IV Therapy

UNIVERSITY OF THE PHILIPPINES, MANILA

The Health Sciences Center COLLEGE OF NURSING

Sotejo Hall, Pedro Gil St., Ermita, Manila

SKILL RETENTION AND LEVEL OF KNOWLEDGE AND ATTITUDES ON INTRAVENOUS THERAPY

AMONG SENIOR NURSING STUDENTS

Submitted in partial fulfilment of the requirements in

Introduction to Nursing Research (N 199) Second Semester, Academic Year 2012-2013

by

Caballero, Izzah Mei C. Santos, Ma. Leoant B.

Singson, Daniel Joshua M. Tan, Joyce Camille L.

Tating, Dan Louie Renz P. Templonuevo, Lyzka Camille G.

Trinidad, Lyka Eunice F. Tuazon, Patricia Louise L.

Untalan, Axle Maria Rafaelle D. Vallejos, Anatole Gail P. Yanoria, Alexander T.

Submitted to: Prof. Vanessa M. Manila, MA-HPS, RN

Skill Retention and Level of Knowledge and Attitudes on Intravenous Therapy among Senior Nursing Students

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ACKNOWLEDGEMENTS

The realization of this research paper would not have been possible if not for the

expertise, guidance, support and compassion of the people who assisted us on this endeavor.

The researchers would like to express their heartfelt gratitude to the following people who have

made the completion of this study possible:

To Prof. Lourdes Tejero, RN, PhD, head of the Research and Creative Writing

Program of UP College of Nursing, for reviewing our proposal and the ethical considerations,

and for giving approval to our research.

To all the evaluators for the validation of the research tools, namely: Ms. Cecille Pena,

RN, MAN; Mr. Normal Alviar, MD, MHPEd; Mrs. Josephine Cariaso, RN;Ms. Berling Coto,

RN;Mr. Kim Estella, RN;Ms. Jenniffer Paguio, RN; Ms. Judy Pangilinan, RN; and Ms.

Rebecca Tan, RN, MAN.

To Prof. Arnold Peralta, RN, MAN, Nursing Foundations II (N 11) faculty, for his efforts

in retrieving our subjects’ scores in the Intravenous Therapy skills portion of their grades.

To Ms. Cristina Jose, for her patience and understanding in accommodating the

researchers for their data collection.

To Prof. Vanessa M. Manila, MA-HPS, RN, Introduction to Nursing Research (N 199)

instructor and research adviser, for sharing with us the knowledge and skills essential in the

making of this research paper and for her continuous guidance and support.

To the researchers’ families and batchmates, for their undying support and

encouragement in all our undertakings.

And lastly, to the Almighty Father, for giving the group the strength and courage to

carry out this task. The accomplishment of this study would not have been possible without His

guidance.


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TABLE OF CONTENTS

Content Page

Abstract 8

CHAPTER 1: INTRODUCTION

Statement of the Problem 10

Goals and Objectives 10

Significance of the Study 10

Definition of Terms 11

Scope and Limitations 14

End Notes 15

CHAPTER 2: REVIEW OF RELATED LITERATURE

Intravenous Therapy (IVT) 18

Teaching IVT 25

Theories on Learning 28

Theories on Retention 35

Synthesis of Various Theories of Learning and Retention 38

Conceptual Framework 50

End Notes 50

CHAPTER 3: METHODOLOGY

Research Design 61

Setting 61

Sampling Procedures and Sample 62

Instrumentation and Procedures 63

Data Analysis 78

Ethical Considerations 85

End Notes 86

CHAPTER 4: RESULTS

Participants 89

Tool Validity and Reliability 90

Item Performance Review 92

Assessment of Level of Skills, Knowledge and Attitudes 96

Evaluation of Skill Retention 105

Factors Related to Retention of Skills and Level of SKA 106

Learning Framework 112

CHAPTER 5: DISCUSSION AND ANALYSIS

Skills 114

Knowledge 116

Attitudes 117

End Notes 123

CHAPTER 6: CONCLUSION AND RECOMMENDATIONS

Conclusion 127

Recommendations 127

BIBLIOGRAPHY 130


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APPENDICES

I. Research Schedule and Budget 137

II. Research Instruments Packet for Subjects 139

III. Research Instruments Packet for Validity and Reliability Testing 150

IV. Original UPCN Skills Laboratory Checklists 166

V. Initial Pool of Items (for IVT Knowledge Exam and IVT Attitudes Survey) 174

VI. Qualitative Analysis of Content Validity of the IVT Knowledge 180

Assessment Examination (Test Blueprint and N11 IVT Course Objectives)

VII. Data Tables from Validity and Reliability Testing 185

VIII. Data Tables and Statistical Printouts from Pre-testing 196

IX. Transcription of Focused Group Discussion 206


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LIST OF ACRONYMS

FGD – Focus Group Discussion

GWA – Grade Weighted Average

IV – Intravenous

IVF – Intravenous Fluid

IVT – Intravenous Therapy

KR-20 – Kuder-Richardson Formula 20

SBPR – Spearman-Brown Prophecy Formula

SKA – Skills, Knowledge, and Attitudes

SPSS – Statistical Package for the Social Sciences

UPCN – University of the Philippines Manila College of Nursing


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LIST OF TABLES

Table No. Title Page

Table 1 Number of items included in IVT Knowledge Assessment Exam according 69

to concept and test type

Table 2 Number of items included for each attitudinal domains/concepts for IVT 72

Attitudes Survey

Table 3 Measures of Central Tendency and Measures of Variation of General 90 Grade Weighted Average (GWA) of 4th year UPCN students Table 4 Measures of Central Tendency and Measures of Variation of knowledge 96

and skill scores of 4th year UPCN students Table 5 Independent t-test of knowledge scores of male and female 4th year 97

UPCN students Table 6 Independent t-test of skill scores of male and female 4th year UPCN 98 students Table 7 Classification of Nursing courses with the year and semester taken 98

Table 8 Cross tabulation of scores on setting up IV infusion and when skill was 99 emphasized and fully appreciated by 4th year UPCN students

Table 9 Cross tabulation of scores on changing an IV infusion and when skill was 100 emphasized and fully appreciated by 4th year UPCN students

Table 10 Cross tabulation of scores on discontinuing an IV Infusion and when skill 100 was emphasized and fully appreciated by 4th year UPCN students

Table 11 Cross tabulation of scores on administering medications through IV Push 101

and when skill was emphasized and fully appreciated by 4th year UPCN

students

Table 12 Cross tabulation of scores on administering medications through Heplock 102

and when skill was emphasized and fully appreciated by 4th year UPCN

students

Table 13 Cross tabulation of scores on incorporating medications in IV Fluid and 102

when skill was emphasized and fully appreciated by 4th year UPCN

students

Table 14 Cross tabulation of scores on incorporating medications into Soluset 103

and when skill was emphasized and fully appreciatedby 4th Year

UPCN Students

Table 15 Measures of Central Tendency and Measures of Variation of attitudinal 104 domain scores of 4th year UPCN students

Table 16 Measures of Central Tendency and Measures of Variation of percent 105 difference of Skill Score of 4th year UPCN students

Table 17 Paired t-test of Skill scores of 4th year UPCN students from sophomore 106 year and senior year

Table 18 Correlation Coefficients of Various Factors Perceived to be affecting skills 107

Skills and Knowledge on IVT of 4thUPCN Students

Table 19 Cross tabulation of learning style (according to Kolb) and Knowledge 108 scores of 4th year UPCN students

Table 20 Cross tabulation of learning style (according to Kolb) and skills scores 108 of 4th year UPCN students


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LIST OF FIGURES

Figure No. Title Page

Figure 1 IV regulation formula and drop factors 19 Figure 2 Conceptual Framework 50 Figure 3 Data collection and analysis algorithm 64

Figure 4 Learning Style profile 74

Figure 5 Instructions for IVT Skills Observation 77

Figure 6 Percentage distribution of sex of 4th year UPCN students 89

Figure 7 Percentage distribution of age of 4th year UPCN students 90

Figure 8 Frequency distribution of 4th year UPCN students who did not perform 93

important IVT procedures

Figure 9 Percentage distribution of the learner type (according to Kolb) of 4th year 105

UPCN students

Figure 10 Learning Framework (similar to Path Analysis) 112


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ABSTRACT

Intravenous Therapy competency is essential for any beginning nurse in matters of patient

safety. This retrospective cohort study aims to explore the level and factors related to retention

of Intravenous therapy skills, knowledge and attitudes. As a pilot investigation, ten senior

students were chosen by convenience sampling from the University of the Philippines College of

Nursing. Students were assessed using the IVT Skills Observation Checklist (Multi-rater

Kappa=0.86), IVT Knowledge Assessment Exam (CVI=0.978; Cronbach’s alpha=0.339), and

IVT Attitudes Survey (CVI=0.973, Cronbach’s alpha=0.912; split-half reliability=0.846).

Knowledge level was relatively high (M=23.9, SD=1.79).Paired t-test revealed no relative

retention of skills, t(9)=13.065, p=.000. Factors including learner attitudes had weak negative

correlation to skill decay. Differences between ideal and actual practice are perceived barriers to

retention.

Keywords: intravenous therapy, skills, knowledge, attitudes, retention, nursing students


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CHAPTER I

INTRODUCTION

Intravenous Therapy (IVT) is among the various aspects of nursing care expected from a

student nurse. Skills, knowledge and attitude, if properly done, make up a student nurse’s

competence in the said skill. In a clinical setting, IVT should be carefully practiced or applied as

complications, whether local or systemic, may arise. Infiltration, extravasation, phlebitis,

thrombosis site infection, embolism, speed shock are some of the complications in IVT.

Moreover, medication errors and potential adverse drug events are most common in

Intravenous route because of its complexity and greater number of steps in preparation,

administration, and monitoring (Bates, Clapp, Federico, Goldmann, Kaushal, Landrigan,

McKenna, 2001; Williams, 2007). Most nurses adapt the intravenous skills they observe which

often times lead to bad practice (Morris, 2006). Furthermore, there have also been marked

differences between how IVT is done by the nurses-on-duty in the clinical area and the ideal

process of IVT taught to the student nurses. These give opportunities for discrepancies in the

nursing care rendered by the student nurses, compromising the safety of actual patients.

The UP Manila College of Nursing is a center for excellence in nursing education in the

Philippines. Its curriculum has been the epitome of competency-based instruction in the country.

IVT is taught among its students beginning sophomore year, and clinical exposure is provided in

various fields until senior year.

Several factors are looked into to further understand a student nurse’s performance on

IVT. These factors affect the wide continuum on IVT from learning the nursing care to the

retention of the student nurses of the said care. In context, the learning process and the factors

that go into play after relatively immediate performance on IVT affect the level of retention of the

student nurse. Indeed, the learning and possibly mastery of the nursing skills and knowledge,


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coupled with the right attitudes, are important in the making of competent nurses and in the care

of their patients.

Statement of the Problem

Proper skill, knowledge and attitude on IVT are few of the expected competencies of a

student nurse. As IVT is considered essential and commonly encountered in the clinical areas,

students need to be evaluated in terms of how this is retained in order for them to become

effective caregivers once they graduate. IVT competency is essential for any beginning nurse

especially in matters of patient safety and well-being. How IVT is retained through the formative

years of nursing education remain unexplored. It is therefore the intention of this study to

measure the level of retention of senior students on IV Therapy, and the factors which may be

related to the measured retention of skills, knowledge, and attitudes on IVT.

Goal: To explore the level and factors related to retention of skill, knowledge and attitudes of

senior students on IVT.

Objectives:

1) To assess the current level of skills, knowledge and attitude of fourth year students

on IVT.

2) To evaluate the retention of skill of fourth year students on IVT.

3) To derive a learning framework that would describe factors perceived and

experienced by senior students on retaining skills, knowledge, and attitude on IVT.

Significance of the Study

The study will explore the level and factors related to retention of skill, knowledge and

attitudes on IVT of student nurses, particularly the seniors, at the University of the Philippines

College of Nursing.Through this study, nurse educators and student nurses themselves may be


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able to devise strategies based on the factors identified which can help enhance their level of

skill, knowledge and attitude retention in performing IVT. Also, nurses themselves, who work

with student nurses in the clinical setting, may be able to gain knowledge on how to help the

students perform IVT on their patients well. Furthermore, the findings of this study may bring

about change in the teaching of the said skill to future students of the College of Nursing so that

they may be more effective and confident in their performance. There is also limited literature

regarding skill retention of student nurses in IVT. In a higher sense, administrative personnel

may also realize the effects of this study by changing the current status of the College in terms

of its academic and clinical facilities.

This study does not pose implications on the student nurses and educators alone; it is

also significant in the patient’s involvement in health care. Because this study tackles the ideal

IVT; performances of the student nurses on actual and real patients, this can make patient

safety and prevention of complications possible and easier to achieve.

Derivation of a learning framework, as one of the objectives of the study, could be a tool

to devise teaching strategies that will effectively provide students high quality education while

still taking into account individual difference of these students as factors that affects retention

are identified. To date, there has been no literature that provides a theoretical framework about

the factors perceived and experienced by senior nursing students in learning and retaining

skills, knowledge and attitudes on IVT. In addition to this, a learning framework that successfully

does the above function may be the cornerstone for further improvement and refinement of the

way intravenous therapy is taught in various nursing institutions.

Definition of Terms

Adverse drug effects – the undesirable or potentially dangerous effects of drugs, which are

more severe than the side effects that may justify the discontinuation of a drug (Karch,

2008; Kozier, Erb, Berman, & Shirlee, 2008)


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Attitude – the feelings, beliefs, approaches, and values towards others, one’s self or one’s work

which facilitate the execution of the skill of a particular task (University of the Philippines

Manila College of Nursing, 2006)

Drug – any chemical compound that is introduced into the body to cause some sort of change

and is taken for disease prevention, diagnosis, cure or relief (Kozier et al., 2008; Amy

Karch, 2008)

Feedback – the modification of one’s learning through the use of corrective processes such as

reinforcement and punishment

Intellectual skill – the knowledge of how one applies what he knows into practice or how one

performs procedure that may be applied to a class of task (White and Mayer, 1980)

Intravenous Fluid Regulation –the control of the rate of flow of Intravenous fluids, whether

manual or involves an automatic pump, as it is delivered to the vein (Martelli, 2002)

Intravenous Fluid/Drug Administration – administration of the medication or intravenous fluid via

the intravenous route (Bulechek et. al, 2008)

Intravenous Fluid/Drug Calculation –the process which determines the exact amount or dose of

any medications to be administered or added to a solution and the rate of flow in which

the infusion is to be completed (Kozier et al., 2008)

Intravenous Fluid/Drug Error –a term used interchangeably with medication error that refers to

the deviation in the preparation or administration of a medication/fluid from a doctor’s

prescription, hospital intravenous procedures, or the manufacturer’s instruction (Cousins,

Sabatier, Bengue, Schmitt, & Hoppe-Tichy, 2005)

Intravenous Fluid/Drug Preparation – the process of preparation, reconstitution and assembling

of fluids or drugs for administration

Intravenous site care – different interventions whose goal is to prevent the occurrence of

untoward events or complications on the intravenous access or adjacent to the

intravenous site (Kozier et al., 2008)


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Intravenous therapy (IVT) – the infusion of fluids, electrolytes, blood components, nutrients, or

medications directly into the vein which is appropriate when rapid effect is required

(Kozier et al., 2008). In this study, IVT covers skills such as calculating dosages,

regulating, and preparing and administering intravenous medications.

Knowledge –one’s understanding of the concepts of IVT such as intravenous medication

calculation, regulation, preparation, administration and intravenous site care gained

through experience or study

Learner Satisfaction – the positive attitudes or any blissful feeling towards activities that promote

learning and knowledge acquisition (Yu-Je Lee, 2008)

Motivation – the perception of the importance of a given task affected by needs, potential

outcomes, and the individual’s estimate of the probability that a certain behavior will lead

to the desired outcome

Percent Difference of Skill Score – the difference between the skill score from the IVT

Observational Skills Checklist and the score from the IVT practical examination taken

during the sophomore year all over the score from Observational Skills Checklist

Retention – a preservation of the effects of learning and experiences which makes recognition

and recall probable (Merriam Webster Dictionary, 2012). It is the output of the learning

process which deals with preservation of essential skills, knowledge, and attitude on IVT.

Self-perception – the awareness of and how one feels about one’s self, whether satisfied or

dissatisfied

Skill Decay – the magnitude measured in absolute value of the negative percent difference of

skill score, indicating deterioration of trained or acquired skills


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Scope and Limitations

The study is simply an exploration of factors affecting retention of skills, knowledge and

attitude on IVT. The researchers want to determine and explore the reasons why fourth year

students of University of the Philippines Manila College of Nursing retain their respective skills,

knowledge and attitude on IVT. This nature of the study is limited only on the ability to retain by

the respondents towards the said criteria.

In addition to the above limitation, the study will focus on IV medication administration.

Indications for IVT such as blood transfusion and total parenteral nutrition are outside the scope

of the study. Also, this study does not include the skill on inserting an IV cannula. However, the

concept of venipuncture is still very relevant to IVT that the nurse must also know this in order to

look out efficiently for complications. The skill on IV site care is not highlighted in this study, but

it is a very crucial component of other IVT skills so that site infection will be avoided.

Part of the limitation is that the data collection and analysis will be conducted within 2

months limiting the study population to 1 year level, the fourth year students of The University of

Philippines Manila College of Nursing. The study is limited only to the effects of skills,

knowledge, and attitude of the participants. Because of the limited number of sample available,

results may not necessarily reflect for all student nurses in The University of Philippines Manila

College of Nursing.

This study is part of a pilot research on student nurses at the University of the

Philippines College of Nursing. At this point in time, the results obtained cannot be applied to all

nursing schools in the Philippines. Further studies on larger populations may be done to

produce findings that can be generalized.


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End Notes

Arthur W., Bennett W., Stanush P., & McNelly T. (1998). Factors that influence skill decay and

retention: A quantitative review and analysis. Human Performance11(1), 57-101.

Retrieved from http://www.owlnet.rice.edu/~antonvillado/courses/09a_psyc630001/

Arthur,%20Bennett,%20Stanush,%20&%20McNelly%20(1998)%20HP.pdf

Bates, D., Clapp, M., Federico, F., Goldmann, D., Kaushal, R., Landrigan, C., & McKenna, K.

(2001).Medication errors and adverse drug event in pediatric inpatients. American

Medical Association, 285: 2114-2120. Retrieved from http://jama.jamanetwork.com/

article.aspx?articleid=193775

Cousins, D. H., Sabatier, B., Bengue, D., Schmitt, C., & Hoppe-Tichy, T. (2005). Medication

errors in intravenous drug preparation and administration: a multicentre audit in the UK,

Germany and France. Quality and Safety in Health Care, 14(3), 190-195. doi:

10.1136/qshc.2003.006676

Bulechek, G. M., Butcher, H. K., & Dochterman, J. M. (2008).Nursing interventions

classification. (5th ed., p. 483). Missouri: Mosby Elsevier.

Kozier B, Erb G, Berman A, Shirlee S. (2008). Fundamentals of Nursing.Concepts, Process,

and Practice.8th edition.Prentice Hall.

Martelli, M. E. (2002). Intravenous Fluid Regulation.Gale Encyclopedia of Nursing and Allied

Health. Retrieved from http://www.healthline.com/galecontent/intravenous-fluid-

regulation.

Merriam-Webster Dictionary. (2012). Merriam-Webster, Incorporated. Retrieved from

http://www.merriam-webster.com/info/copyright.htm

Morris, R. (2006). Intravenous drug administration: a skill for student nurses? Paediatric

Nursing, 18. Retrieved from http://www.biomedsearch.com/nih/Intravenous-drug

administration-skill-student/16634383.html


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O’Neil H., Rivera N. (2011). Educational psychology and human factor issues involved in

studying (or evaluating) degradation of skills. Powerpoint presentation on Skills

Deterioration Symposium held in Newport beach, CA. Retrieved from

http://www.tatrc.org/conferences/MMVR_2011/ppt/ONeil-MMVR-CCC-2011.pdf

University of the Philippine Manila College of Nursing (2006).Competency-based BSN

curriculum: a model (Vol. 1). Ermita, Manila: The College of Nursing University of the

Philippines Manila.

White, R. T., & Mayer, R. E. (1980).Understanding intellectual skills. Instructional Science 9,

101-127. doi: 10.1007/BF00120858

Williams, D.J.P. (2007). Medication errors. Journal of the Royal College of Physicians of

Edinburgh, 37:343–346. Retrieved from http://www.rcpe.ac.uk/journal/issue/journal_

37_4/Williams.pdf

Yu, J. (2008). A study of the Influence of instructional innovation on learning satisfaction and

study achievement. The Journal of Human Resource and Adult learning, 4(2). 43-54.

