte degli infermieri a seguito di specifici training formativi e progettazione di un evento formativo ECM- FSC (audit).Metodi:E' stato condotto uno studio osservazionale di tipo retrospettivo. Lo studio è stato svolto presso l’Azienda“Ospedali Riuniti” di Ancona. Nell’anno accademico (a.a) 2018/2019 è stata seguita l’effettuazione di eventi ECM di tutoraggio tenuti dalla PICC Unit rivolti agli infermieri del Dipartimento di Medicina Interna. È stato utilizzato un campionamento non probabilistico con strategia di convenienza. Per indagare la compliance al corso sono strati distribuiti dei questionari ad ogni SOD che ha partecipato agli eventi formativi per un totale di 360 questionari, da luglio a settembre 2019. I dati sono stati analizzati utilizzando le metodiche della statistica descrittiva ed inferenziale. Alla luce dei risultati emersi, nell’a.a 2019/2020 è stato ideato un corso ECM diretto agli infermieri delle SOD i cui i risultati del questionario somministrato l’anno precedente fornivano il migliore e il peggior esito riguardo la gestione degli accessi venosi (clinica ematologica e chirurgica generale). La tipologia di corso ECM organizzato è la formazione sul campo (FSC), tramite gruppi di miglioramento di audit. Risultati:Lo studio è stato eseguito da luglio a settembre 2019, su un campione di 83 soggetti. I risultati dimostrano che la formazione ha avuto esito positivo nei gruppi osservati ma non possono essere generalizzati all’intera popolazione che ha frequentato i corsi di formazione, in quanto statisticamente non significativi. La correttezza delle risposte date al questionario varia a seconda del setting in cui gli infermieri lavorano. L’attività di audit articolata nell’a.a 2019/2020 è stata definita nel format prodotto.Discussione:Dai risultati emerge che, coloro che hanno partecipato allo studio, non hanno maggiori conoscenze e maggiori competenze nella gestione, cura e monitoraggio dei CVAD. Risulta inoltre essere rilevante l’appartenenza a specifiche SOD. Per quanto riguarda le percentuali di risposte esatte è possibile osservare come i reparti che fanno un uso più frequente di CVAD siano più informati e aggiornati rispetto a quelli in cui la frequenza risulta inferiore.E' stato ideato un evento formativo formazione sul campo (FSC) di audit in cui gli infermieri riflettessero sulla pratica clinica. Conclusione:il corso si è dimostrato essere inefficace sull’apprendimento in quanto, non ci sono stati stati significativi cambiamenti e miglioramenti delle conoscenze. È stata così progettata a delineata una modalità FSC di audit per studiare l’efficace cambiamento e miglioramento del comportamento nella gestione degli AVC.
Gestione degli accessi venosi centrali e sviluppo delle competenze infermieristiche- Progettazione di un evento formativo
FERRACUTI, GIULIA
2019/2020
Abstract
The central venous access (CVAD) are insert to provide a wide range of intravenous treatments. Although important improvments have been done to reduce blood flow infections (CRBSI) during the insertion of these devices, the risk of complications is important. These complications are principally caused by health professionals, who usually forget or don’t precisely apply for the recommendations for the prevension of infections. To reduce the morbility, the health professionals have to be well behaved about potential complications and strategies necessary to reduce them. CDC suggests that implementation of education and programmes of development for health professionals can reduce the infections acquiered in hospital. The decision of write this thesis is born from the idea to examine the most efficient modalities to reduce the morbility and the mortality in carrier patients of CVAD, studying how professionals are informed about potential complicances and ways to reduce them. Object:The object is to analyse the application of Evidence Based Practise in the management of CVAD from nurses after specific trainings and planned a training event Continuing medical education (CME)– Field Training (audit). Methods:A retrospective observational study was conducted. The study was carried out at the University Hospital "Ospedali Riuniti" in Ancona. In the academic year 2018/2019, has been studied the carrying out of CME events of tutoring held by the PICC Unit to the nurse working in the Department of Internal Medicine. Not probabilistic sampling with convenience strategy was used. To investigate the compliance with the course, questionnaires are distributed to each SOD who participated in the above-mentioned training events for a total of 360 questionnaires, from July to September 2019. The data were analyzed using common methods of descriptive and inferential statistics. In view of the results of the previous study, In the academic year 2019/2020, an CME course was designed for department nurses whose results of the questionnaire given the previous year provided the best and worst results regarding venous access management (Haematology clinic and general surgical clinic department). The type of course CME organized is field training, through improvement groups of clinical audit. Results:The study was performed in the period from July to September 2019, on a sample of 83 subjects.The results show that the training has been successful in the groups observed but the results cannot be generalised to the entire population that has attended the training courses, as statistically not significant.The correctness of the answers given to the questionnaire varies depending on the setting in which the nurses work. The audit activity articulated in the academic year 2019/2020 was defined in the product format. Discussion:The results show that those who participated in the study do not have more knowledge and skills in the management, care and monitoring of Cvads. In this research work, it is also very important to belong to SOD specifications: there are in fact important differences in the percentages of correct answers between the different SOD observed and their statistical significance (p 0,05). With regard to the percentages of correct answers, it can be observed that departments that make more frequent use of CVAD are more informed and more up to date than those where the frequency of use is lower. On the basis of these results, an audit training event (Field Training) was devised in which nurses reflected on clinical practice.Conclusion:The course proved to be ineffective on learning as, there were no significant changes and improvements in knowledge from nurses. An audit mode was designed to study the effective change and improvement of behaviour in the management of Avcs.| File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12075/4604