Retrieved from http://www.hraljournal.com/Page/6%20Yu-Je%20Lee.pdf


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CHAPTER II

REVIEW OF RELATED LITERATURE

Intravenous Therapy (IVT) is among the various aspects of nursing care expected from a

student nurse. The discrepancies on how IVT is done, the severity of possible intravenous

complications, and the prevalence of intravenous medication errors lead to compromised patient

safety. Several factors are looked into to further understand a student nurse’s performance on

IVT. These factors affect the wide continuum of IVT from learning the nursing care to the

retention of the student nurses of the said care.

The research aims to explore the level of and factors related to retention of skills,

knowledge, and attitudes of fourth year nursing students on IVT. The factors related to the said

difference in retention shall also be described.

The various literatures presented here were searched using keywords such as IVT,

intravenous skill, intravenous skill retention and retention factors. These were used for MedLine,

PubMed, Google Scholar, ProQuest and other internet database searches. Combinations of

these keywords were used to limit or expand search hits. However, no limiting time frame was

used in searching for literatures because few researches have been done on retention of IVT

skills of nursing students. The search yielded approximately a total of 30,000 journals and other

relevant materials on IVT. Using the keyword nursing students in the advanced search, the

journals were reduced to 11,000. 60 journals from the said list were found to be beneficial in

answering the questions needed to meet the objectives in this study. 10 secondary references

were also obtained from these materials. In addition, books on general nursing concepts such

as IVT skills were also utilized. A total of 3 books were found to be useful in the search.

The literatures are classified under four main topics which are IVT, teaching IVT,

theories on learning and retention and the synthesis of these various theories. The first topic

presents skills involved in IVT, namely intravenous calculations and regulations, and medication


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or fluid preparation and administration. The second part discusses the methods in teaching IVT

in the University of the Philippines Manila College of Nursing compared with other local and

international nursing institutions. The sections on the theories of learning and retention aim to

give the reader a short background information about several theories used to come up with a

synthesis, which is discussed in the next section.

Intravenous Therapy (IVT)

IVT is the infusion of fluids, electrolytes, blood components, nutrients, or medications

directly into the vein which is appropriate when rapid effect is required (Kozier et al., 2008). It is

used for the purpose of providing nutrition, maintaining fluid and electrolyte balance,

administering medications, and transfusing blood and blood products.

This portion is divided into 2 sections namely Medication/Fluid Preparation and

Administration, and Intravenous Calculation and Regulation. Each section includes the

standards, the common errors, and the nursing interventions implemented to minimize the said

errors.

Intravenous Calculation and Regulation

Intravenous fluid therapy is a mainstay treatment for patients experiencing severe fluid

losses or for those who cannot tolerate oral fluid intake (DeLaune & Ladner, 2002). Nurses take

this critical responsibility of making sure that accurate flow rate calculations of intravenous fluids

are infuse to their patients (Koohestani & Baghcheghi, 2009). Being a fundamental skill for

nurses, it is imperative that nurses acquire enough skills and knowledge and the right attitude to

correctly and confidently perform this skill.

Standards: Intravenous Calculation and Regulations

Intravenous fluid calculation and regulation is part of a sequence of skill that comprises

IVT. Depending on the type of administration set used in the patient, the formula for calculation

will differ based on its drop factor. There are three types of commonly used administration set in


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the clinical setting: macrodrip, microdrip and blood transfusion set (DeLaune & Ladner, 2002).

The figure below shows the formula used in IV regulation and the corresponding drop factors for

each administration set.

Figure 1. IV Regulation Formula and Drop Factors

( )

( )

DROP FACTORS

Macrodrip 15 gtts/min

Microdrip 60 ugtts/min

Blood Transfusion 20 gtts/min

Source: Fundamentals of Nursing. Kozier et al. (2008).

Errors: Intravenous Calculation and Regulations

To date, many studies have shown errors in IVT caused by incorrect calculation or

wrong infusion rate. Medication errors and potential adverse drug events are more common in

intravenous route followed by oral and inhalation (Bates et.al, 2001).

There are many types of intravenous medication errors. In the study conducted by Parry,

Rob, Westbrook, and Woods (2011), four types of intravenous medication administration errors

were accounted for 91.7% (n=363) of all clinical errors. These errors are related to wrong

mixture, wrong volume, wrong rate, and drug incompatibility.

Many reasons account for the medication errors associated with intravenous

medications. First, it is because intravenous medications come with higher risks and severity of

errors because of its complexity and greater number of steps in preparation, administration, and

monitoring. This is consistent with Williams (2011) that states that because of its complexity,

intravenous drug administration had an error rate of 50% found in either administration or

preparation of drug based on a recent study.

Second reason, which is consistent with different researches conducted worldwide, is

that nurses lack the necessary skill to calculate drug doses correctly. Some of the most


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common factors contributing to dosing errors include miscalculation and failure to titrate the

dose to the patient’s needs (NPSA, 2007).

Several studies prove this claim. In a study conducted by Parshuram and his colleagues

(2008), they have identified volume calculations, rounding calculations, and syringe volume

measurement as major causes of IVT errors. Also, proportion of wrong rate and dilution errors

can be attributed to poor calculation skills of nurses. To support this claim, it was identified that

the most common error associated with intravenous fluid administration was wrong

administration rate (Wright, 2009; Rooker and Gorard, 2007; Coombes and Green, 2005).

In summary, the possibility that a medication error is likely to occur is increased when

calculations are needed in order to determine the correct dosage. Errors have been observed

and many of which can be attributed to incorrect preparation, including incorrect dilution of

drugs. Clearly, numeracy is a vital skill for a nurse. Thus, efforts were made to ensure nurses

are properly evaluated in their mathematical skills before they are accepted in an institution

(Williams, 2007; Pauly-O’Neill, 2009; Coben et. al).

Nursing Interventions

Researches about strategies aiming to devise effective ways to develop excellent

numerical skills among student nurses became a product of the various researches citing

rampant IV calculation errors in the clinical area. Koohestani and Baghcheghi (2009) compared

two educational methods in teaching intravenous drug rate calculation: the traditional formula

method and dimensional analysis method which focuses on conversion relationship.

In addition, various factors may have a positive impact on this type of medication error.

Some of which include teaching students about calculation of dilutions and rates correctly by

applying basic mathematical principles, and supervision by on-site faculty. The delivery and the

course content are also included in the factors that affect safe medication administration among

students (Pauly-O’Neill, 2009; Burston et al., 2011).


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In line with this, an effective teaching strategy to drug calculation involving a three stage

approach was proposed. This includes addressing mathematical concepts, teaching the formula

for drug calculation, and practicing the skill in the clinical setting. In a clinical setting, it is

essential for the dosage calculation to be checked by another health care professional before

administering the drug as suggested by Williams (2007). In addition to this teaching approach,

face-to-face tutorials, on-line training, refresher classes and practice sessions were suggested

as effective strategies as well. These medications administration and calculation workshops

were suggested to be held regularly to improve the knowledge and skills of student nurses

(Wright, 2005; Emanuel & Pryce-Miller, 2009; Burston et al., 2011).

Medication/Fluid Preparation and Administration

Intravenous Administration is the process of giving medication or fluid directly into a

patient’s vein. It is done for the purpose of initiating a rapid response to a medication, controlling

the amount of drug delivered to the body, replacing fluid loss and imbalances, maintaining fluid,

electrolyte and acid-base balance, administering blood and blood products, providing parenteral

nutrition and monitoring cardiac function (Martelli, 2002; Chamley & Wilson, n.d; Lippincott,

2001).

Standards: Intravenous Medications/Fluid Preparation and Administration

The process of IV administration starts with preparing the fluid/medication to be

administered. The first thing that must be done is to verify the doctor’s order. Upon verifying, the

nurse must accomplish an IV label form with the following information: patient’s name, room

number, solution, drug incorporation, bottle sequence and duration. The patient must then be

oriented with the procedure to be done and during this time, the nurse must be able to select the

appropriate vein to be used for administration. Afterwards, the nurse observes aseptic technique

through hand washing and he/she prepares the necessary equipment to be used (IV tray with IV

solution, administration set, IV cannula, antiseptic solution, cotton balls with alcohol, plaster,

tourniquet, gloves, splint and IV stand). When all the materials needed were prepared, the nurse


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attaches the IV label form that he/she accomplished to the IV bottle while making sure that it

doesn’t cover the original label of the IV bottle. Following the procedure, the nurse opens the

seal of the IV solution and disinfects the port with cotton balls with alcohol. The nurse then open

the administration set aseptically and close its clamp. After opening the administration set, the

nurse spikes it straight to the port of the IV bottle aseptically. He/she fills the drip chamber to at

least half and prime the tubing aseptically. If there is any air bubble left, the nurse removes it

and he/she puts back the cover of the distal end of the tubing (Fundamentals of Nursing

Checklist, Unpublished, University of the Philippines Manila College of Nursing, 2011).

Proper IV administration should follow the five "rights" of medication administration to

avoid medication errors. The nurse is accountable in checking if it is the right patient, the right

drug, the right dose, the right time, and the right route before giving any medication (Kozier et

al., 2008).

The IV line must also be intact before any IV medication can be administered. As

mentioned in Lippincott’s Manual for IVT, some IV medications can cause severe tissue

damage if injected into the tissue through an infiltrated IV site. Some IV push medications must

be diluted before injection. The health care professional must check the directions for giving the

specific drug IV before performing the injection. Incorrect dilution may cause adverse reactions

from mild to severe, compromising the health of the patient. Administration guidelines for giving

IV medications must be followed to avoid serious complications from the drug injection. Most

medical settings have an approved IV drug list and instructions for injecting each drug IV

(Martelli, 2002).

Intravenous medications may be given through the IV port, heparin-lock device, piggy

back or volumetric chamber and infusion pump. Various techniques of administration are also

observed in IVT. IV push medication techniques deliver a bolus of medication directly into a vein

or access port to produce an immediate peak drug level in the patient's bloodstream. Bolus is a

dose of medication injected all at once intravenously. A bolus injection is most often given


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through a peripheral IV line, a saline lock, directly into a vein, or through a vascular access port

Martelli defined saline (heparin) lock as “a peripheral IV device that has been locked off to

prevent venous fluid from flowing out.” It is primarily used to access a vein for intermittent IV

drug therapy (Martelli, 2002; Kozier et al., 2008).

When medications are to be given intermittently, there are many types of tubing and

apparatus that can be used to deliver IV therapy, one of which is the piggyback or volumetric

chamber. The basic principles in delivering intermittent intravenous medications include:

ensuring that the IV secondary set (piggy back) is positioned into the correct port on the main IV

line and verifying that the pump is set to deliver the IV medication over the correct amount of

time that was ordered by the physician. All lines are primed before they are connected to the IV

to avoid delivering air through the lines (Martelli, 2002; Kozier et al., 2008).

Preparation of intravenous medications does not only involve the lines to be prepared

but also the site. Intravenous site preparation consisted of the standard for the peripheral IV

catheter securement upon installation of the catheter and also how long will the “secured”

catheter last. The reason for the much needed standard for IV site preparation is because of the

frequent catheter restarts. It has been found out that nurses are already stressed by this and

they tend to get less of their routine work done. Furthermore, it was determined the most

efficient way of securing a peripheral IV catheter line by comparing three ways. These ways are

the traditional method namely using a non-sterilized tape, second is using a securement device

called StratLock and lastly using a HubGuard device (Smith & Royer, 2007).

Errors: Medication/Fluid Administration

In recent years, reports on medication errors have found that administration of

medications is an area of weakness, where potentially life-threatening mistakes could be made

(Social Care Association, 2008).

The most common medication errors concerning intravenous medication administration

root from wrong dose, wrong drug and wrong route (Hugh & Belgen, 2010). Medication errors,


24

specifically in intravenous therapies, also occur when there is a breach in the standards of

safety. These unsafe breaks in best practice include inappropriate syringe reuse between

patients, contamination of vials or bags by way of improper accessing techniques, failure to

follow basic safety recommendations for the preparation and administration of parenteral

medications, and unsuitable maintenance of multiuse devices shared between patients (Clifford,

2010).

Nursing Interventions

As in any health care setting, the welfare of the client is the priority of the health care

professionals. Medication administration is a potential avenue for the occurrence of errors which

may be detrimental to client’s safety. Hence, the accountability of the nurse to his or her patient

is very essential. The College of Nurses of Ontario in 2006 released a practice guide to help

nurses in minimizing the possibility of errors to ensure high quality care.

Nurses are most involved at the medication administration phase. They avoid errors in

medication administration and promote patient’s safety. “Rights” were established as guide in

preparing and administering drugs. Among these rights are the following: right drug; right client;

right dose; right route; and right time (Social Care Association, 2008).

According to the College of Nurses of Ontario, during medication administration, the

nurse must observe standards, including the rights aforementioned, as these will ensure the

safety of the client. The standards of medication administration in the handbook released by the

said college include the application of principles of aseptic techniques and preparation and

administration of medication according to the practice setting medication administration system.

Standards observed may vary from one institution to another but although there are

variations every standard system for medication administration aims to protect the welfare of the

patient. This is consistent with Rosenthal (2007) that gave due emphasis on the reducing the

risks for potential complications specifically infiltration and extravasation arising from IVT. This

included the range of effects of these complications and what signs to watch out for.


25

The role of the nurse in medication therapy and patient safety is very crucial. Hence, he

or she must be guided by the principles of correct drug preparation and administration.

Nurses are expected to administer medications in a timely fashion, considering the

nature of the medication, the action and the client’s condition (Shawyer et al., 2007). There are

numerous reasons why the timing of medication preparations, including the preparation of

intravenous solutions, requires careful consideration (Clifford, 2010). Workplace processes can

potentiate conditions that lead to unsafe breaches in infection control methods.

The College of Nurses of Ontario does not specify a time frame for when medication

must be administered; however, nurses should consult their practice setting policies and

government guidelines that may require a specific time frame. Appropriate monitoring while

administering the medication, and intervening if necessary, is also required. After administration,

nurses are tasked to evaluate client outcomes including benefits, side effects and signs of drug

interactions.

In brief, the role of the nurse is integral in drug administration, especially in intravenous

therapies. IVT is one which requires cognitive knowledge and competence in performing the

skills needed in intravenous drug administration. As stated by Shawyer and colleagues, “nursing

students can now undertake IV drug administration following local guidelines.” Nursing schools

are the primary institutions accountable for the training of nursing students in IV therapy.

Training of students does not only involve the cognitive learning but also the mastery of skills in

this nursing practice.

Teaching IVT

University of the Philippines College of Nursing

The University of the Philippines Manila College of Nursing utilizes a competency based

framework in its curriculum to ensure a systematic approach to acquiring and improving

competence in nursing practice. The college believes that the acquisition and effective use of


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the abilities, skill, knowledge, judgment, attitude, and values yields competence in an individual.

A student must possess entry competencies, intermediate competencies, and terminal

competencies before advancing to a succeeding course or to a higher year level. Moreover, as

part of the competency-based framework, the college uses Skill, Knowledge, and Attitude

Analysis or SKA Analysis per nursing task and responsibility (University of the Philippines

Manila College of Nursing, 2006).

The college systematically ensures that there is variety in the teaching-learning

experiences and that student participation and opportunities to practice behavior is maximized.

With this, the college utilizes several instructional functions based on Segall’s Systematic

Course Design for the Health Fields. These includes (a) providing a frame of reference, (b)

providing a reason to learn, (c) shaping student’s attitudes, (d) transmitting information, (e)

demonstrating behaviors to be learned, (f) allowing students to practice behaviors, and (g)

providing feedback on student performance (UPCN, 2006).

IVT is a nursing intervention taught to second year students in the course Nursing

Foundations II (N-11). The course tackles particular concepts, principles, and basic procedures

while emphasizing the nurses’ role in diagnosis, treatment, and rehabilitation. Part of the nursing

responsibility covered by this course includes planning and implementing with the client the

appropriate nursing interventions such as meeting the client’s need for fluid and electrolyte

balance through IVT.

Several instructional activities are utilized in teaching IVT. The faculty conducts lecture-

discussion about the principles in making medication cards, transcribing orders, computing

infusion rates, and preparing and administering drugs emphasizing the nurses’ roles and legal

consequences in case of negligence. Films or slides regarding the methods of drug

administration are shown and discussed. Students are allowed to demonstrate proper drug

administration on models or simulated patients. Hand-outs on common abbreviations used in

medication administration and on the correct step-by-step procedures in IVT are also provided.


27

Through a laboratory session or an actual clinical experience, the students are tasked to return

demonstrate IVT skills, explain principles behind each procedure and implement appropriate

nursing interventions under supervision.

Given relevant questions and simulated or actual situations, the students are expected

to demonstrate procedures such as calculating and regulating of intravenous fluids, preparing

the intravenous infusion set-up, preparation of blood transfusion set-up, assisting in intravenous

insertion, and starting and discontinuing intravenous fluids or blood transfusions.

The different competencies are evaluated through the use of objective, short answer or

essay type exams, practical examination using Observed Structured Clinical Evaluation,

performance on clinical practice based on criteria, and attitudinal rating scale (UPCN, 2006).

Local and International Nursing Institutions

Similar to the University of the Philippines Manila, several schools in the country, such

as the Our Lady of Fatima University College of Nursing, and several international nursing

schools and colleges, such as the New York University College of Nursing and the John

Hopkins School of Nursing, utilize didactic classes, laboratory simulations, and clinical

experiences to achieve the competencies of the students.

However, the New York University College of Nursing uses innovation and the most up-

to-date technologies to facilitate learning. The college has a Clinical Simulation Learning Center

which serves as a virtual hospital wherein student nurses can practice their skills in an

environment similar to the real life patient care setting in order to provide safe and competent

nursing care. Half of the students’ clinical learning experience stake place at the Clinical

Simulation Learning Center. This learning center also has Human Patient Simulators

programmed with case-based scenarios where students can practice various skills such as IVT

without the fear of harming the patients (New York University College of Nursing, 2013).

Similarly, the Our Lady of Fatima University College of Nursing in the Philippines also

has a Nursing Virtual Laboratory which utilizes a Paperless Training Program geared towards


28

advance learning for students to better integrate their nursing knowledge and skills to the

management of information (Our Lady of Fatima University).

In Johns Hopkins School of Nursing, medication administration including IVT is tackled

in two courses namely NR 110.304: Principles and Applications of Nursing Technology and NR

110.307: Patient Centered Care. The first course, which is taken in an earlier semester,

addresses the skills and knowledge needed to provide a safe and effective nursing care.

Principles of safe medication administration and monitoring are also included in this course. The

second is a combined clinical and laboratory course which integrates skill, knowledge, and

attitudes learned from the previous semester (The Johns Hopkins School of Nursing, 2012).

Theories on Learning

Over the years, numerous theories regarding the process of learning have introduced

different views through which to study this phenomenon, such as behaviorism and cognitivism.

Behaviorist Theories on Learning

Behaviorism contended that only the observable and measurable aspects of behavior

can be studied and, eventually, learned. Jean Watson, who coined the term “behaviorism”, had

proposed that the learning of a certain behavior can be associated with specific environmental

stimuli: the learner will associate specific stimuli with a certain response (Parkay & Hass, 2000;

Internet Encyclopedia of Philosophy, 2005).

B.F. Skinner’s Operant Conditioning

For B. F. Skinner, reinforcement plays a role in facilitating learning. Operant conditioning

is the process wherein the learner behaves in certain ways to produce desirable outcomes, or

reinforcements. Reinforcing a behavior leads to repetition of that behavior; conversely, when a

behavior is not reinforced, it tends to be weakened or die out. Reinforcement may either be

positive or negative. Positive behavior can strengthen a behavior and leads to repetition of that

behavior. Negative reinforcement can also strengthen behavior as it involves the removal of an


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adverse stimulus leads to a feeling of being rewarded in the individual. The concept of

punishment has also been applied in learning. It is designed to weaken or eliminate the

behavior through presenting an aversive stimulus (positive punisher) or through the removal of a

positive stimulus (negative punisher) (Recio, et al, 2004).

Clark Hull’s Theory

Developing the stimulus-response (S-R) framework further, Clark Hull introduced the

concept “intervening variables” into the S-R relationship. The importance of these intervening

variables, which were identified as the internal mechanisms of the learner, was shown in Hull’s

theory that made use of deductive reasoning similar to that used in geometry. He formed a

system of basic laws or “postulates” which would predict the behavioral responses (as “output

variables”), based on the external stimuli present (as “input variables”) and the internal

mechanisms of the learner (as “intervening variables.”) The system of “postulates” Hull has

created would contain and define the different relationships and attributes among the three

variables. This theory of Hull, known as the Mathematico-Deductive Theory of Behavior which

was published in 1940, showed the makings of the cognitivist approach into learning, as it

considered not only the impact of the environmental stimuli, but also the importance of learner

himself and his internal mechanisms (Schrock, 1999; Internet Encyclopedia of Philosophy,

2005).

Cognitivist Theories on Learning

Cognitivist approaches the process of learning by studying the mental processes

occurring in the learner. The existing mental structures and previous experiences of the learner

are factors that influence the process of learning. It argues that not all learning occurs through

the shaping and changing of behaviors and that learning is a change in the state of knowledge

of the learner. The cognitivist approach is widely known for its view of the learner as an

information processor, wherein the learner is an active participant of learning. The information

processing theory makes use of a computer model to describe the process of learning in the


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individual. The process starts with the information being sensed and registered in the computer.

It then momentarily becomes a part of short-term or, working memory. The information will then

be encoded and stored in the long-term memory. Depending on how well it was encoded, the

information will then be retrieved (Ally, 2008; Ertmer & Newby, 1993).

David Ausubel’s Assimilation Learning Theory

David Ausubel, a cognitive psychologist, explained learning through his assimilation

learning theory, wherein the learner is characterized as having existing concepts and ideas and

that this existing framework in the learner is broadened with the introduction (assimilation) of

new concepts and ideas. He further defined learning as being meaningful and effective when

the learner himself is able to match and connect the newly acquired structures of knowledge

with the existing organization of knowledge that he already has. He strongly believes that the

single most important and influential factor to learning is the learner’s existing knowledge

(Novak, 1998).

Albert Bandura’s Observational Learning

Albert Bandura (1977) introduced observational or social learning which primarily shows

that the process of learning takes place simply by observing another individual. Through

modeling, the learner will observe and then repeat the behavior. He identifies two types of

models: (1) a live model, or an actual person demonstrating a behavior, and, (2) a symbolic

model, or a person or character that is portrayed in a medium, such as a television or book. For

a learner to observe and repeat the behavior of the model, several factors such as the

characteristics of the model and of the observer, as well as the reward consequences of the

behavior are considered. Observational learning is composed of four component processes: (1)

attentional processes, (2) retention processes, which may occur through creating visual images

or describing the behavior verbally; (3) reproduction processes, and, (4) motivational processes.

The learner must first pay attention to the model. He then must remember the aspects and

recognize patterns in the behavior. He will then use these behavioral patterns and aspects,


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which have been translated into visual images or verbal descriptions, as a guide to practice the

observed behavior. Finally, with proper motivation, the learner will be more attentive to the

model, retain more information, and be more eager to practice the behavior. This concept of

observational learning provided the foundation for Bandura’s later work in 1986: the social

learning theory, which he later renamed, the social cognitive theory.

Other Theories, Models and Concepts on Learning

Aside from these well-known schools of thought and their implications on learning, there

are other theories that explain learning in terms of the learner himself and the conditions in

which the learning occurs.

Robert Gagne’s Conditions and Outcomes of Learning

Robert Gagne related the concepts of learning and instruction design to provide better

understanding on how to facilitate learning more effectively. His theory of conditions of learning

recognizes five types of learning or learning outcomes, which are somewhat similar to the three

domains of learning that Bloom had created (skill, knowledge, and attitude). The five learning

outcomes are, namely, (1) verbal information, (2) intellectual skills, (3) cognitive strategies, (4)

motor skills, and (5) attitudes, each of which leads to a different class of human performance.

Also, two types of conditions in which the process of learning takes place were stated by

Gagne: internal and external conditions. Internal conditions were described as those intrinsic

states which were required in a learner to acquire the outcomes of learning. It is in other words

what the learner knows prior to the instruction. External conditions refer to the environmental

circumstances which may influence the process of learning in an individual, an example of

which is the instruction design. Furthermore, central to Gagne’s theory is the importance of

using instruction designs in the context of the learner’s needs. Instructions should be designed

in order to meet the needs of different learners using various instructional methods. Gagne

summarizes his points in nine instructional events: (1) gaining attention, (2) informing learner of

the objective/s, (3) stimulating recall of prerequisite learning, (4) presenting the stimulus


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material, (5) providing learning guidance, (6) eliciting the performance, (7) providing feedback

about performance, (8) assessing performance, and (9) enhancing retention and transfer

(Gredler,1997).

Patricia Benner’s Novice-Expert Model

Patricia Benner believed that clinical judgments to maintain physiological parameters

within acceptable range requires experience-based intuitions explaining that nurses should

undergo several experiences to reach maximum competence on a certain skill. Different levels

of competence were defined by Benner and her colleagues. These are novice, advanced

beginner, competent, proficient and expert. A nurse has to pass these stages to acquire and

develop skills expected of him or her. A novice or a beginner acquires theoretical knowledge

from the instructor, lacks experience and bases his or her actions on fixed situations making it

limited and inflexible and unable to make complex clinical judgment. Advanced beginners are

those who already gained little experience in clinical setting enabling them to perform clinical

tasks with more confidence and more knowledge on the skill. A competent nurse displays more

experience and is now more confident, efficient in performing tasks and bases his or her nursing

care plan on abstract and more complex analysis of the case. The proficient nurse perceives the

case as a whole and proposes plans to achieve long-term goals and is now able to decide, with

lesser doubt, what to do next to prevent harm and to promote wellness. And lastly, as a result of

years of experience, the expert nurse displays a more subtle and discriminational ability on

looking at seemingly similar situations but is able to achieve goals uniquely for each client and

intuitively grasps each situation with rationality (Benner, Tanner, & Chesla, 1996).

David Kolb’s Experiential Learning Model

David Kolb believes that the learner has preconceived ideas with which he approaches a

certain topic. The different learning styles are results of past experiences of the learner, heredity

and the demands of the present environment. Also known as the cycle of learning, Kolb’s

model includes four types of learners which reflect two major dimensions: perception and


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processing. The model identifies four types of learners which are the diverger, the assimilator,

the converger, and the accommodator. Kolb created the classifications, taking into consideration

two factors: (a) how the individual takes in the information (perception), and (b) how the

individual processes that information (processing). Some learners may perceive through

concrete experience (CE mode) or “feeling” while others may use abstract conceptualization

(AC mode) or “thinking”. Also, on one hand, some learners may process information through

reflective observation (RO mode) or “watching and listening” while others may process

information through active experimentation (AE mode) or “doing”. The four types are a

combination of the four basic learning modes (CE, AC, RO, AE). The learner predominantly

demonstrates the characteristics of one of the four types. The diverger (CE and RO) likes to

observe, gather information and gain insights rather than take action. The assimilator (RO and

AC) is good in inductive reasoning and value theory over the application of ideas. The

converger (AC and AE) finds practical application for theories and facts learned use deductive

reasoning for problem solving. The accommodator (AE and CE) likes hands-on experience,

takes risks and enjoys new and challenging situations (Bastable, 2008).

Felder and Brent’s Influences to Student’s Learning

Specific factors affecting learning have also been studied by several researchers.

According to Felder and Brent (2005), the three major influences on a student’s learning are the

(1) differences in learning styles, (2) approaches to learning, and (3) intellectual developmental

levels. Keefe (1979 in Felder & Brent [2005]) defined learning styles as “characteristic cognitive,

affective and psychological behaviors that serve as relatively stable indicators” that determine a

learner’s perceptions, interactions and responses to the environment. The concept of inferiority

and superiority does not apply in learning styles; one learning style is simply different from

another, each with its own set of strengths and weaknesses.

Felder and Brent (2005) identified three different approaches to learning – surface, deep,

and strategic approach. A student utilizing the surface approach relies on memorization and rote


34

learning. A student who uses the deep approach, on the other hand, not only knows the ideas

but also tries to process them to gain better understanding. A student who uses the strategic

approach first assesses what is needed to be learned and then decides which of the two

approaches would be best suited for use.

Several models aim to explain intellectual development in students. Felder and Brent

(2005) identified four models which have a general form that is as follows: students at the lowest

levels of intellectual development believe that every question has one correct answer and that

their instructors know what it is. As they encounter different interactions and challenges as they

pursue their learning, they gradually discover that in answering queries and analyzing

phenomena, there is not only one but a variety of viewpoints from which they can study the

situation and gain learning. At the highest level of intellectual development, students “reject the

notions of the certainty of knowledge” and attempt to construct their own ideas and concepts,

using analysis and intuition, and taking into account the ideas of experts whom they

acknowledge.

Timothy Blair’s Factors in Student Learning

Blair (1988) identified four factors in students influence their capacity for learning, which are,

namely, (1) self-perception, (2) student needs, (3) emotional maturity, and (4) motivation. A

positive self-perception engages a student to learn and engage in new things and experiences

than a student who has a negative self-perception. For learning to be achieved, student needs

must also be satisfied, following Maslow’s hierarchy of needs. Emotional maturity is another

factor that students must exhibit as in the process of learning, situations of stress and

frustrations will be encountered. Lastly, motivation is an important factor to learning as it is the

beginning of the learning process.


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Theories on Retention

Few attempts have been made to create a model on retention due to various reasons.

However, there were studies that present theoretical models about skill acquisition and

forgetting which is closely linked to retention. Using these theories, we can be able to broaden

our understanding of retention. In addition there were also strategies developed to remember

things easily which may prove to be contributory to student’s retention.

Theories of Skill Acquisition

On skill acquisition, several theories were created to explain the phenomena. Moreover,

Speelman (2005), in his literature review, divided skill acquisition theories as either those

pertaining to strategy refinement or those pertaining to memory retrieval. This subdivision is

similar to what Tulving (1989) said. He claimed that memory has two important aspects: storage

which we equate with strategy refinement and retrieval which is similar to the term used by

Speelman.

Skill Acquisition as strategy refinement

Crossman (1959) explained in his theory on skill acquisition that, when faced with a new

task, we have many strategies that can be potentially useful. With practice, we monitor which

among these strategies is the most efficient and this is how we come to favor this strategy. In

another theory which is the Adaptive Character of Thought (ACT-R) by Anderson et al. (1996),

complex cognition arises from the interplay of procedural and declarative knowledge. Through

encoding of both types of knowledge, we create a large database in our brain and from this

large database; the appropriate units are selected for a particular context by activation

processes that are tuned to the statistical structure of the environment. In many respect, the

State, Operator and Result Theory (SOAR) by Laird, Newell & Rosebloom (1992) is quite similar

to the ACT-R theory by Anderson and the theory proposed by Crossman. In SOAR, there is also

a mechanism of production which is used to solve problems. In each decisional cycle,


36

productions are executed and whichever is the most effective will be retained in the long-term

memory (Speelman, 2005).

Skill Acquisition as memory retrieval

In the latter theories, particularly in ACT-R and SOAR, it generally describes

improvement with practice as resulting from refinement and tuning of procedural skills. However

in this theory by Logan (1990) called The Instance Theory, the improvement in skill is seen as a

result of an increased range of representation of past experiences. Representation results when

we pay attention to an item or event. Logan (1988) claims that a performance can be termed as

skilled when it relies on the retrieval of instance/representation only. With sufficient practice,

exposure to the task will result in retrieval of past solutions. Clearly, person faced with new task

will have to rely on his solutions and with practice; his performance can improved through

retrieval of past solutions. This mechanism is quite similar to Crossman’s model which also uses

past experiences which have been successful (Speelman, 2005).

Theories of Forgetting

Forgetting occurs when one isn’t able to bring into immediate consciousness what he is

trying to derive from his memory. It does not imply complete loss of that object from memory, it

is just that it cannot be retrieved (Lefrancois, 2000). Unlike retention, many theoretical models

were created pertaining to forgetting.

Huang (1977) found a close relationship between time and the accuracy of recognition.

He believed that as time passes, whatever changes or traces learning leaves behind become

less distinct. This phenomenon was coined as Fading Theory. The mechanism of forgetting

from the latter theory is very different from the second theory termed as Distortion Theory. In

this theory, it says that people only remember the main ideas which are abstractions and later

they will regenerate and create details which are far from the original. Another theory was based

on Freud’s notion that people tend to forget those things which are anxiety-provoking or

traumatic and called this Repression Theory. However, this theory is only applicable to


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emotional-related experiences and there are a lot of studies, done which states that when

people were asked to forget information, they are unsuccessful in doing so. A widely known

theory of forgetting termed as Interference Theory, explains that new learning can interfere with

recall of old learning or old learning can interfere with recall of new learning. Although people

may be occasionally subjected to interference of items, indications are that they can continue to

learn all sorts of things without running the risk of becoming progressively more subject to the

effects of interference (Lefrancois, 2000; Lehman, Mc-Kinley-Pace, Wilson & Slavsky, 2000).

Aside from the theories mentioned above, there are also a lot of models and studies that

have been done to explain forgetting. Kolers (1979) conducted a study testing the memory of

people through reading inverted texts. Initially, participants took a long time to read the items but

eventually, when they are exposed sufficiently to the items, they were able to read it faster and

retained a good deal. A year later, the researcher repeated the test but resulted in a fewer

retention of items compared to the previous test done a year ago. He then concluded that only

components of a skill could be forgotten. This study is quite related to the next research done by

Shields, Goldberg and Dressel (1979) in a sense that a part of the skill that is initially acquired is

forgotten. However, in this research about the retention of skills by soldier, they have found out

that certain steps are forgotten and not the whole skill is uniformly subject to forgetting. Those

steps that were prone to forgetting are those that are not related to the previous step or not

suggested by the previous. A striking similarity exists between this study and the one conducted

by Engelback (1986). The participant in his research learned a series of step and a day after

they were tasked to perform the same thing. The results were surprising as the participants

mostly forgot 4 items out of the 61. These items were the ones that are not of big use to them

during the session and those that appeared in a context where a common method is more

appropriate. In summary, Koler’s study claims that skill is forgotten while Shields et al.’s and

Engelback’s studies claims that skills are forgotten systematically and rapid.


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Remembering

Psychology has identified three main strategies that are useful in moving items from

short-term memory to the long-term memory. These strategies are Rehearsal, Elaboration and

Organization. Rehearsal involves the act of repeating. This is a means of maintaining

information on the short-term memory. It is also a means of transferring information to the long-

term memory. The second strategy is elaboration which involves associating information with

previously learned experiences, mental images or materials. Finally, the last strategy which is

organization involves arranging material according to some system. The systems being referred

to in the previous paragraph are: Rhymes and Little Saying, The Loci System and The Phonetic

System. The first one involves the use of mnemonic devices, the second one focuses on the

use of visual imageries and the third one uses associations of visual appearances. Through

these things, it is believed that learning and remembering can be improved (Lefrancois, 2000).

Synthesis of Various Theories of Learning and Retention

Understanding the different theories and understanding the context in the UP College of

Nursing, the researchers have processed to divide the learning process into two main factors

which are the Inputs and Outputs. The elements of these are discussed in the succeeding

paragraphs.

The input-output framework adopted in this study is similar to that of Hull’s. He called the

conditions that affect the organism but that might or might not lead to behavior as input

variables. Similarly, responses are described as output variables. In this study, input variables

considered were the student/learner attributes and the instruction characteristics while the

output variables include the learning outcomes – skills, knowledge, and attitudes.

Individual differences in how the student learns or retains information have been found

to be vital in the level of skill retention. Student related factors are the ones deemed intrinsic to

the person learning the skill. These factors come into play either during the time of learning or


39

when the skill is performed. Factors that affect the initial learning are also important to consider.

Summers et al. (1998) believed that skills do not deteriorate because they are forgotten but it is

due to that they were learned properly in the first place. The skill or information could be

recalled during the time of performance even though it was stored into memory due to it not

being “effectively structured during acquisition” thus lacking a strong association of information

that would help recall (RSSB, 2011).

Robert Gagne identified intrinsic states required in the learner to acquire the new skills,

knowledge, and attitudes, which he later called outcomes of learning (Gredler, 1997). These

states are referred to as internal conditions of learning. These can be categorized as student or

learner attributes, which may be advantageous or considered barrier to the learning process.

Student or Learner Attributes

The learner’s intrinsic states, cognitive processes, and attitudes are important factors in

learning (Gredler, 1997, Gagne, 1984). Moreover, Felder and Brent (2005) also believe that

learning styles, approaches to learning are major influences in student’s learning. Learning

theories grounded on behavioral and cognitive schools of thought may also be used to further

classify the various attributes of the learner.

Motivation

Motivation is an important component in the process of learning (Blair, 1998; Lefrancois,

2000; Sana, 2010). Needs, potential outcomes, and the individual’s estimate of the probability

that a certain behavior will lead to the desired outcome, affect motivation. Aside from these, self-

efficacy and the learner’s need for achievement – the individual’s need to reach some standard

of excellence – are also determinants of motivation, and, thus, of learning. Blair (1988)

characterizes a person with high motivation as someone who “perceives the importance of the

given task, and, when conditions are such that he or she can be successful.” Without

motivation, the learning process cannot commence (Sana, 2010).


40

Student needs are reflected very well by Maslow’s hierarchy of needs. Before the

student reaches the point of self-actualization, or learning, the needs of the student that

precedes this stage must be met. Physiologic, safety, belonging and esteem needs must first be

satisfied in order for the student to achieve learning (Blair, 1988).

Self-perception

Attitudes, as an outcome of learning, appear to modulate behavior (Gagne, 1984). Also,

in contrast with other outcomes of learning, no specific condition for learning attitudes has been

identified. However, Bandura (1977) said in his human model of behavior that when the model

is perceived as admirable, powerful and credible, learning is most effective. This also occurs

when the model is reinforced for his or her choices of action.

In addition to Gagne’s extensive discussion on the internal conditions of learning, other

attributes of the learner may affect the entire process. His or her intrapersonal relationship is

one. Feelings or emotional stability is clearly linked to student learning. Self-perception is an

important aspect of intrapersonal relationship. Blair (1988) related that students who feel good

about themselves are not afraid to learn new things and are interested in gaining new

experiences, while students who have negative self-perceptions are less confident and do not

feel worthy. Self-perceptions are also affected by prior experiences. Events wherein the student

performed well in a given task can boost his or her confidence and help him or her perform well

in the next task.

It is composed of two dimensions, self-concept and self-esteem. Self-concept is the

“description an individual attaches to himself or herself” while self-esteem refers to “the

evaluation one makes of the self-concept and description and to the degree to which one is

satisfied or dissatisfied with in, in whole or in part” (Bean & Lipka, 1986).

Emotional maturity is also an important factor that could affect learning. Emotional

maturity, as explained by Blair (1988), encompasses eight sub-concepts, namely, belonging,

achievement, economical security, love and affection, sharing and respect, to be free from fear,


41

to be free from intense feelings of guilt, and the need for self-concept and understanding. A

student who has achieved all of these is able to handle new situations, periods of frustration and

stress with appropriate reactions and a greater capability for effective coping. When effective

coping is done, learning is better facilitated leading to enhanced knowledge and skills.

Learner Satisfaction

In various studies where teaching of a new skill and/or knowledge is introduced, analysis

of the student’s learning satisfaction is also taken into account. Learning satisfaction is defined

by Yu-Je Lee (2008) as the positive attitudes or any blissful feeling towards activities that

promote learning and knowledge acquisition. Several external factors affect learning satisfaction

such as teachers’ expertise, courses offered, classroom facilities, and ways of teaching (Butt &

Rehman, 2010). In the same study, it showed that these factors have significant impact on the

satisfaction of students in higher education, but of varying degree. Positive relationship with

learning satisfaction was established for each of the factors. Among these factors, the teachers’

expertise is considered to be most highly influential on satisfaction. According to Butt and

Rehman, it shows that the factor that scored high impact on satisfaction “does a good job

enhancing students’ satisfaction in higher education” (2010).

Several studies also looked into the impact of learning setting on students’ learning

satisfaction and outcomes. Macedo-Rouet, et. al (2009) showed that paper-based practice

quizzes and lecture notes helped students perform better than with web-based lectures. The

superiority of paper-based lecture notes and quizzes can be brought by the task coming from

utilizing web-based learning. Web-based texts were more difficult to be understood and less

interesting for the students than the same texts on paper. In another study done by Hale et al.

(2009) comparing the student satisfaction and learning outcomes in the classroom and online

setting, they have identified these additional factors aside from the ones mentioned by Butt and

Rehman: instructor rapport, peer interaction and self-perceived knowledge gains which affect

the learning outcomes. Such factors mentioned result in a better learning outcome for the


42

students. Muldoney & McKee’s study (2011), which involved intensive care as their clinical

environment for learning, also suggests that satisfaction scores were positively associated with

higher levels of the commitment of clinical nurse managers to support learning, fostering the

environment a positive experience for learning.

Learning Styles and Approaches to Learning

According to Felder and Brent (2005), the three major influences on a student’s learning

are the (1) differences in learning styles, (2) approaches to learning, and (3) intellectual

developmental levels.

Students perceive knowledge in different ways. One thing may mean two different things

to two different students. Four types of learners have been identified through Kolb’s Model.

These are the diverger, the assimilator, the converger, and the accommodator. The diverger is

able to relate his or her own experiences to what is being taught. The assimilator uses an

organized manner in processing the information and requires time to reflect on what has been

taught. The converger is geared towards a more “hand-on” type of learning. He or she uses the

trial-and-error method in acquiring knowledge. The accommodator uses his or her own

environment to apply the knowledge he or she has acquired, usually applying it to real life. It has

been mentioned in the research that for a student to be able to maximize his or her learning, he

or she must possess skills characteristic of each type of learner if possible. An instructor, on the

other hand, has the task of catering to the needs of a specific learner and of reducing or

eliminating bias to a specific type of learner.

As previously mentioned by Felder and Brent (2005), identified three different

approaches to learning – surface, deep, and strategic approach. A student who uses the

surface approach usually relies on memory to learn things. In more common terms, this student

may also be known as the ‘book-smart.’ He or she is confined to what the books have to offer

and usually does not question what has been read or told in class. A student who uses the deep

approach, on the other hand, usually tries to take in, digest, and sometimes even question what


43

he or she has learned. For this student, it is not only about knowing, but also about

understanding. A student who uses the strategic approach is a mixture of the other two types.

He or she first assesses what is needed, then makes the necessary decision on whether to use

the surface or deep approach.

Intellectual developmental levels also greatly affect learning. According to Baxter

Magolda, the four levels are the absolute, transitional, independent, and contextual knowing. A

student in the absolute level is much like the student who uses the surface approach. He or she

believes that his or her task is to memorize what has been taught by the instructor. A student in

the second level is able to make judgments about the knowledge acquired. On the level of

independent knowing, a student does not rely solely on his or her instructor. He or she has the

initiative to obtain knowledge from other sources. A student in the contextual knowing level is

open to new evidences; thus, he or she is able to adjust, whether to remove or to add into, his

or her acquired knowledge as needed.

However, the conditions for learning are not all within the individual. The particular kinds

of interactions between the learner and the external environment are also important. The types

of environmental stimuli that may support or hinder learning and the internal learning processes

are called external conditions of learning (Gredler, 1997). Gagne posed the question “What

factors really can make a difference in instruction?” This implies that learning depends greatly

on environmental circumstances, not only on internal processes.

Educational Practices

Guidelines intended for faculty and administrators and for the students themselves,

Chickering and Gamson (1987) enumerated the Seven Principles for Good Practice in

Undergraduate Education. It emphasizes what good practice must be able to provide in order to

facilitate learning and improve teaching. Furthermore, while each principle can be applied

individually in certain situations, applying them all in a given situation yields even greater and

better results in student learning and teacher performance. As Chickering and Gamson (1987)


44

states, all of these principles, when applied together, employ the six powerful forces of

education: 1) Activity, 2) Expectations, 3) Cooperation, 4) Interaction, 5), Diversity, and 6)

Responsibility.

1. Good practice encourages contact between students and faculty.

Faculty and student contact, in and out of the learning setting, increases student

motivation and the student’s involvement in his or her learning. The concern of a teacher to

his or her student communicates support to the student and helps him or her do better.

Furthermore, as Astins’s Student Involvement Model presents, frequent interaction between

faculty and student is more strongly related to satisfaction of the student with college, than

any other type of instructional or student characteristic.

Consultation with professors outside of class hours and promoting interaction between

the student and the faculty in discussions and lectures are some of the ways by which

frequent faculty-student contact is exercised.

2. Good practice develops reciprocity and cooperation among students.

Working with peers and interacting with professors enhances learning and often

increases involvement in learning. Good learning is collaborative and social rather than

competitive and isolated. The products of interactions with other students and the faculty

improve thinking and deepen the understanding of the student. Also, involvement with other

students and the faculty is closely linked to student’s academic performance and satisfaction

with college.Study groups, group assignments and activities are examples of collaborative

leaning strategies.

3. Good practice encourages active learning.

In active learning, students and their learning needs are in focus. It requires the

engagement of the students in learning activities. The students are able to reflect on the

information that they are taught and in turn encouraged to express what and how they

understood the information. Activities such as group discussions, case studies, role playing


45

and journal writing are beneficial to the learner as these activities can improve critical

thinking skills, increase retention and transfer of information, increase motivation and

improve interpersonal skills (University of Minnesota, n.d).

4. Good practice involves giving prompt feedback.

Providing feedback enables the student to focus on his or her learning. Feedback helps

the student know in which areas of the subject matter he needs to improve. Learning is not

only facilitate on reflecting on what you have learned, what you already understand, but also

making efforts on understanding concepts which you need to know. Feedback also assists

students in how they might assess their performance in the future.

Utilizing rubrics for grading and assessment checklists can assist the student in

assessing what he or she knows about the subject matter and be guided with what areas he

or she needs to know or know more about.

5. Good practice emphasizes time on task.

When one desires to learn, a certain amount of energy and time is required. Effort

combined with a realistic amount of time allotted for a particular task facilitates effective

learning. Thus time management skills are very important for students, as well as

professionals. Time expectations can influence the performance of the student.

Establishing deadlines of projects and activities and estimating the appropriate amount

of time for each task are some possible applications of emphasizing time on task.

6. Good practice communicates high expectations.

High expectations are very important. It is especially needed by students, be they the

high-performing group or the unmotivated and poorly prepared. When the faculty expects

more from the students, they themselves are holding high expectations from themselves.

They put more effort in teaching the students and helping them learn. The high expectations

the faculty have set for the students will then be translated into reality.


46

Providing with realistic expectations from the course utilizes this concept of expecting

more from the students.

7. Good practice respects diverse talents and ways of learning.

Even in the learning setting, the uniqueness of people is recognized. Students are

equipped with different talents and capabilities which they utilize to better grasp and

understand the things that they need to learn. They learn in ways that they are comfortable

with. To improve the ways by which they learn, the educational institution and the faculty

can introduce other methods of learning from which the students may gain new strategies

and techniques.

Examples of methods that can be introduced that may not be easily accessible to the

students include simulations and virtual experiences.

Environment and Instruction Characteristics

In a similar manner that he identified states for the various outcomes of learning, Gagne

also named several instructional events for each outcome It is sufficient to establish that the

events happening in the classroom, laboratory and clinical instruction affect learning

Instructional Methods

In a classroom setting, teachers are the main characters in facilitating learning and have

direct control in the implementation of the teaching-learning process. However, in determining

educational outcomes, studies have demonstrated that, instead of focusing on student’s

background or non-school factors, teacher practices when applied in the right context lead to

successful learning (Blair, 1988). These teacher practices are specifically referring to positive

and optimistic ways. It was also stated that that teachers may not have a direct control over the

student’s status in life or background or other environmental factors however, the teacher has a

direct control of face-to-face interactions with the students and the strategies and manners in

which the teacher utilize learning process and instructional time.


47

Professors, instructors and clinicians are individuals who should have already acquired

the skills in performing safely the tasks intended for them, for instance, for a nurse to administer

IV medications properly and safely, for surgeon to perform an operation with knowledge and

skills to alleviate the disease of his or her client. Expertise of a certain field or subject requires

extensive focused education and sustained deliberate practice for a number of years which

gives the individual the experience so that sharing and providing his/her expertise to a group will

be much easier as he/she is knowledgeable about it. Students are not isolated in their own

learning, aside from it being a partnership; it is also an apprenticeship between the teacher and

the student as he quoted from Lave and Wenger. The students learn within a professional

context. As the teacher is knowledgeable about a certain field, the student learns from the

teacher and acquires skills, knowledge, and attitudes in the course of learning and experience

while the teacher or professor facilitates the learning experience (Kneebone, 2005). In addition,

Roberts, et al (2008) stated three factors that affect students’ lack of proficiency: (1) variation in

the rate and ease of student skill acquisition, (2) threatening learning environment created by

teachers, and (3) inconsistent teaching technique.

With this, the instructor or teacher’s ability should be shaped according to the student’s

needs. According also to Roberts, et al, constant and appropriate teaching strategy is a very

important part on the student’s learning experience and retention skills. It was recommended in

that the teaching per se as well as the strategy should be based from research and evidence

(Morris, 2006). It was recommended that aside from nurse preceptors and clinical instructors, a

pharmacist should also be one of the professionals to teach medication administration because

they are the most knowledgeable when it comes to drugs.

To render holistic and efficient care to a patient, a nurse must be able to think critically

and consider the three key elements of this process, namely, skill, knowledge, and attitude as

identified by Watson and Glaser in 1980 (Bradshaw and Lowenstein, 2011). From these key

elements, teaching/learning strategies can be identified.


48

According to Arthur, Bennett, Stanush and McNelly (1998), in conducting an inquiry on

long-term skill retention, the relationship between the initial acquisition of the skill and the

subsequent retention is of vital importance. The acquisition of the skill is carried out through the

use of different instructional strategies. In training contexts, instructional strategies used to

facilitate learning are referred to as training methods. Such methods are used to impart learning

to nursing students, making use of the classroom, laboratory and clinical settings as their

training grounds. However, extensive discussion on these instructional methods is outside the

scope of this research study. It is sufficient to note that there are many ways of teaching

knowledge to students.

Khan, Ali, Vazir, Barolia, and Rehan (2011), enumerated four teaching strategies,

namely demonstration, reflection, problem based learning, and concept map, were utilized

among nursing students. Each strategy was then assessed based on the students’ perceptions.

By using the reflection strategy, students believe that they are able to look back; thus, making

them see what they have done right, which they will continue to do, and those which they have

done wrong, which they will correct. In the problem based learning strategy, students found that

this greatly enhanced their communication, an important skill in nursing. They were able to listen

and speak to each other and give the necessary feedback. The concept map strategy enhanced

the students’ management skills since they were able to practice their organization and

prioritization skills. Though these strategies have been found to aid the students’ learning, it was

concluded that demonstration was the most effective as this strategy allows the students to not

only acquire the necessary knowledge and skills, but also apply them directly to the real clinical

situation. The students also believe that this strategy produces more long-lasting effects in their

minds.

Opportunity for Practice

Skill decay is defined by Arthur et al. (1998) as the progressive deterioration of

knowledge and skills when they are not used over extended periods of time. The more time


49

passes, the more the skill deteriorates. It is often that nursing students are able to pass tests

measuring clinical skills in simulation laboratories at first however due to time passing without

any opportunity to perform those skills on an actual clinical setting they will lose proficiency in

doing those clinical skills. According to Hamilton (2005), even health professionals experience

skill deterioration when they have not performed a particular skill within 2 weeks and may need

to review how the procedure is done. If the skill is not done within 2 months, it may need to be

relearned (Roberts, Vignato & Moore, 2009). For nursing students who are learning about the

clinical skills for the first time, it is to be expected that their retention of skills will be much worse.

In an actual clinical setting, not all nursing student have the opportunity to perform all the

learned clinical skills as it will be dependent on the type of illness the patient assigned to him

has. Sometimes, a nursing student is not able to perform a clinical skill after the whole clinical

rotation, thus having to wait for the next semester to get a chance to do so.

Feedback: Reinforcement or Punishment

Feedback by the instructor or teacher about the examination provides opportunity for the

students to know and correct mistakes and to keep themselves on track as they are guided. It

can also lead to a higher student achievement and satisfaction. Motivation of the students is

another advantage of feedback especially an encouraging and constructive feedback

(Nicholson, 2010). Recent studies show no significant effect of immediate feedback timing as

compare to delayed feedback (Larsen, et al., 2008). However, it was stated in an article that an

immediate feedback of not only test questionnaires but also of skills is important and a crucial

component of learning as it will provide gradual improvement for the students but it should be

given clearly and without judicial remarks as it can be counterproductive for the student

(Kneebone, 2005).

From the behaviorist school of thought, practice provides an opportunity for making the

same response or learning in a wide variety of different situations (Lefrancois, 2000). Skinner’s

concept of reinforcement may also be a relevant environment characteristic. In Skinner’s


50

system, the type of reinforcement is one independent variable. Reinforcement has two types:

positive and negative. Another concept, punishment, also two types: presentation and removal.

Positive reinforcement is equivalent to rewarding. Its opposite, penalizing, is removal

punishment. Castigation, an aversive consequence following a behavior, is termed presentation

punishment. The removal or relief of something resulting into a response occurring more often is

called negative reinforcement.

Conceptual Framework

Figure 2. Conceptual Framework.

Synthesized from Hull’s input-output framework (1940 in Gredler, 1997); Gagne’s conditions of learning and outcomes of learning(1977, 1984, 1985 in Gredler, 1997 and Lefrancois, 2000); behaviorist and cognitivist views(in

Lefrancois, 2000); Bandura’s observational learning (1977 in Gredler, 1997 and Lefrancois, 200), and Benner’s novice to expert model(1996 in Sana, 2010).

End Notes

Ally, M. (2008). Foundations of educational theory for online learning. In T. Anderson

(Ed.) Theory and practice of online learning (pp. 15-43). Retrieved February 5, 2013,

fromhttp://www.aupress.ca/index.php/books/120146

INPUT:

Student Attributes - Motivation - Self-perception - Learner Satisfaction - Learning Styles - Educational Practices

Environmental and Instructional Characteristics - Instructional Methods - Opportunity for Practice - Feedback (Reinforcement and

Punishment)

OUTPUT

Levels of: - Skills - Knowledge - Attitudes

Retention of Skills


51

Anderson, J. (1996). A simple theory of complex cognition. American Psychologist. 51(4),335-

365. Retrieved January 27, 2013 from http://act-r.psycmu.edu/papers/97/ACT.ASimple

Theory.pdf

Arthur, W., Jr., Bennett, W., Jr., Stanush, P. L., &McNelly, T. L. (1998). Factors that influence

skill decay and retention: A quantitative review and analysis. Human Performance, 11,

57–101.

Backer, E. K. (1993).The effect of teacher-advocated concept attainment upon student

subsequent learning of cognitive and psychomotor nursing skills. ProQuest Dissertations

and Theses.

Bandura, A. (1977). Social learning theory. New York: General Learning Press.

Bastable, S. B. (2008).Nurse as educator: principles of teaching and learning for nursing

practice (3rded.). Sudbury, Massachusetts: Jones and Bartlett Publishers.


(2001). Medication errors and adverse drug event in pediatric inpatients. American


article.aspx?articleid=193775

Behaviorism (2005). In Internet Encyclopedia of Philosophy. Retrieved from http://www.iep.

utm.edu/behavior/#SSH1a.ii

Bell, M. L. (1991, May). Learning a Complex Nursing Skill: Student Anxiety and the Effect of

Preclinical Skill Evaluation.Journal of Nursing Education, 30(5), 222-226.

Benner, P. E., Tanner, C. A., & Chesla, C. A. (1996). Expertise in nursing practice: Caring,

clinical judgment, and ethics. (2nd ed.) New York, NY: Springer Pub. Co.

Blair, T. (1988).Emerging patterns of teaching: From methods to field experiences 3rd ed.

Columbus, OH: Merrill Publishing Company.

http://www.iep/


52

Bradshaw, M. J., & Lowenstein, A. J. (Eds.) (2011). Innovative teaching strategies in nursing

and related health professions (5thed.). Sudbury, MA: Bartlett Publishers, LLC. Retrieved

from http://books.google.com.ph/books?id=aLH77WXH5JIC&pg=PA603&lpg=PA603

&dq=teaching+strategies+definition+in+health+profession+courses&source=bl&ots=UA9

einoieD&sig=T98NuUrQy8_s28Uy3ciAOHro8aA&hl=en&sa=X&ei=d8O5UPfNGu2XiAfeo

oDIDQ&ved=0CG0Q6AEwBw#v=onepage&q=teaching%20strategies%20definition%20i

n%20health%20profession%20courses&f=false on December 1, 2012.

Bravery, K., Dougherty, J., Gabriel, J., Inwood, S., Kayley, J., Malster, M., et. al. (2010).

Standards for infusion therapy: The RCN IV therapy forum (3rded). London: Royal

College of Nursing

Burston, S., Sheriff, K., & Wallis, M. (2011). Medication calculation competencies for registered

nurses: a literature review. Australian Journal of Advanced Nursing, 28(4):75-83.

Retrieved from http://www.ajan.com.au/Vol28/28-4_Sherriff.pdf

Butt, B.Z., & Rehman, K. (2010). A study examining the students satisfaction in higher

education. Procedia – Social and Behavioral Sciences, 2(2), 5446-5450. Retrieved from

http://www.sciencedirect.com/science/article/pii/S1877042810009286 on March 27,

2013.

Carson, D., Dychter, S.S., Gold, D.A., & Haller, M. (2012). IVT: A review of complications and

economic considerations of peripheral access. Journal of infusion of nursing, 35(2), 84-

91. Retrieved fromhttp://www.nursingcenter.com/lnc/static?pageid=1374284

Chamley C., Wilson M. (n.d.). IVT. Palgrave Macmillan. Retrieved January 27, 2013.

Cheung, R., Au, T. 2010.Nursing Students’ Anxiety and Clinical Performance. Journal of

Nursing Education.

Chickering, A. W., & Ehrmann, S. C. (1996).Implementing the seven principles: Technology as

lever. American Association for Higher Education Bulletin. Retrieved on March 28,

2013 from www.aahebulletin.com/public/archive/sevenprinciples.asp?pf=1.Clarke, S.,


53

Gale, C., Hopkins, T., Hutton, S., Van Dyk , S., & Webster, J. (2008). BMJ, 337.doi:

10.1136/bmj.a339

Coben D, Hall C, Hutton M, Sabin M. (n.d.). Numeracy for Nursing: the case for a benchmark.

Retrieved from http://nursingnumeracy.info/page13/assets/ALM14_Coben_Extract.pdf

De Laune S,& Ladner P. (2002). Fundamentals of nursing standards and practice 2nd edition.

Retrieved from http://rs51p8.rapidshare.com/cgibin/rsapi.cgi?sub=download&fileid=3297

06731&filename=Fundamentals.of.Nursing.3HAXAP.pdf&directstart=1

Emanuel, V., &Pryce-Miller, M. (2009). Exploring the factors contributing to errors in medicines

administration. Nursing Times; 105: 46. Retrieved from NursingTimes.net. Retrieved

from http://www.nursingtimes.net/nursing-practice/clinical-zones/prescribing/exploring-

the-factors-contributing-to-drug-errors-and-how-to-improve-knowledge/5008730.article

Engelbeck, GE. (1989). An integrated model of the initial acquisition and retention of cognitive

skills. Retrieved January 27, 2013 from http://www.colorado.edu/ics/sites/default/files/

attached-files/89-02.pdf

Engum, S. A., Jeffries, P., & Fisherb, L. (2003). Intravenous catheter training system:

Computer-based education versus traditional learning methods. The American Journal

of Surgery, 67-74.

Ertmer, P. & Newby, T. (1993). Behaviorism, cognitivism, constructivism: Comparing critical

features from an instructional design perspective. Performance Improvement Quarterly,

6 (4), 50-72. Retrieved February 5, 2013, from http://uow.ico5.janison.com/ed/subjects

/edgi911w/readings/ertmerp1.pdf

Fang, C. T., Huang, C.H., Lee, W.C., Lee, W.L., & Liao, S.F. (2010). Soft tissue infections

related to peripheral intravenous catheters in hospitalised patients: a case–control study.

Journal of hospital infection, 76(2), 1240129.doi:10.1016/j.jhin.2010.05.012

Felder, R.M. & Brent, R. (2005). Understanding student differences. Journal of Engineering

Education, 94(1), 57-72.


54

Gredler, M. E. (1997). Learning and Instruction: Theory into Practice. New Jersey: Prentice-Hall,

Inc.

Gagne, R. M., (1985). The conditions of learning and Theory of Instruction. New York: CBS

College Publishing.

Hale L, Mirakian E & Day D. (2009). Online vs. classroom Instruction: student satisfaction and

learning outcomes in an undergraduate allied health pharmacology course. Journal of

Allied Health.38:2.Retrieved fromhttp://www.ingentaconnect.com/content/asahp/jah

/2009/00000038 /00000002/art00010on March 27, 2013.

Han P.Y., Coombes I.D., & Green B. (2005). Factors predictive of intravenous fluid

administration errors in Australian surgical wards. Quality & Safe Health.

Hess, J. C., Sun, R. A., & Golinski, M. (n.d.).The influence of timing between classroom

instruction and simulator laboratory reinforcement on knowledge retention of critical

skills. Wayne State University.

Huitt, W. (2003).The information processing approach to cognition. Educational Psychology

Interactive. Valdosta, GA: Valdosta State University. Retrieved from http://www.edpsyc

interactive.org/topics/cognition/infoproc.html

Huitt, W. (2004). Observational (social) learning: an overview. Educational Psychology

Interactive. Valdosta, GA: Valdosta State University. Retrieved from

http://www.edpsycinteractive.org/topics/soccog/soclrn.html

Jamison, R. J., Hovancsek, M. T., & Clochesy, J. M. (2006). A pilot study assessing simulation

using two simulation methods for teaching Intravenous Cannulation. Clinical Simulation

in Nursing Education, 2, 9-12.

Jeffries, P. R., Rew, S., & Cramer, J. M. (2002). A comparison of student-centered versus

traditional methods of teaching basic nursing skills in a learning laboratory. Nursing

Education Perspectives, 23(1), 14-19.


55

Johns Hopkins University School of Nursing (2012). Course listings and descriptions. Retrieved

January 13, 2013, from The Johns Hopkins University School of Nursing:

http://www.nursing.jhu.edu/academics/resources/course_listings/index.html

Jones, S. J., Staib, S. A, & Fusner, S. (2009). Expanding classroom time: teaching clinical

intravenous skills in campus laboratory. Teaching and Learning in Nursing, 4, 94-97.

Josephson, D.L. (2004). Intravenous infusion therapy for nurses: Principles and Practice. USA:

Delmar Learning

Kerfoot, B. P., DeWolf, W. C., Masser, B. A., Church, P. A., & Federman, D. D. (2007). Spaced

education improves retention of clinical knowledge by medical students: A randomized

controlled trial. Medical Education, 41, 23-31.

Khan, B.A., Ali, F., Vazir, N., Barolia, R., & Rehan, S. (2011). Students' perceptions of clinical

teaching and learning strategies: a Pakistani perspective. Nurse Education Today, 32,

85-90.

Kneebone, R. (2005). Evaluating clinical simulations for learning procedural skills: a theory-

based approach. Acad Med, 80 (6), 549-553.

Koohestani, H., & Baghcheghi, N. (2009). Comparing the effects of two educational methods of

intravenous drug rate calculations on rapid and sustained learning of nursing students:

Formula method and dimensional analysis method. Nurse Education in Practice, 10:233-

237. Retrieved from http://217.219.202.60/documents/10129/37159/COMPAR~1.PDF

Kozier B, Erb G, Berman A, & Shirlee S. (2008). Fundamentals of Nursing: Concepts, Process,

and Practice 8th edition.Prentice Hall.

Lapkin, S., Fernandez, R., Levett-Jones, T., & Bellchambers, H. (2010). The effectiveness of

using human patient simulation manikins in the teaching of clinical reasoning skills to

undergraduate nursing students: a systematic review. JBI Library of Systematic

Reviews, 8(16), 661-694.


56

Larsen, D., Butler, A., & Roediger III, H. (2008).Test-enhanced learning in medical education.

Medical Education.42: 959–966.doi:10.1111/j.1365-2923.2008.03124.x

Laschinger, S., Medves, J., Pulling, C., McGraw, R., Waytuck, B., Harrison, M. B., & Gambeta,

K. (2008). Effectiveness of simulation on health profession students’ knowledge, skills,

confidence and satisfaction. Int Journal of Evidence Based Healthcare, 6, 278-302.

Lefrancois, G. R. (2000). Theories of Human Learning: What the Old Man Said. California:

Wadsworth/Thomson Learning.

Leonard, B. & Martin, L. (2007). Literature review on skill fade. Human Factors Integration

Defence Technology Centre.

Leonard, B., & Martin, L. U.K. (2007). Ministry of Defence Scientific Research Programme,

Human Factors Integration Defence Technology Centre. Literature review on skill fade

(HFIDTC/2/WP10.3/2). Retrieved from website:http://www.hfidtc.com/research/training

/training-reports/phase-2/2-10-3-2-skill-fade.pdf

Macedo-Rouet, M., Ney, M., Charles, S., & Lallich-Boidin, G. (2009). Students’ performance and

satisfaction with web vs. paper-based practice quizzes and lecture notes. Computers &

Education, 53(2), 375-384. doi: 10.1016/j.compedu.2009.02.013

Macklin, D. (2008). Infusion pump therapy: a guide for clinicians and educators. Lake Forest,

IL: Hospira. Retrieved from http://www.ivclinicalintegration.com/wpcontent/uploads

/2011/11/InfusionPumpTherapy_AGuide.pdf

Macklin, D. (2011). IV catheter care and maintenance minimizes catheter-related blood

stream infection. Cardiac catheter lab director, 1(1), 20-24.doi: 10.1177/21501335103

95572

Martelli, M. (2002). Intravenous medication administration. Gale Encyclopedia of Public

Health. Retrieved January 27, 2013 fromhttp://www.healthline.com/galecontent/

intravenous-medication-administration#3

McCallum, L. (2012). Care of peripheral venous catheter sites. Nursing times 108,(34/35).


57

Retrieved from www.nursingtimes.net

McCann, D., McGrail, M.R., Munnings, J., & Rickard, C.M. (2010). Routine resite of peripheral

intravenous devices every 3 days did not reduce complications compared with clinically

indicated resite: a randomised controlled trial. BMC Medicine, 8(53).doi: 10.1186/1741-

7015-8-53



administration-skill-student/16634383.html

Morris, W., & Tay, M.H. (2008).Strategies for preventing peripheral intravenous cannula

infection. British journal of nursing, 17(19). Retrieved from http://www.turrellmm.com/

drug_calcs_online/d1/tutorials/NT_PIVC_resources/Article%20PIVC%20Strategies%20

for%20preventing%20PIVC%20Infection.pdf

New York University College of Nursing (2013). Academics. Retrieved January 19, 2013, from

New York University College of Nursing: http://nursing.nyu.edu/simulation-center

Nicholson, A. 2010. Comparison of selected outcomes based on teaching strategies that

promote active learning in nursing education. University of Iowa.

Novak, Joseph D. (1998). Learning, Creating, and Using Knowledge: Concept Maps as

Facilitative Tools in Schools and Corporations (pp. 49-78; ch 5 – Ausubel’s Assimilation

Learning Theory). Mahwah, NJ: Erlbaum.

NPSA (2007). What can we learn from serious medication safety incidents. In Safety in Doses:

Improving the use of medicines in the NHS (17-25). Maple Street, London. Retrieved

from http://www.nrls.npsa.nhs.uk/EasySiteWeb/getresource.axd?AssetID=61626&type

=full&.

Our Lady of Fatima University. (n.d.). College of Nursing. Retrieved January 20, 2013, from Our

Lady of Fatima University: Improving Man as Man: http://fatima.edu.ph/content

.asp?pid=213&cat=3


58

Parkay, F.W. & Hass, G. (2000).Curriculum Planning (7th Ed.). Needham Heights, MA: Allyn &

Bacon.

Parry, D., Rob, M.I., Westbrook, J.I., & Woods, A. (2011). Errors in the administration of IV

medications in hospital and role of correct procedures and nurse experience. BMI

Journals, 20, 1027-1034. 10.1136/bmjqs-2011-000089

Parshuram C, To T, Seto W, Trope A, Koren G, & Laupacis, A. (2008). Systemic evaluation of

errors occurring during preparation of intravenous medication. CMAJ. 178(1). Retrieved

from http://www.cmajopen.com/content/178/1/42.short

Pauly-O’Neill, S. (2009). Beyond the five rights: improving patient safety in pediatric medication

administration through simulation. International Nursing Association for Clinical

Simulation and Learning 5:181-186. doi:10.1016/j.ecns.2009.05.059

Pettit, J., & Wyckoff, M.M. (2007). Peripherally inserted central catheters: Guideline for

practice(2nd ed). Glenview, IL: National Association of Neonatal Nurses.

Rail Safety and Standard Board LTD., (2011). Research programme operations and

management a model for optimising competence retention in the railway (skills fade):

Optimising competence retention in the rail industry. Retrieved from website:

http://www.rssb.co.uk/sitecollectiondocuments/pdf/reports/research/T717_apps_final.pdf

Rainboth, L., & DeMasi, C. (2006). Nursing students' mathematic calculation skills. Nurse

Education in Practice, 6, 347-353.

Randle, J. (2007). The care and maintenance of peripheral intravenous catheters. Nursing

times, 103(12), 30-31. Retrieved from Nursing Times. Retrieved from http://www.nursing

times.net/the-care-and-maintenance-of-peripheral-intravenous-catheters/201769.article#

Recio, D. M., Mejico, M. F., & Añonuevo, C. A. (2004). Human behavior: from the disciplines of

anthropology, psychology, and sociology. Mandaluyong City: Books Atbp. Publishing

Corporation.

Reinhardt, A. C., Mullins, I. L., Blieck, C. D., & Schultz, P. (2012). IV Insertion Simulation:


59

Confidence, Skill, and Performance. Clinical Simulation in Nursing, 8, e157-e167.

Reo, J. A., & Mercer, V. S. (2004). Effects of live, videotaped, or written instruction on learning

an upper-extremity exercise program. Phys Ther, 84, 622-633.

Roberts, S., Vignato, J., Moore, J., & Madden, C. (2008). Promoting Skill Building and

Confidence in Freshman Nursing Students with a “Skills-a-Thon”. Journal of Nursing

Education. doi:10.3928/01484834-20090518-05

Rooker, J. & Gorard, D. (2007). Errors of intravenous infusion rates in medical inpatients.

Ingenta Connect, 7(5). Retrieved from

http://www.ingentaconnect.com/content/rcop/cm/2007/ 00000007/00000005/art00015

Sana, E. A. (2010). Teaching and Learning in the Health Sciences. Quezon City: UP Press.

Smith, A. M., Ortiquera , S. A., Laskowski, E. R., Hartman, A. D., Mullenbach, D. M., Gaines, K.

A., Larson , D. R., & Fisher , W. (2001). A preliminary analysis of psychophysiological

variables and nursing performance in situations of increasing criticality. Mayo Clinic

Proceedings, Retrieved from http://www.ncbi.nlm.nih.gov /pubmed/11243274

Speelman (2005). Skill Acquisition: History, Questions, and Theories. Chapter 2: Literature

Review. Retrieved January 27, 2013 from http://www.enactionschool.com/

resources/papers/02-Speelman-Chap02.pdf

University of Florida Center for Instructional Technology & Training.(2012, November).

Chickering and Gamson: 7 rules for undergraduate education. Retrieved on March 28,

2013 from http://citt.ufl.edu/tools/chickering-and-gamson-7-rules-for-undergraduate-

education/.

University of Minnesota (n.d). What is active learning? Retrieved on March 28, 2013 from

http://www1.umn.edu/ohr/teachlearn/tutorials/active/what/index.html.

University of the Philippines Manila College of Nursing (2006).Competency-based BSN


Philippines Manila.

http://www.enactionschool/


60

University of the Philippines Manila College of Nursing (2011). Intravenous Therapy Skills

Checklist.

Washington Center News (1987). Seven principles for good practice in undergraduate

education by Arthur W. Chickering and Zelda F. Gamson. Retrieved on March 28, 2013

from https://docs.google.com/viewer?a=v&q=cache:QTxBkOC9ePAJ:www.lonestar.edu/

multimedia/SevenPrinciples.pdf+educational+practices+chickering+and+gamson&hl=en

&gl=ph&pid=bl&srcid=ADGEESgm91WyCpD1nkw4FqPUDJrZefmRkDU9VzJTrp5tXDphi

tdmisJRxQ50zT5MZHvCwh1JBjg1jNVjxaiMlkQZvYI9hFs3_K1eh5faCrt17PjiP5wQq2iknt

HOFEbv-gHwOq53&sig=AHIEtbSpZN0HP1O1lNEZ7vTG-EYo2Zy4NQ.


Edinburgh, 37:343–346. Retrieved from http://www.rcpe.ac.uk/journal/issue/journal_3

7_4/Williams.pdf

Wright, K. (2005). An exploration into the most effective way to teach drug calculation skills to

nursing students. Nurse Education Today, 25:430-436.doi:10.1016/j.nedt.2005.04.004

Wright, K. (2009). Do calculation errors by nurses cause medication errors in clinical practice? A

literature review. Nurse Education Today, 30:85–97. doi:10.1016/j.nedt.2009.06.009

Wu, P.-H., Hwang, G.-J., Su, L.-H., & Huang, Y.-M.(2012). A context-aware mobile learning

system for supporting cognitive apprenticeships in nursing skills training. Educational

Technology & Society, 15 (1), 223-236.

Yu, J. (2008). A study of the influence of instructional innovation on learning satisfaction and




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CHAPTER 3

METHODOLOGY

Research Design

The study employed a retrospective cohort design in such a way that the current skills

on IVT of fourth year UPCN students were compared to the previous grade on IVT during their

sophomore year. A retrospective cohort design is usually used to permit inferences about

processes evolving over time, such as retention and the processes involved at different points in

its progression (Polit & Beck, 2008). The independent variables of this study were the student

attributes and the instruction characteristics. The dependent variable was the level of retention

of IVT skills, knowledge, and attitudes. Possible intervening variable identified in this research

was the inherent intelligence of the students which was measured through the student’s grade

weighted average (GWA) during the past semesters. Other possible intervening variable was

from the various experiences of the subjects. Irregular students may have additional exposure

to cases or patients involving the skill under study. This may also be seen in the variations

possible in the ward exposure and the clinical instructors or preceptors.

Hawthorne effect was expected because the subjects were knowledgeable about their

participation in the study, and that they were being observed. Several measures will be done to

potentially minimize or totally eliminate these threats. The subjects were informed that they

would be asked to demonstrate a skill prior to the day of the data collection. However, the

specific skill was only revealed to them during the same day. Constancy of conditions was

ensured as data collection happened in the same setting, with the same means of

communication, same set of instruments and same data collection procedures.

Setting

The entire study was conducted in the UP College of Nursing (UPCN). Filling up of the

needed preliminary forms was done at UPCN Clinical Skills Laboratory. These forms were the


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demographics questionnaire, intravenous knowledge assessment examination, and IVT attitude

survey which will be discussed in the succeeding section. The actual observation of the IVT

skills using the observation checklist took place in a controlled setting at the clinical skills

laboratory. This provided an ideal setting with the complete equipment needed to perform the

said skill. The focused group discussion was conducted at the UPCN Student Lounge.

Sampling Procedures and Sample

This study targeted the entire fourth year UP College of Nursing (UPCN) students

currently enrolled in N121.1 Intensive Clinical-based Experience course and N121.2 Intensive

Community-based Experience course for the academic year 2012-2013. The fourth year

students were the chosen sample because these students are taught the basics of IVT in their

undergraduate course, and that it is important for them to be competent in this area of client

care. This was important that the construct of retention be reflected by the subjects because it

has been at least two years since IVT was taught to them, and it can be said that they have

been exposed to enough cases regarding this skill in their various clinical experiences.

As a pilot investigation, ten senior students were chosen by convenience sampling from

the UPCN. The sampling frame of the fourth year students was gathered from the Office of the

College Secretary, which holds all the academic records of the students enrolled in the college.

The researchers requested for a list of students enrolled in the Intensive Hospital-based

Experience course and the Intensive Community-based experience course during the semester.

This was done to avoid any conflicts with the subject’s schedule and the research’s time table

for data collection. All of the students included in the list were invited to participate in the

research. The subjects who were available during the data collection were included in the

sample. This was sufficient for pre-testing the developed tools on skills, knowledge, and

attitudes regarding IVT, and for establishing the reliability and validity of these tools.


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In cases when subjects declined to participate in other parts of the study, the data

already collected from them were discarded because a complete set of data from the same

person was preferred by the researchers. For incompletely-answered forms, a list of control

numbers and the names of the students were kept confidentially to enable the researchers to

contact the students.

Instrumentation and Procedures

The objective of describing factors related to the retention of these skills, knowledge,

and attitudes was accomplished by using the observational guide, questionnaire, and focused

group discussion (FGD) guides. The research study was divided into two phases, namely: (1)

validity and reliability testing of research instruments, and (2) pre-testing and data collection

using the validated and reliable tools. Figure 3 on data collection and analysis found on the next

page summarizes these phases, and shows in detail the flow of the research study.

The research schedule and budget allocation are found in Appendix I.

Instrumentation

The instruments used to accomplish the objective of assessing the current level of skills,

knowledge, and attitudes of fourth year students regarding IVT were developed by the

researcher. These included the IVT Skills Observation Checklist, IVT Knowledge Assessment

Exam, IVT Attitudes Survey, and Focus Group Discussion Guide. Some of the items in each

tool were derived from previous studies and reliable sources. The instruments were subjected to

validity and reliability testing before they were used in the pre-testing. The forms used to

validate and establish the reliability of the research instruments are found in Appendix III. These

forms were given as a packet to the experts in IVT, health professions education and clinical

nursing practice.

Moreover, a demographics questionnaire was used to determine the basic information

from the subjects and the additional data about the confounding variable inherent intelligence.


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Figure 3. Data Collection and Analysis Algorithm


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The subsections that follow will discuss in detail each instrument focusing on skills,

knowledge and attitudes on IVT.

IVT Skills Observation Checklist

The intravenous skill observation checklist was based on concepts discussed in the

preceding chapter including medication calculation, fluid regulation, and medication preparation

and administration. The UPCN skills laboratory checklist which was used in teaching and

evaluating the IVT skills in the Nursing Foundations II course of the students was adopted and

used by the researchers for their tool on measuring skill competency. However, as seen in

Appendix IV, the original UPCN skills laboratory checklist lists each step in every sub-skill of IVT

(such as setting-up an IV infusion, etc.) In order to ensure a systematic checking for retention of

skills, the repetitive steps were deleted and each step in every sub-skill was collapsed to come

up with the comprehensive IVT skills observation checklist (see Appendix II).

The skill competency in IVT was determined by the subject’s performance graded using

the said checklists by a rater from the researchers. Each step in a procedure was scored as 0

(not performed), and 1 (performed). The scores were summed for each procedure to reflect the

level of competency.

The researchers were the ones who assessed the skill competency of the students in

IVT for convenience. Moreover, the researchers were already familiar with the said skills

checklist and training on how each item in the skills checklist would be assessed was minimal.

The validity of this tool was no longer determined because the researchers assumed that

it was already valid on its own considering that these observation checklists were used in

introducing the IVT skills and in evaluating the competence of the students in performing IVT

during their sophomore year. This was also done to ensure that the students were evaluated

with the same standards taught to them by their professors and instructors. Moreover, using

another tool would make the Nursing Foundations II IVT practical exam score incomparable to

their current score.


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On the other hand, equivalence of the raters for the skills observation checklist was

measured by inter-rater reliability. After reviewing the steps and procedures thoroughly, the

three raters assessed two subjects to determine the inter-rater reliabilities for each step. The

inter-rater reliability was assessed between and among observers through the multi-rater kappa,

which is used for more than two raters independently observing the same thing (Polit and Beck,

2008).

IVT Knowledge Assessment Examination

The current levels of knowledge of the students were assessed by the knowledge

assessment examination score. In order to develop the tool on knowledge, the researchers

made exam items from Kozier and Erb’s Fundamentals of Nursing, and Potter and Perry’s

Fundamentals of Nursing. These books were used as references for the Nursing Foundations

course which first tackled the concepts on IVT. Brunner and Suddarth’s Textbook of Medical-

Surgical Nursing and Clayton’s Basic Pharmacology for Nurses were also used because they

were one of the reference books for the subsequent professional courses where the concept of

IVT was reinforced (Nursing Interventions courses, Critical Care course and Pharmacology

course). The true or false items in the questionnaire was adopted from the one used by

Shamsuddin and Shafie (2012) to measure the knowledge of nurses in preparing and

administering intravenous medications.

Since this tool was developed by the researchers by adopting several sources, there

was a need to establish their validity and reliability measures. Content validity of the knowledge

tool was determined through the panel of experts in the field related to the study. Two rounds

were conducted and a total of 8 experts participated in the validation of the said tools. The six

experts who participated in the first round of content validation included Ms. Jenniffer T. Paguio,

R.N., a faculty member of UPCN who handled clinical courses where there were also exposure

to IV therapy; Ms. Cecille Peña, R.N., M.A.N., a chief nurse at the Philippine General

Hospital(PGH) and head of the Division of Nursing Education and Training (DNET) in PGH; Ms.


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Rebecca R. Tan, R.N., M.A.N., a chief nurse in the Chinese General Hospital and Medical

Center (CGHMC) and a trainer and preceptor for Association of Nursing Service Administration

of the Philippines (ANSAP); Ms. Berling S. Coto, R.N., an assistant chief nurse in CGHMC,

trainer and preceptor for ANSAP and head of the Nursing Service Education Committee; Ms.

Judy I. Pangilinan, R.N., a nurse supervisor in CGHMC and trainer and preceptor for ANSAP;

and Mr. Kim T. Estella, R.N., an IV therapy nurse working in PGH. They evaluated whether the

questions in the knowledge assessment questionnaire were representative, and relevant to the

concept being measured. The original tool tested for validation contained 31 items for multiple

choice, 9 items for problem solving, and 16 items for true or false questions. The initial pool of

questions can be seen in Appendix V.

The content validity of the items was established first by asking the experts to rate each

as being relevant or irrelevant to the concept being measured by the specific item. The

relevance to the dimension of contract was scored as (4) relevant, (3) moderately relevant, (2)

somewhat relevant, and (1) not relevant. The experts were also asked whether the wordings of

the questions were clear or not. In addition, general recommendations for each item was asked

and classified as “retain”, “revise”, or “drop”. The experts were also provided a space wherein

they added their comments and remarks for each item. The questions were then revised

according to the comments of the experts. The mean rating of each item was computed and

ranked according to their content validity index (CVI).

The number of items was reduced to 17 for multiple choice, 5 for problem solving, and

11 for true or false. 4 multiple choice questions were added based on the suggestion of the

experts. The tool was then subjected to the round 2 of validation wherein seven experts

participated. One expert who previously validated the tool was no longer available and two new

experts were asked to validate the tool, namely Mr. Nomar M. Alviar, M.D., M.H.P.Ed., an

associate professor of the National Teacher Training Center for the Health Professions (NTTC-

HP), education consultant and trainer for faculty development programs at undergraduate and


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postgraduate levels, and for human health resources development programs of the Department

of Health in the Philippines, and Mrs. Josephine E. Cariaso, R.N., a faculty member of UPCN

who was also the coordinator of the N11 (Nursing Foundations II) course during the students’

second year. The same process during the first round was done with these seven experts and

the questions were revised according to their comments. This validated questionnaire was used

for administration to the subjects (see Appendix II).

Two reliability measures were used for the assessment exam after administration to the

subjects. The internal consistency reliability of each sub-tests were measured using the Kuder-

Richardson Formula 20 (KR-20) to estimate the degree to which all of the items measure a

common concept. In addition to this, to estimate the reliability of the entire assessment exam,

the split-half reliability was measured using Spearman-Brown Prophecy Formula (SBPR). This

was done because homogeneous content cannot be assumed across all items in the entire

exam, which limits the use of the KR-20 (Thorndike, 1997).

In addition to validity and reliability testing of the tools, another way to check the

accuracy of the items in meeting the objectives of the N11 course on IV therapy was to cluster

the items according to which objective in the curriculum they are under and applied. The

objectives of the N11 course specifically on IV therapy were derived from the competency-

based curriculum of UPCN. Then, the items in the knowledge tool were selected according to

the objectives being met in the question. With the alignment of the objectives and the items, the

tool would be able to yield precise data regarding the level of knowledge on IV therapy as it

reflects the objectives of the curriculum. This is reflected in the excerpts from the N11 course

syllabus and in the test blueprint found in Appendix VI.

Each item in the final tool was about a particular concept about assessment, planning,

monitoring, IV solutions, purposes of IVT, venipuncture sites, troubleshooting IVT problems,

fluid regulation, and medication calculation, preparation and administration. Items were of the


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following test types: multiple choice questions, problem solving and true-or-false statements.

The table below summarizes the distribution of items according to topic and test type:

Table 1. Number of items included in IVT Knowledge Assessment Exam

according to concept and test type

According to concept According to test type

Assessment and Planning – 1 items Multiple Choice – 14 items IV Solutions – 3 items Problem Solving – 5 items Venipuncture Sites – 2 items True or False – 11 items Monitoring – 3 items

Purposes of IVT – 1 item Troubleshooting Complications- 4 items IV Medications and Fluid Reg’n Calculation – 5 items IV Medications Preparation & Administration – 11 items

Total: 30 items

A majority of the items were devoted for IV Medication and Fluid Regulation Calculation

(5 items or 17%) and for IV Medication Preparation and Administration (11 items or 37%)

because these concepts are continuously done in the clinical areas where patients involve IVT.

Also, these concepts have been reinforced in the Nursing Foundations course, the

Pharmacology course and the Nursing Interventions course. Monitoring was assigned 3 items

(10%) because complications are always unwanted in IVT. Other beginning concepts, such as

assessment and planning (1 items or 3%), IV solutions (3 items or 10%), venipuncture sites (2

items or 7%), and IVT purposes (1 item or 3%) were also included because they are introduced

as early in the Nursing Foundations course. They may not be completely excluded from making

these items because they remain essential knowledge for IVT.

IVT Attitudes Survey Tool

The attitudes toward IVT were measured by the subject’s score on the attitude survey.

Each item about a specific construct on learner satisfaction, self-perception, educational

practices and motivation was marked accordingly with a five-point Likert scale. The scores were

summed for each domain/construct to reflect the various levels of attitudes.


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For the attitudes tool, several items were adopted from different tools of various studies

to come up with a comprehensive item pool to measure the specific dimensions such as learner

satisfaction, self-perception, educational practices and motivation. The development of the

various instruments were heavily based on theories of human learning, such as Hull’s input-

output framework, Gagne’s conditions of learning and outcomes of learning, behaviorist and

cognitivist views, Bandura’s observational learning, and Benner’s novice to expert model. These

theories were discussed in the preceding chapter.

Learner satisfaction items were adopted from a study conducted by Engum, Jeffries and

Fisher in 2003, which aimed to compare computer-based education and traditional learning

methods for intravenous catheter training systems. The researchers measured learner

satisfaction among students using a 5-point, 5-item Likert scale. Furthermore, an evaluation of

self-efficacy and self-reliance in learning of skills was conducted by the researchers using a 5-

point 6-item Likert scale.

The Rosenberg Self-Esteem Scale, developed by sociologist Dr. Morris Rosenberg, was

one of the scales used as basis for measuring the self-esteem of the students. The original

scale consists of a 4-point, 10-item scale scored as a Likert scale with its design similar to that

of a Guttman scale. Reliability of the scale was high, as demonstrated by a test-retest

correlations range of .82 to .88, and a Cronbach’s alpha for various samples ranging from .77 to

.88. (Blascovich and Tomaka, 1993; Rosenberg, 1986). Studies have demonstrated both a

unidimensional and a two-factor (self-confidence and self-deprecation) structure to the scale

(University of Maryland, n.d.).

Items from the Hare Area Specific Self-Esteem Scale developed by Shoemaker in 1980,

which is part of the compendium of assessment tools co-published by the Center for Disease

Control and Prevention, were also taken by the researchers. This assessment tool consists of

10 items which measure feelings toward worth and importance. As a specially designed tool for

adolescents, the measurement of self-esteem was divided into three: among peers, as students,


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and as family members. The researchers took the questions from the “As Students” part for the

specificity of the tool for the study. It has an internal consistency of .71 (CDC, as cited by

Paschall & Flewelling, 1997).

Also, items from Chickering and Gamson’s (1987) tool assessing seven principles of

learning (active learning; feedback; student-faculty interaction; collaboration; high expectations;

diverse ways of learning; time on task) were used. To accomplish the tool, one must rate his or

her agreement with each item, and, each item’s importance to them.

To assess both motivation and learning strategies, items from McKeachie and Pintrich’s

Motivated Strategies for Learning Questionnaire (MSLQ) were adopted. The tool was

specifically designed for college students in order to improve their learning. The MSLQ consists

of 81, self-report items divided into two broad categories: (1) a motivation section which consists

of 31 items that assess students’ goals and value beliefs for a course, their beliefs about their

skill to succeed in a course, and their anxiety about tests in a course; and (2) a learning

strategies section which includes 31 items regarding students’ use of different cognitive,

metacognitive strategies and 19 items concerning student management of different resources.

Scores for the individual scales are computed by taking the mean of the items that make up the

scale. MSLQ has relatively good internal reliability as evidenced by Cronbach’s alpha of greater

than .70 for majority of individual scales tested (i.e. 0.93 for self-efficacy for learning and

performance).

The selected items from the abovementioned validated tools were modified by the

researchers to formulate an attitudes assessment tool that is specific for learning IVT. The

items were clustered according to the four domains indicated in the research’s conceptual

framework namely: (1) learner satisfaction, (2) self-perception, (3) educational practices/learning

styles, and (4) motivation.

Similar with the knowledge tool, the reliability and validity of the attitudes tool was

measured. This tool was validated along with the knowledge tool. Moreover, internal


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consistency of each subscale concept was also computed through Cronbach’s alpha (Polit and

Beck, 2008). The original tool consisted of 37 statements. The validity of items was established

by asking the experts to rate each from 5 to 1, with 5 being the “for” the attitude and 1 being the

“against” the attitude. The median score for each item and the corresponding interquartile range

will be determined. The experts were also asked whether the wordings of the questions were

clear or not. In addition, general recommendations for each item was asked and classified as

“retain”, “revise”, or “drop”. The experts were also provided a space wherein they added their

comments and remarks for each item. The questions were then revised according to the

comments of the experts.

After doing so, items with medians around 3 were considered poor or neutral in

measuring the attitude (i.e. the statement is either “for” or “against”). Items with high interquartile

ranges suggested a great disagreement among judges to each step position from one to five

(Thorndike, 1997). These items were either revised or eliminated from the final tool. The initial

pool of items can be found in Appendix V. After the first round of validation, the total number of

items was reduced to 27. The same process was done during the second round of validation.

The items were then ranked and the top 5 for each domain were included in the final IVT

Assessment Survey. Finally, the reliability for each sub-scale and the entire attitudes survey

was determined using KR-20 and SBPR, similar to those of the assessment exam. Table 2

shows the distribution of items per domain found in the final tool.

Table 2. Number of items included for each attitudinal domains/concepts for IVT Attitudes Survey

Domains / Concepts Items included

Learner satisfaction 1-5

Self-efficacy, self-reliance, and self-esteem 6-10

Educational practices and learning styles 11-15

Motivation 16-20

Total: 20 items


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The researchers deemed these items to be necessary to measure the students’ attitudes

toward IVT as they reflected the general ideas of the attitudinal domains sufficiently in the

context of nursing education and tertiary education. The rationale for each item that is included

can be seen in the discussion in the preceding paragraphs.

Items for assessing learning style were taken from the Learning Style Inventory which

was derived from Kolb’s experiential theory and model of learning. The tool evaluated how one

learn, not his/her learning ability. Subjects were asked to rank four (4) words across 9 items. A

“4” was assigned to the word that best characterizes one’s learning style, and “1” for the least

characteristic word. Making ties in each item was not allowed. Each word corresponded to

Kolb’s four dimensions, namely: Concrete Experience, Active Experimentation, Reflective

Observation and Abstract Conceptualization.

The scoring of the inventory depended upon the sum of the rank numbers in each

column, which represented each of the Kolb’s dimensions. Not all of the rank numbers per

column were taken for the scoring of each dimension. Only the rank numbers of the specified

items per dimension were added up (ie. For the First Column (Concrete Experience dimension),

the rank numbers of items 2, 3, 4, 5, 7, 8 were the only ones summed up). The sum for each

column was plotted on the Learning Style Profile (see Figure 4), and the points were then

connected with straight lines.

Each quadrant in the Learning Style Profile represented the styles of learning:

convergent, divergent, assimilative and accommodative. The dominant learning style of a

person was determined by locating the quadrant with the largest enclosed space on the

Learning Style Profile.

The LSI has undergone a series of revisions from 1971 to 2005, due to issues with

validity and reliability. The original version (LSI1) was used for this study. Several studies of

LSI1 identified psychometric weaknesses of the instrument, particularly low internal consistency

reliability and test-retest reliability. Kolb (1984, as cited in Koob & Funk, 2002) defended these


74

results by stating that these scores should be low, because the learning modes are

“interdependent, context contingent, and variable”. The evaluation of the construct validity of the

LSI has focused on the underlying theory rather than “outcome criterion”. Since the underlying

model of the LSI has received much support (Hunsaker, 1981; Kolb, Boyatzis, & Mainemelis,

1999), the original version was still used by various studies. Later versions which were created

in 1985 and 2005 were able to present increased internal consistency range (ie. For LSI2, .73 to

.88) (Kolb & Kolb, 2005).

Figure 4. Learning Style Profile

Source: Kolb, D. (1984). Experiential learning: Experience as the source of learning and development. Englewood Cliffs, NJ: Prentice-Hall.


75

Focused Group Discussion Guide

Lastly, a focus group discussion was done by the researchers to attain the objective of

exploring environment or instructional characteristics affect the assimilation of skills, knowledge,

and attitude on learning IVT. The FGD guide questions were developed based on the

conceptual framework constructed by the researchers. Domains were selected considering the

limitations of the research. The domains are as follows: (1) opportunity for practicing IVT, (2)

feedback of the instructors, and (3) teaching methods of the instructor. Literatures searched and

reviewed by the researchers helped in creating the questions related to each domain. The FGD

guide, as part of the research tool, was also subjected to an evaluation done by experts and the

comments and suggestions received were considered in revising the tool. In the same reason

that the researchers were the raters of the IVT skills, the facilitators for the focused group

discussions were also the researchers.

The focused group discussion guide was included in the instruments packet given to the

experts for validation. However, only the general recommendations and the remarks were used

by the researchers in modifying the items accordingly.

Procedures

After the tools have been validated and tested for reliability, they were used to achieve

the research study’s goals of assessing the level of skills, knowledge and attitudes of fourth year

students on IVT, evaluating the level of retention of fourth year students on IVT and deriving a

learning framework that would describe factors perceived and experienced by senior students

on retaining skills, knowledge, and attitude on IVT. The level of skills, knowledge, and attitudes

was evaluated by using validated and reliable skills observation checklist, knowledge

assessment exam, and attitudes survey. This is one of this study’s objectives. Other pertinent

socio-demographic data about the subjects were also collected through the demographics

questionnaire.


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In the first part of the data collection, the subjects were asked to perform the intravenous

therapy (IVT) skills in the college’s clinical skills laboratory. There were three stations during the

evaluation of the IVT skills. Each of the three researchers who participated in the inter-rater

reliability was assigned in a specific station to check how the subjects performed the individual

steps in each IVT skill. Three other researchers served as assistants and one assistant was

assigned in each station. Their task was to give specific instructions to the subjects to guide

them through the skills evaluation and to minimize interaction between the rater and the subject.

To maintain constancy of conditions, the raters and the assistants were assigned in each station

permanently during the entire data collection. About thirty minutes was needed to finish the

evaluation of the clinical skills of the subjects.

As the subjects enter the first station, the assistant verbally explained the overview of the

procedures and skills involved in the IVT skills demonstration as part of the data collection. It

was ensured that the same verbal instructions were given during the entire data collection

procedure. There were three stations simulating an actual setting. The first station was the area

for medication preparation. Station two and station three served as bed one and bed two,

respectively. IVT arm mannequins were used in these two stations. These IVT arm mannequins

denoted two patients receiving intravenous therapy. A folder containing the instructions for the

whole demonstration was given and the subjects were advised to scan all of the instructions for

them to be acquainted with the IVT procedures they are expected to perform. This folder also

contained the list of medications to be administered, medication cards, and drug-drug

incompatibility chart. The contents of the folder are seen in Figure 5 on the next page.

The subjects were then verbally directed to perform the skills as if they were in an actual

and ideal setting. However, it was explained that some of the drug dosages & particular method

of its administration written in the instructions were hypothetical and were changed for the

convenience of this demonstration. They were also instructed that they could talk to the

mannequins, if needed, as if they were real patients.


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Figure 5. Instructions for IVT Skills Observation

DRUG-DRUG INCOMPATIBILITY CHART

Ampicillin Sodium &

Sulbactam Sodium C C X C C

Ceftriaxone C

C C C C

Ceftazidime C C

C C C

Furosemide C C C

C C

Meropenem C C C C

C

Penicillin G C C C C C

Ampicillin Sodium &

Sulbactam Sodium Ceftriaxone Ceftazidime Furosemide Meropenem Penicillin G

INSTRUCTIONS

1. Prepare materials needed for IV insertion.

2. Start IV Infusion of 1L PNSS to run for 8 hours (Note: Use 20 drops/mL)

3. Administer the following for Patient 1

>Ceftriaxone 1g IV OD (-) ANST via slow IV push

>Meropenem 1g IV q8h via Soluset (Note: Only for the purpose of this demonstration, dilute with PNSS to make 20cc)

>Ceftazidime 1g IV q8h (-) ANST incorporated to ongoing IVF

4. Administer the following via heplock for Patient 2:

>Ampicillin Sodium and Sulbactam Sodium 3g IV q6h

>Furosemide 20mg IV q8h

>Penicillin G Sodium 4 Mil U IV q6h (+) ANST

5. Change IV fluid to 1L LRS to run for 8 hours (Note: Use 20 drops/mL)

6. Discontinue ongoing IV infusion

The first station was the medication preparation area. All of the drugs to be administered

for patients one and two were prepared in this station. To test whether the subjects were

checking for drug incompatibilities, a drug which was incompatible to another drug was written

on the list of medications to be administered. In addition, a drug which was positive for skin test

was also added to the list of the drugs to test if the subjects are checking for positive allergic

reaction to a drug, as well. The skills assessed in the first station were as follows: (a)

preparation of materials for intravenous insertion; (b) preparation of intravenous medications;

and (c) setting up an intravenous infusion.

The next two stations were the location of the IVT arm mannequins. The second station

served as bed 1 and the following skills were assessed in this station: (a) administration of


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intravenous medications via injection port, incorporating intravenous medications into ongoing

IV fluid, and administration of medication via soluset; (b) changing an ongoing intravenous fluid;

and (c) discontinuing an ongoing IVF. The third and last station served as bed 2, wherein the

subjects were instructed to administer an intravenous medication via a heplock.

The subjects who wished to know the results of their skill evaluation were informed that it

would be given by the researchers after the entire data collection to minimize possible effect on

the knowledge score.

The exam, survey and questionnaire were administered to the subjects as a packet after

the scheduled skill performance evaluation. This was also done by the researchers in the

college’s clinical skills laboratory. An estimated thirty minutes was needed by the subjects to fill

up the necessary questionnaire, and answer the exam and survey.

The other factors that affect retention were determined through the focused group

discussions with the subjects conducted after filling up the necessary questionnaires, exams

and survey. This was another objective of this study. It was done in the form of a panel

discussion, where three researchers were directing the flow of the discussion with the FGD

guide: one researcher acted as the moderator, another was the assistant moderator, and the

third researcher served as the logistical assistant which allowed the two researchers to focus

and to provide incentives to the participants of the FGD (Eliot et al., 2005). The focused group

discussion lasted for about 15 minutes. In order to minimize the possibility of the facilitators

influencing the responses of the subjects in the focused group discussions, the facilitators were

trained to eliminate their biases before conducting the research study.

Data Analysis

As part of a larger pilot study of developing tools to assess the SKA levels with regard to

the different clinical skills, the validity and reliability of the tools used were determined through


79

statistics, as described in the section about instrumentation and procedures. The data tables for

validity and reliability testing are seen in Appendix VII.

Validity Testing

For the validity testing of the knowledge tool, the feedback from each rater was encoded

in Microsoft Excel. The individual remarks for each item were simplified by the encoders, and

were used for item revisions. The codebook developed for the study indicated the following

instructions for encoding:

- For Clarity: Encode “1” for YES, “0” for NO

- For Relevance: Encode “1” for NOT Relevant, “2” for MODERATELY Relevant, “3”

for SOMEWHAT Relevant, “4” for Relevant

- For the General Recommendation: Encode “1” for Retain, “2” for Revise, “3” for Drop

Questions with clarity ratings less than 80% were revised according to the expert’s

remarks. The relevance ratings were used to rank the questions and to further select the final

questions for the second round of validation. The same procedure was used for the second

round. The second round revealed that the questions are already valid. An over-all content

validity index (S-CVI/Ave) was reported by taking the average of the relevance ratings for each

item. According to Polit and Beck (2008), the content validity index is ideally measured as the

number of raters giving a rating of either 3 or 4, divided by the number of experts (i.e. the

proportion in agreement about relevance).

For the attitudes tool, the validity was tested by asking the experts about the relevance

of the statements in the Likert scale to the dimension being measured. Also, general

recommendations were also collected from them to guide the researchers in revising certain

items.

The codebook instructed the encoders as follows (in Microsoft Excel):

- For Relevance: Encode “1” for Against, “3” for Neutral, “5” for For, and “2” or “4” for

values intermediate between the three points.


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- For General Recommendations: Encode “1” for Retain, “2” for Revise, “3” for Drop

The median was used for the relevance ratings as suggested by Polit and Beck (2008).

Items with medians from 1.00 to 2.49 were marked “Against”. Those with medians from 2.50 to

3.50 were marked “Neutral. Finally, items with medians from 3.51 to 5.00 were marked “For”.

After the necessary revisions and deletions, these items were then passed for a second round

of validation, using the same procedure for analysis. A combination of the results from

relevance and general recommendation was used to select five items per attitudinal dimension.

Reliability Testing

As discussed earlier, the performance of a step in the skills observation checklist was

encoded as 1 (performed) or 0 (not performed) in Microsoft Excel. Inter-rater reliability of the

consensus type is described by Polit and Beck (2008) as based on assumptions that the goal is

to have observers share a common interpretation of the construct under observation. For each

step, it was determined by dividing the number of agreements that the step was done (i.e. 1) by

the number of raters (i.e. 3). However, if every rater gave the step a “0”, the inter-rater reliability

value is set to 1 because they all “agreed” that the step was not done (i.e. 3 divided by 3). Since

there are two subjects being rated, the average inter-rater reliability value for each was

determined. Whenever there are steps that did not get an inter-reliability value of 80% (i.e. if

only 2 out of 3 agreed, equivalent to 67%), the step was discussed again and clarified with the

raters. An over-all inter-rater reliability value was determined by taking the average of the values

for each step. This is the multi-rater kappa, which is used when more than two raters are

independently rating the same thing (Polit and Beck, 2008). Values of 0.75 and higher are

excellent for this index of agreement between observers.

For the knowledge assessment examination, the results of each item per subject were

encoded as ‘0’ for wrong answers, and ‘1’ for right answers in Microsoft Excel. After this, the

data table was exported to SPSS 20 for reliability testing. However, the function of SPSS for

reliability testing is limited for scales and is not applicable for dichotomous values such as ‘0’ or


81

‘1’. The program was just used to get the inter-item correlations. From this correlation values,

the average was determined and was reported as the Cronbach’s alpha for the entire

knowledge assessment examination. Also, the Cronbach’s alpha for each sub-test (i.e. multiple

choice, problem solving and true-or-false questions) was determined using the same procedure.

Cronbach’s alpha is used to evaluate the internal consistency or homogeneity of scales and

tests that involve summing item scores and consist of different items in an instrument (Polit and

Beck, 2008).

For the attitudes survey, the responses of the subjects were encoded accordingly in

Microsoft Excel. After exporting the data table to SPSS 20, the functions for determining the

split-half reliability and the Cronbach’s alpha were used. The split-half reliability function

analyzed the correlations between the odd-numbered items and the even-numbered items.

Split-half reliability is a measure of the stability of an instrument (Polit and Beck, 2008). This was

used instead of the test-retest reliability coefficient because the design of the study did not

involve administration of the instrument one after the other, separated by a time period. The

Cronbach’s alpha function was applied to each sub-scale in the survey.

Pre-testing

After tool validation and reliability testing, the results of the pre-testing using these tools

were analyzed using descriptive statistics, inferential statistics and thematic analysis. The

details for each are discussed in the succeeding paragraphs. The data tables from pre-testing

are found in Appendix VII.

An item performance review of the results from the IVT skills observation checklist and

the IVT knowledge assessment questionnaire was done first to determine which steps or

concepts had the highest or lowest percentages among subjects. Not all that qualify in these

criteria was included in the results because only the notable ones were mentioned and

supported with available literature.


82

In order to determine the level of skills and attitudes of the subjects on IVT, measures of

central tendency and variation such as the range, mode, median, mean and standard deviation

were reported. Aside from that, cross tabulations of the various component skill (such as

setting-up an IV infusion, etc.) scores of the subjects versus to what course and year level the

different IVT Skills was given emphasis and when it was fully appreciated in practice were

presented to determine whether emphasis and full appreciation of the component skill play a

role on the score on that skill. A cross tabulation, or a contingency table, is a two-dimensional

frequency distribution in which the frequencies of two variables are cross-tabulated (Polit and

Beck, 2008). It allows the reader to see at a glance any trend that is observable from the data.

Though commonly used with nominal and ordinal measures, it was used in the study to illustrate

patterns in our interval level data. Also, it was used instead of the correlation procedures to

describe two variables because it is simpler to understand and is easier to interpret.

For the level of attitudes on IVT, the measures of central tendency used to describe the

values include only the median and the mode while the measures of variation used include the

range because they are only ordinal variables. For the second part of the attitudes survey on the

learning style inventory from Kolb’s theory, the generated data were analyzed according to the

instructions from the tool where it was adopted. A pie chart was presented to aid in showing the

percentage of the subjects with the four learning styles.

In order to evaluate the retention of IVT skills of 4th year nursing students, their score

from the observational checklist was compared to their previous score in the practical exam for

IVT from their Nursing Foundations II course. These data came from their previous N11 faculty.

Their previous scores, which had a total of 25 items, were converted through ratio and

proportion to become comparable with the current IVT Observational Checklist Score which was

over 81. This was done by multiplying their score by 81 and then dividing by 25.

The percent difference of skill score was used as a proxy indicator for skill retention

because no pre-test data was available for comparison. The percent difference between the


83

subject’s score on the IVT skills observation of this study and the subject’s previous score in

their practical exam for IVT from their N11 course was computed by using the formula:

%difference of skill score IVT skills observation score-N11IVT practical exam score

IVT skills observation score

Skill decay was taken as the indicator of the magnitude of skill deterioration, measured

by taking the absolute value of the percent difference of skill score given that it is negative.

Measures of central tendency and variation such as mean, median, mode, range and

standard deviation were also computed for the percent difference of skill score. A two-tailed t-

test of paired means was also used to determine if the difference between the mean skill scores

is statistically significant and is not attributable to random error. Also, this statistical test was

chosen because both of the variables are of the interval level of measurement and because the

groups compared are not independent. A 5% level of significance was chosen for all statistical

tests performed because it is the most commonly used value in many statistics and studies. The

statistical hypothesis is shown below.

Ho: There is no significant difference between the mean skill scores of fourth year UPCN

students from their sophomore year and their current mean skill score.

Ha: There is a significant difference between the mean skill scores of fourth year UPCN


Other possible variables were also looked into by the researchers including sex of the

students. Two-tailed t-tests of independent means were done to determine if the difference

between the mean skill scores and the mean knowledge scores between the two sexes are

statistically significant. This statistical test was chosen because the dependent variables, the

mean skill scores and the knowledge scores, are in the interval level, and the groups being

compared are independent of each other. The statistical hypotheses are shown below.


female and male students


84

There is no significant difference between the mean knowledge scores of fourth

year UPCN female and male students



There is a significant difference between the mean knowledge scores of fourth

year UPCN female and male students

To explore the related factors in skill retention and level of knowledge and skills on IVT,

analyses done were grouped into learner attitudes, and environment and instruction

characteristics. For the analysis of the attitudes such as motivation, learner satisfaction,

motivation, educational practices and learning styles, a tabulation of the correlation coefficients

of these attitudinal components to the skill decay, to the skill score, to the knowledge score, and

to the attitudes themselves. Both Pearson’s r and Spearman’s rho were used for correlation

analyses because the latter is used for ordinal dependent variables (such as attitudinal scores)

and the former is used for interval dependent variables (such as scores on skills observation

and knowledge assessment examination. Most of the coefficients are based on a 5% level of

significance. However, there was a chance that a 1% level of significance was possible in a

correlation coefficient which indicates that it is very statistically significant. Furthermore, item

performance review was also done for each component, together with some explanations and

generalizations about the data gathered.

The environment and instruction characteristics were gathered from the subjects through

a focused group discussion. Thematic analysis of the data from this FGD was performed to

identify important themes. It essentially involves the detection of patterns and regularities, as

well as inconsistencies (Polit and Beck, 2008). A transcription of the focused group discussion is

presented in Appendix IX.

Finally, to accomplish the last objective of deriving a learning framework to describe

factors perceived and experienced by senior nursing students in retention of skills, knowledge


85

and attitudes on IVT, a method similar to path analysis was performed on the conceptual

framework presented in Chapter II and the correlation coefficients for each of the variables were

also indicated. Path analysis is not a method for discovering causes; it is just a method applied

to a pre-specified model (i.e. our conceptual framework) formulated on the basis of prior

knowledge and theory (i.e. related literatures cited in Chapter II).

Ethical Considerations

Informed consent was secured from the subjects, three days before pilot study and

actual data collection. The informed consent is found in Appendix II, part of the packet that was

given to the subjects. The outline of the informed consent is adapted from ICF template of World

Health Organization Ethics Review Committee (WHO-ERC).In addition to this, consent was

secured from the students to allow the researchers to have access to their previous Nursing

Foundations II IVT practical exam scores.

The subjects were informed that their participation in the study would be voluntary and

they have the right to withdraw at any time of the study. The forms indicated that they will be

answering questionnaires and performing return demonstrations that will measure their skill,

knowledge, and attitude toward a nursing skill chosen by the researchers. The study does not

present risks of any form to the participants. However, the subjects may benefit indirectly from

this study through the possible changes in the way IVT is taught in the college that may be one

implication of the study results.

This research was subjected to the college’s ethics review board to ensure that the

subjects’ rights will be preserved. The proposal was submitted on February 8, 2013, and then

the study was approved with minor modifications. Moreover, confidentiality and anonymity were

strictly followed. After data analysis and presentation, the subjects were also allowed to ask for

the results of their individual performance. There is no conflict of interest involved in the study.


86

The researchers do not have any financial or personal ties with people or organizations that

could inappropriately influence their judgment regarding the material discussed in this paper.

End Notes

Alexandrou, et al. (2012). Training of Undergraduate Clinicians in Vascular Access: An

Integrative Review. JAVA.17 (3).146-158.

Artino, A. R. Jr. (n.d.). A review of the motivated strategies for learning questionnaire. Retrieved

from www.sp.uconn.edu/~aja05001/comps/documents/MSLQ_Artino.pdf on January 28,

2013.

Behrens, C.B., Dahlberg, L.L., Swahn, M.H., & Toal, S.B. (2005). Measuring violence-related

attitudes, behaviors, and influences among youths: A compendium of assessment tools.

2nd ed. Georgia: CDC

Curran V., Aziz K., O’Young S., &Bessell C. (2004). Evaluation of the effect of a computerized

training simulator (ANAKIN) on the retention of neonatal resuscitation skills. Teach Learn

Med 16, 157–64.

Eastham, V. (n. d.) .Learning Style Inventory (adapted from Kolb and McCarthy). Retrieved

from http://medialab.st-ndrews.ac.uk/documents/design_tips/kolblearningsurvey.pdf on

January 27, 2012.

Eliot et al. (2005) Guidelines for conducting focus group discussions. Retrieved from

http://assessment.aas.duke.edu/documents/How_to_Conduct_a_Focus_Group.pdf on

February 6, 2013.

Engum, S. A., Jeffries, P., & Fisherb, L. (2003). Intravenous catheter training system: Computer-

based education versus traditional learning methods. The American Journal of Surgery,

67-74.

Hadaway, L. (2005). Innovative staff education techniques. JAVA.10 (4).193-198.

http://assessment.aas.duke.edu/documents/How_to_Conduct_a_Focus_Group.pdf%20on%20February%206



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using two simulation methods for teaching intravenous cannulation. Clinical Simulation in

Nursing Education, 2, 9-12.

Koob, J. J., & Funk, J. (2002). Kolb's Learning Style Inventory: Issues of Reliability and Validity

.Research on Social Work Practice, 12, 293.

Laschinger, S., Medves, J., Pulling, C., McGraw, R., Waytuck, B., & Harrison, M. B. (2008).

Effectiveness of simulation on health profession students’ knowledge, skills, confidence

and satisfaction. International Journal of Evidenced-Based Healthcare, 6, 278-302.

Lasater, K. (2007). Clinical judgment development: Using simulation to create an assessment

rubric. Journal of Nursing Education, 46, 496-503.

Mundy, C. (2007). Innovative teaching strategies: educating student nurses on vascular access

management. JAVA, 12(4), 232-236.

Paolucci, H. & Albert, N. (2011). RN knowledge of vascular access devices management.

JAVA, 16 (4).221-225.

Pintrich, R. R., & DeGroot, E. V. (1990). Motivational and self-regulated learning components of

classroom academic performance. Journal of Educational Psychology, 82, 33-40.

Polit, D.F. & Beck, C. T. (2008). Nursing Research: Generating and Assessing Evidence for

Nursing Practice (8th Ed.). Philadephia: Lippincott Williams & Wilkins.



Reinhardt, A. C., Mullins, I. L., Blieck, C. D., & Schultz, P. (2012). IV Insertion Simulation:

Confidence, Skill, and Performance. Clinical Simulation in Nursing, 8, 157-167

Rosenberg, M., (1989). Society and the adolescent self-image. Revised edition. Middletown,

CT: Wesleyan University Press.

Shamsuddin & Shafie (2012). Knowledge of nurses in the preparation and administration of

intravenous medications. Procedia Social and Behavioral Sciences, 60, 602-609.


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The motivated strategies for learning questionnaire. Retrieved from https://docs.google.com/vie

wera=v&q=cache:MaglRhIELmsJ:www.brazosport.edu/sites/CurrentStudents/Faculty/Ro

bertIrizarry/PSYC%25201300/MSL%2520Questionnaire.doc+msl+questionnaire&hl=en&

gl=ph&pid=bl&srcid=ADGEESgFPAny_AZWqpnqhUIjVJVKPMXvZEly0VQfmtv6jisKGm5

7j6Xm1w21yIw6b4xSIAJ2fOvkt3PDjlXDyfGFpL1QJxvXxY4GBXZx3OlpOE6TbNc8NUFF

1aNP0Uz3jqhsbljoH&sig=AHIEtbRTe_HhkNlbO64hcGDJ_bwXe-U9hQ on January 27,

2013.

Think Impact Solutions, LLC. Self-motivation assessment tool. Retrieved from http://www.think

impactsolutions.com/images/Self-Motivation_Assessment_Tool_-_Best.pdf on January

27, 2013.

Thorndike, R. M. (1997). Measurement and evaluation in psychology and education (6th Ed.).

New Jersey: Merrill, Prentice Hall.

University of Maryland. The Rosenberg Self-Esteem Scale. Retrieved from http://www.bsos.

umd.edu/socy/research/rosenberg.htm on January 28, 2013.

http://www.bsos/


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CHAPTER IV

RESULTS

Participants

The target population for this research includes fourth year UP College of nursing

students currently enrolled in either N121.1 (Intensive Hospital-based Nursing Experience) or

N121.2 (Intensive Community-based Nursing Experience). Out of the 55 students, 10 (18.18%)

were included in the pilot study. Among which, 5 are males and 5 are females. Figure 6 shows

the age distribution of the sample.

All of the 10 students in the sample were regular. Two students shifted to the college of

nursing during their second year in the university. All of them entered UPCN at the year 2009.

One intervening variable in the study was the inherent intelligence of the students. This was

measured through the general grade weighted average of the students which ranged from 1.75

to 2.34. Table 3 on the next page shows the measures of central tendency and measures of

variability of the general grade weighted average of the students.

The range age of the sample of 10 fourth year students was 2 years and the mean was

20.1 years. Figure 7 on the next page shows the age distribution of the sample.

Male 50%

Female 50%

Figure 6. Percentage distribution of sex of 4th year UPCN students


90

Table 3. Measures of Central Tendency and Measures of Variation of General Grade Weighted Average (GWA) of 4th year UPCN students

n Mean Median Mode Range

SD

General GWA 10 1.994 1.995 2.000 0.590 0.153

Tool Validity and Reliability

The instruments developed by the researchers include the IVT Skills Observation

Checklist, IVT Knowledge Assessment Exam, and IVT Attitudes Survey. The over-all Content

Validity Index (S-CVI/Ave) is 0.978 and 0.973, which are very excellent for the IVT Knowledge

Tool Assessment and IVT Attitudes Survey respectively. The IVT Skills Observation Checklist

was derived from the UPCN Skills Checklist used in the Nursing Interventions II course. Inter-

rater reliability was done by the 3 raters using the IVT Skills Observation Checklist and had a

multi-rater kappa of 0.86. This can be considered excellent. However, some items had a

reliability of less than 0.80. These items were clarified and discussed with the raters (see

Appendix VII)

In addition, in order to ensure that all items measure the same trait, the entire IVT

Knowledge Assessment Exam, and IVT Attitudes Survey subscales were tested for internal

19 y.o. 10%

20 y.o. 70%

21 y.o. 20%

Figure 7. Percentage distribution of age of 4th year UPCN students


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consistency. Two reliability measures were used for the final Attitudes Survey. The internal

consistency reliability of each sub-test was measured using the Kuder-Richardson Formula 20

(KR-20) to estimate the degree to which all of the items measure a common concept. SPSS

(Statistical Package for the Social Sciences) Version 20 was used to calculate Cronbach’s alpha

of the IVT Attitudes tool. This tool was a Likert scale with a total of 20 items. The Cronbach’s

alpha of each subscale was calculated as follows: (a) Learner satisfaction subscale was 0.838,

(b) Self-perception subscale was 0.801, (c) Educational Practices subscale was 0.419, and (d)

Motivation subscale was 0.912. The Attitude Assessment tool had an overall Cronbach’s alpha

of 0.912. This signified that the different subparts of the instrument were reliably measuring the

critical attribute accordingly. In addition to this, to estimate the reliability of the entire attitudes

survey, a split-half reliability was measured using Spearman-Brown Prophecy Formula (SBPR).

This was done because homogeneous content cannot be assumed across all items in the entire

exam, which limits the use of the KR-20 (Thorndike, 1997). The split half reliability was also

calculated using the same software. The even numbered items were compared to the odd

numbered items. It had a value of 0.846 indicating good internal consistency.

Because there was no function for the calculation of Cronbach’s alpha in SPSS for

dichotomous variable, a manual calculation was done for the Knowledge Assessment Exam.

The inter-item correlation of the items was calculated using Spearman Rho function because

dichotomous variables are in the nominal level of measurement. The average correlation

coefficient then calculated manually using Microsoft Excel 2010, thus the Cronbach’s alpha was

0.179 for the 14 multiple choice questions, 0.379 for the problem solving questions, and 0.379

for the 11 true or false questions. The average Cronbach’s alpha of the entire Knowledge

Assessment Tool was 0.339. This was low because several items were answered correctly by

all 10 students and because of low sample size.


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Item Performance Review

Skill Observational Checklist

There were several steps on the skills observational checklist wherein 3 or less of the

samples were able to remember to perform. None of the 10 students performed hand washing

while setting up an IV infusion, preparing and administering IV medications, and changing an

ongoing IV infusion. One out of 10 students (10%) performed hand washing before and after the

procedure while discontinuing an ongoing IV infusion. 3 out of 10 students (30%) checked the IV

site for signs of infiltration and inflammation before administering IV medications via the injection

port and using the heplock. During the preparation of IV medications in syringes, there were

only 3 out of 10 students (30%) who had checked for skin test of the drug for IV push, and 2 out

of 10 students (20%) who checked for drug-drug and drug-IV fluid incompatibility. While

incorporating medication into ongoing IV fluid, 3 out of the 10 students (30%) kinked the tubing

before removing the administration set from the bottle. While administering medications via IV

push using Heplock, 1 out of 10 students (10%) was able to fill the tuberculin syringe with the

correct amount of heparin solution. While incorporating and administering medications via

soluset, 2 out of 10 students (20%) checked the present IV fluid label, level and incorporated

into the soluset and placed an IV label tag on the soluset to indicate the drug administered.

While changing an ongoing IV infusion, 2 out of 10 students (20%) explained the procedure to

the patient and documented accordingly. 1 out of 10 students (10%) checked the sterility and

integrity of the IV. While discontinuing an ongoing IV infusion, 3 out of 10 students (30%)

inspected the IV catheter for completeness and performed documentation.

There were several steps on the skills observational checklist wherein all of the 10

students (100%) had performed. During preparation of IV medications in syringes, these steps

are counterchecking medication card against written orders, observing 10 Rs when preparing

medication, checking for dosage computation, preparing the necessary materials for the

procedure, and preparing the medications accordingly. During administration of medications via


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injection port, the steps included are kinking the tubing and pushing the IV drug slowly or as per

manufacturer’s instructions. During the administration of IV medications via push using Heplock

port, the step included is inserting medication into injection port, inject medication into vein and

timing the flow rate according to the doctor’s order. During the incorporation of medication into

soluset and administering medications via soluset, the step included is adding the desired IVF

diluent into soluset by opening the clamp on the bottle then closing the clamp after. During the

changing of an ongoing IV infusion, the step included is verifying the doctor’s order. During the

discontinuation of an ongoing IV infusion, the steps included are closing the IV clamp of the IV

tubing and getting a cotton ball with alcohol and then without applying pressure removed the IV

cannula.

Some important steps involved in IVT were not performed by the subjects. It can be

noted that some of the steps such as administration of heparin when administering medications

through Heplock, placement of IV label on the Soluset, and kinking the tubing before removing

the administration set are not done by the students in the actual hospital setting. Those notable

steps are indicated in Figure 8.

0

1

2

3

4

5

6

7

8

9

10

Figure 8. Frequency distribution of 4th year UPCN students who did not perform important IVT procedures

Hand washing Administration of Heparin

Checking of integrity of IVF

Checking of drug compatibility Checking of IVF label & level

Placement of IV label on soluset Explaining procedure to the patient

Documenting procedure

Checking for skin test Assessing IV site

Inspection of catheter for completeness

Kinking the tubing before removing the administration set


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Knowledge Assessment Exam Tool

There were several items in the knowledge tool wherein only half or less of the sample

was able to answer correctly. For the first item in the multiple choice section, 4 out of 10 (40%)

were able to get the correct answer. This item is about assessment and planning in fluid and

electrolyte imbalances. In the sixth item, which is about venipuncture sites, 4 out of 10 (40%)

were able to answer correctly. In the 11th, 12th, and 13th items, which are all about

troubleshooting IV therapy problems, there were 4 (40%), 3 (30%) and 5 (50%) out 10 students

respectively that were able to get the correct answers. It can be noted that most errors fall on

items related to troubleshooting IV therapy complications.

There were also several items in the multiple choice section that were all answered

correctly by the 10 students. These items were about monitoring of IV infusions and

complications, purposes of IV therapy, and troubleshooting IV therapy problems.

It is of note that there were 3 items on troubleshooting IV therapy problems that few

were able to answer correctly but another item on the same topic was answered correctly by all

the students. This might be because the situation presented in the latter item was a more

common occurrence during their clinical rotation thus they had to address this problem more

frequently and as such contributing to increased remembrance of what they do during those

times.

In the problem solving section, all the students were able to answer correctly the item on

calculating the appropriate drop rate according to the given time and amount of IV fluid.

In the true or false section, there were five items that were answered correctly by all the

students. Three items were on IV medication preparation, while the other two items were on IV

medication administration.

Attitudes Survey

The item performance review for the attitude survey is divided into the 4 domains

including learner satisfaction, self-perception, educational practices, and motivation.


95


The participants displayed satisfaction with regards to teaching methods, learning

materials used and instructional designs applied in the curriculum of the university in teaching IV

therapy knowledge and skills. Among the five items for learner satisfaction, the item #1 (The

teaching methods used in teaching IV therapy skills are helpful) scored the highest median of

4.5 indicating that the participants perceive teaching methods in IV therapy helpful or effective.

However, item #5 (The way IV therapy skills is taught is consistent with the way I like to

learn)had a median score of 4.0. Although the value can still be considered high, there were 2

participants who disagreed with the statement indicating that the way IV therapy skills is taught

is not consistent with the way they like to learn the said skill. This is consistent with the findings

in the Focused Group Discussion (FGD) which will be discussed in the later portion of this

chapter. The participants in the FGD stated that the practice of IV therapy in the actual setting

during their clinical rotations is inconsistent with the ideal practices which are taught in the

classroom or laboratory sessions.

Self-perception

The highest median score of 4.5 was recorded for item #7 (I am confident that I am

developing the practical skills needed to become a good health professional). This may be due

to their increased clinical exposure and increased opportunities for practicing IV therapy skills,

as well as troubleshooting possible complications. In general, the students have high self-

efficacy and self-esteem in their knowledge and skills towards IV therapy.


Item # 13 (I like to collaborate with my classmates during learning) showed the highest

median score of 4.5 for the educational practices dimension revealing that collaboration among

student nurses is highly favored during learning activities such as in clinical rotations or in

classroom. Educational practices such as active learning, feedback system, collaboration


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among members of a team, and using various learning methods and time management are

generally beneficial to learning IV therapy.

Motivation

Among the given items for motivation, items # 18 (It is important for me to learn IV

therapy) and # 20 (I think it is useful for me to learn IV therapy) scored the highest median of 5.0

indicating that what motivates the students in learning IV therapy is its importance and

usefulness in their chosen career. In general, the participants demonstrated high motivation in

learning IV therapy taking into account experiences of setbacks, having pride in one’s work and

interest in IV therapy.

Assessment of Level of SKA of 4th year Students

Skill and Knowledge

Assessment of the current level of skills, knowledge, and attitudes of fourth year nursing

students was done through the use of the instruments developed by the researchers. The

sample had a mean skill score of 50.00 (61.73%) out of 81. The skill scores ranged from 43

(53.09%) out of 81 to 65 (80.25%) out of 81. The knowledge scores ranged from 21 (70.00%)

out of 30 to 28 (93.33%) out of 30. It had a mean value of 23.90 (79.67%) out of 30 and a

standard deviation of 1.79. Table 4 shows a summary of the measures of central tendency and

measures of variation of the knowledge and skills score of the fourth year students.

Table 4. Measures of Central Tendency and Measures of Variation of knowledge

and skill scores of 4th year UPCN students

n Range Mode Median Mean Std. Deviation

Skill Score 10 22.00 48.00 49.00 50.00 5.91

Knowledge Score 10 7.00 24.00 24.00 23.90 1.79


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Other possible variables were also looked into by the researchers. The sex of the

students was also analyzed with the skill scores and knowledge scores. Two T-tests of

independent means were done. The first t-test t (df=6.785, α = 0.05) = 2.306 was performed and

the calculated test statistic was -1.765. Given the following hypotheses:

Ho: There is no significant difference between the mean knowledge scores of fourth year

UPCN female and male students

Ha: There is a significant difference between the mean knowledge scores of fourth year

UPCN female and male students

The mean of the knowledge score of female students, 24.800 (82.667%), is higher than

the knowledge scores of male students, 23.000 (76.667%) as shown in Table 5. However, the

standard deviation of the knowledge scores of female students (1.924) is also higher than those

of the male students (1.225). The level of knowledge of females is relatively higher but is more

varied.

Because the calculated p-value (.122) is not less than .05, the null hypothesis is

accepted. Therefore, there is no significant difference between the mean knowledge scores of

fourth year UPCN female and male students. A copy of the statistical printout from SPSS is

attached in Appendix VIII.

Table 5. Independent t-test of knowledge scores of male and female 4th year UPCN students

n Mean Std. Deviation p-value* Test statistic

Male 5 23.000 1.225 .122 t=-1.765 Female 5 24.800 1.924

* 2-tailed independent t-test; α=0.05

Another t-test of independent means t (df=4.617, α = 0.05) = 2.306 was also performed

and the calculated test statistic was -.730. Given the following hypotheses:


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The mean of the skill score of female students, 51.40 (63.46%), is higher than the skill

scores of male students, 48.60 (60.0%) as shown in Table 6. However, the standard deviation

of the knowledge scores of female students (8.26) is also higher than those of the male students

(2.30). The level of skill of females is relatively higher but is more varied.

Because the calculated p-value (.501) is not less than .05, the null hypothesis is

accepted. Therefore, there is no significant difference between the mean skill scores of fourth

year UPCN female and male students.

Table 6. Independent t-test of skill scores of male and female 4th year UPCN students


Male 5 48.60 2.30 .501 t=-.730 Female 5 51.40 8.26

* 2-tailed independent t-test; α=0.05

The subjects were also asked to indicate what course the different IVT procedures were

given emphasis and when it was fully appreciated in practice. The different courses are further

classified as show in the table below.

Table 7. Classification of Nursing courses with the year and semester taken

Course Year Taken Semester Taken

Nursing Foundations N 11

2nd year

2nd semester

Nursing Interventions N105 N107 N109.1

3rd year 3rd year 4th year

1st semester 2nd semester 1st semester

Intensive Clinical Experience N121.1

4th year

2nd semester


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The different skills include (a) Setting-up IV Infusion, (b) Changing an IV Infusion, (c)

Discontinuing an IV Infusion, (d) Administering medications through IV Push, (e) Administering

medications through Heplock, (f) Incorporating medications into IV Fluid, and (g) Incorporating

medications into Soluset. The scores for each skill are classified as either low score or high

scoredepending on the total number of items. Scores around 60% are classified as high. These

will be further discussed in the subsections below.

Setting-up IV Infusion

This skill has a total of 15 steps. Raw scores of at least 10 (67%) are classified as high

scores. Half of the students were classified under high scores. All of the students classified

under high scores in setting up IV infusion part came from students who perceived that this skill

was emphasized during the clinical rotation from the Interventions courses. These students

perceived that they fully appreciated this skill during their clinical rotations in the interventions

courses and in the intensive clinical experience. The scores of the students are high because

they fully appreciated the skill in courses recently taken.

Table 8. Cross tabulation of scores on setting up IV infusion and when skill was emphasized and fully appreciated by 4th year UPCN students

Low Scores High Scores Emphasis

n Full Appreciation

n Emphasis

n Full Appreciation

n

Foundations Course

4 (40%) 2 (20%) 0 (0%) 0 (0%)

Interventions Courses

1 (10%) 2 (20%) 5 (50%) 3 (30%)

Intensive Clinical Experience Course

0 (%) 1 (10%) 0 (0%) 2 (20%)

Total 5 (50%) 5 (50%)

Changing IV Infusion

This skill has a total of 15 items. Because only one student had a score greater than 9

out of 15 (60%), raw scores of at least 8 (53%) are classified as high scores. 4 out of the 10

(40%) students had high scores. Most of the students who had high scores perceive that this


100

skill was given emphasis during their interventions courses. 2 out of the 4 students who had

high scores perceived that the skill was fully appreciated during their Intensive Clinical

Experience Course which was the last course that they took.

Table 9. Cross tabulation of scores on changing an IV infusion and when skill

was emphasized and fully appreciated by 4th year UPCN students


n Full Appreciation

n Emphasis

n Full Appreciation

n

Foundations Course

4 (40%) 2 (20%) 1 (10%) 1 (0%)


2 (20%) 4 (40%) 3 (30%) 1 (10%)


0 (%) 0 (0%) 0 (0%) 2 (20%)

Total 6 (60%) 4 (40%)

Discontinuing an IV Infusion

This has a total of 12 items. 4 (40%) students who had scores of at least 8 (67%) are

classified as high scores. All of the students who have high scores for the discontinuing IV

infusion part perceived that this skill was given emphasis during the interventions courses.

These students perceived that they fully appreciated this skill during their clinical rotations in

their Intensive Clinical Experience and Interventions Courses.

Table 10. Cross tabulation of scores on discontinuing an IV Infusion and when skill was

emphasized and fully appreciated by 4th year UPCN students


n Full Appreciation

n Emphasis

n Full Appreciation

n

Foundations Course

4 (40%) 2 (20%) 0 (0%) 0 (0%)


2 (20%) 4 (40%) 4 (40%) 2 (20%)


0 (%) 0 (0%) 0 (0%) 2 (20%)

Total 6 (60%) 4 (40%)


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Administering Medications through IV Push

This skill had a total of 5 steps. 8 students (80%) students with scores of at least 4 (80%)

are classified as high scores. 5 out of the 7 (71%) students classified under high scores fully

appreciated this skill in their interventions courses. Similar to the results of the previous steps

discussed, students who had high scores appreciated administering medications through IV

push in the courses taken during their 3rd year and 4th year level.

Table 11. Cross tabulation of scores on administering medications through IV Push and when

skill was emphasized and fully appreciated by 4th year UPCN students


n Full Appreciation

n Emphasis

n Full Appreciation

n

Foundations Course

1 (10%) 1 (10%) 4 (40%) 2 (20%)


1 (10%) 1 (10%) 4 (40%) 5 (50%)


0 (%) 0 (00%) 0 (0%) 1 (10%)

Total 2 (20%) 8 (80%)

Administering Medications through Heplock

Administering medications through heplock had a total of 9 steps. High scores are

defined as scores of at least 6 (67%). 7 (70%) students were classified as high scores. 5 out of

the 7 (71%) students classified as high scores and all of the students classified as low scores

perceived that administering medications through heplock was given emphasis in their

interventions courses. 4 out of these 7 (57%) students also perceived that this skill was fully

appreciated in the intervention courses. 2 out of the 3 (67%) of the students who had low scores

perceived that administering medications through heplock was emphasized during their

foundations courses. In contrast with the students who had high scores, none of the students

who had low scores perceived that this skill was fully appreciated in the intensive clinical

experience course.


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Table 12. Cross tabulation of scores on administering medications through Heplock and when skill was emphasized and fully appreciated by 4th year UPCN students


n Full Appreciation

n Emphasis

n Full Appreciation

n

Foundations Course

2 (20%) 0 (0%) 2 (20%) 2 (20%)


1 (10%) 3 (30%) 5 (50%) 4 (40%)


0 (%) 0 (0%) 0 (0%) 1 (10%)

Total 3 (30%) 7 (70%)

Incorporating Medications in IV Fluid

This part had a total of 6 steps. Half of the students had a score of at least 4 (67%) and

are classified as high scores. Similar to all the other IVT skills, none of the students perceived

that emphasis of IV Therapy skills is first perceived in their intensive clinical course. 4 out of the

5 (80%) students who had low scores and 2 out of 5 (40%) students who had high scores

perceived that this skill emphasized in their interventions courses. 2 out of the 5 (40%) students

who had low scores and 3 out of 5 (60%) students who had high scores perceived that this skill

was fully appreciated also in their interventions courses. Unlike the results of the previous skills

discussed, there is no particular pattern for the perceived emphasis and appreciation of the

students.

Table 13. Cross tabulation of scores on incorporating medications in IV fluid and when skill was emphasized and fully appreciated by 4th year UPCN students


n Full Appreciation

n Emphasis

n Full Appreciation

n

Foundations Course

1 (10%) 1 (10%) 3 (30%) 1 (10%)


4 (40%) 2 (20%) 2 (20%) 3 (30%)


0 (0%) 2 (20%) 0 (0%) 1 (10%)

Total 5 (50%) 5 (50%)


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Incorporating Medications into Soluset

This skill had a total of 8 steps and scores of at least 5 (63%) are classified as high

scores. 5 out of the 6 (83%) students who had high scores perceived that incorporating

medications into soluset was fully appreciated in their interventions course. None of the

students perceived that full appreciation of the skill was made during their sophomore year. In

addition, most of the students who had high scores perceived that this skill was emphasized

also during their interventions courses.

Table 14. Cross tabulation of scores on incorporating medications into Soluset and when

skill was emphasized and fully appreciated by 4th year UPCN students


n Full Appreciation

n Emphasis

n Full Appreciation

n

Foundations Course

2 (20%) 1 (10%) 2 (20%) 0 (0%)


2 (20%) 2 (20%) 4 (40%) 5 (50%)


0 (%) 1 (10%) 0 (0%) 1 (10%)

Total 4 (40%) 6 (60%)

In summary, all of the students perceived that IVT skills are emphasized during their

foundations and interventions courses. This reflects that clinical instructors in the college ensure

that the students’ competency in the said skills is developed starting from their sophomore year.

Most students who had high scores perceived that they fully appreciated various IVT skills

during their clinical rotations in the interventions and intensive clinical experience courses. The

scores of these students are high because they fully appreciated the skills in courses which

were recently taken. In contrast with the students who had high scores, very few of the students

who had low scores perceived that this skill was fully appreciated in the intensive clinical

experience course.


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Attitude

The attitude score of each student were divided into 4 subsections namely learner

satisfaction, self-perception, educational practices, and motivation. The table below shows the

mode, median and range for the different attitudes. The highest possible score for each domain

was 25.

Among the 4 attitudinal domains, motivation had the highest median score of 23.5 (94%)

while learner satisfaction had the lowest median score of 20.0 (80%). In addition, the motivation

domain also had the lowest range and the highest mode. It can be said that the fourth year

UPCN students are highly motivated to learn IVT. Learner satisfaction had the highest range of

9. Satisfactions among samples are most varied compared to the other 3 domains of attitude.

Table 15. Measures of Central Tendency and Measures of Variation of

attitudinal domain scores of 4th year UPCN students

n Minimum Maximum Range Mode Median

Satisfaction 10 16 25 9 20 20.0

Self-perception 10 18 25 7 20 20.5

Educational Practices 10 19 24 7 21 21.5

Motivation 10 20 25 5 25 23.5

The second part of the attitudes survey was taken from Learning Style Inventory which

was derived from Kolb’s experiential theory and model of learning. The tool was taken as is and

was not revised. It was used to classify the subjects into 4 types of learner namely divergent,

accommodative, convergent, and assimilative. 5 out of the 10 students were convergent

learners, 3 out of 10 were accommodative learners, 1 out of 10 was a divergent learner, and 1

out of 10 was an assimilative learner. The classifications of the subjects are shown in the figure

located on the next page.


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Evaluation of Skill Retention

All of the 10 students had a negative percent difference of skill score. The mean percent

difference of skill score was -49.85 and the variation of the scores was low at standard deviation

14.78. The measures of central tendency and measures of variation are shown in the table

below.

Table 16. Measures of Central Tendency and Measures of Variation of percent difference of skill score of 4th year UPCN students

n Mean Median Mode Range SD

Percent Difference

of Skill Score 10 -49.85 -50.37 -52.08 58.66 14.78

Two-tailed T-test of paired means t (df=9, α = 0.05) = 2.262 was performed and the

calculated test statistic was 13.065. Given the following hypotheses:



Divergent 10%

Accomodative 30%

Convergent 50%

Assimilative 10%

Figure 9. Percentage distribution of the learner type (according to Kolb) of 4th year UPCN students


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The mean skills score of 4th year nursing students was higher during their sophomore

year (74.196 or 91.6%) compared to their skill score from the IVT Observational Checklist

(50.000 or 61.7%). Their current skill scores are more varied compared to their skill scores

during their sophomore year as shown in the table below.

Table 17. Paired t-test of skill scores of 4th year UPCN students from

sophomore year and senior year


Sophomore year 10 74.196 2.837 .000 t=13.065 Senior year 10 50.000 5.907

* 2 tailed paired t-test; α=0.05

Because the p value (.000) is less than .05, the null hypothesis is rejected and the

alternative hypothesis is accepted. There is a significant difference between the mean skill

scores of fourth year UPCN students from their sophomore year and senior year.

From the results of the t-test and the percent difference of skill score, it can be said that

there was no relative retention of IVT skills among fourth year UPCN students. This direction

may change if sample size is increased because of possible sampling error. This may also be

affected by confounders such as student’s temperament or disposition during the data

collection.

Factors Related to Retention of Skills and Level of SKA

Learner Attitudes

Several factors, as discussed in the previous chapters, are thought to affect the retention

of skills and the level of knowledge in IVT of students. Learner attitude as a factor has 4

domains namely learner satisfaction, self-perception, educational practices, motivation, and


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learning style. Pearson product moment correlation and Spearman rho were done depending on

the level of measure of the said variables. Table 18 shows correlation coefficients of these

factors in relation to the skill score, skill decay, knowledge score, and among the said factors.

As seen from the table, none of the 4 domains of learner attitude had a statistically

significant correlation with the knowledge score, skill score, and skill decay. The domains of

learner attitude including learner satisfaction (rs=-.309, α=0.05), self-perception (rs=-.158,

α=0.05), educational practices (rs=-.256, α=0.05), and motivation (rs=-.309, α=0.05) had

negative correlation with skill decay. This indicates that skill decay is higher when these learner

attitude domains are lower. However, the correlation is weak and is statistically insignificant.

Table 18. Correlation coefficients of various factors perceived to be affecting

skills and knowledge on IVT of 4th year UPCN students

Skill Decay

%Skill Score

%Knowledge Score


Self-Perception


Motivation Learning Style

Skill Decay 1.0 %Skill Score -.929

** 1.0

%Knowledge Score

.195 .031 1.0


-.309 .229 -.396 1.0

Self-Perception

-.158 .176 -.549 .677* 1.0


-.256 .084 -.253 .372 .259 1.0

Motivation -.309 .228 -.452 .566 .821**

.423 1.0 Learning Style

.178 -.402 .130 .126 .127 -.356 -.277 1.0

*. Correlation is significant at the 0.05 level (2-tailed). **. Correlation is significant at the 0.01 level (2-tailed).

It can also be seen that several domains of learner attitudes affect each other. Self-

perception had a significant correlation with learner satisfaction (rs=0.667, α=0.05) and

motivation had a significant correlation with self-perception (rs=0.821, α=0.01).

Two significant findings were noted for the type of learner and its effect on the

knowledge and skill scores of the subjects. The knowledge assessment examination had a total

of 30 items. Scores of at least 24 (80%) are classified as high scores. 6 (60%) students are


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classified as high scorers. Students who had low scores fell on all 4 categories of learning style.

It can be noted from the table below that 2 (20%) got a high score from the accommodative

learning style and 4 from the convergent learning style (40%). This may indicate that most

nursing students who has a good knowledge about IV therapy must have come from these two

learning styles, accommodative and convergent.

Table 19. Cross tabulation of learning style (according to Kolb) and knowledge scores of 4th year UPCN students

Learning Style Low Scores

n High Scores

n

Divergent 1 (10%) 0 (0%) Accommodative 1 (10%) 2 (20%) Convergent 1 (10%) 4 (40%) Assimilative 1 (10%) 0 (0%)

Total 4 (40%) 6 (60%)

The skill observation checklist had a total of 81 items. Students who had scores of at

least 49 (60%) are classified as high scores. 6 out of 10 participants (60%) scored high in the

skills observation. All participants who prefer the divergent and accommodative learning styles

obtained high scores. The only participant who preferred assimilative learning style obtained a

low score. In the case of the convergent learners, more participants scored low than high.

Table 20. Cross tabulation of learning style (according to Kolb) and skill scores of 4th year UPCN students

Learning Style Low Scores

n High Scores

n

Divergent 0 (0%) 1 (0%) Accommodative 0 (0%) 3 (20%) Convergent 3 (30%) 2 (40%) Assimilative 1 (10%) 0 (0%)

Total 4 (40%) 6 (60%)

From these results, it may be stated that students who prefer an assimilative learning

style or convergent learning style is more likely to obtain a skill score lower than 60%. While

either a divergent or accommodative learning style can help a student achieve 60% or higher

skill score. An accommodative learning style is more likely to help a student achieve high skill


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score than divergent learning style due to the higher number of participants who prefer this

learning style.

Environment and Instruction Characteristics

To attain the objective of exploring environment or instructional characteristics affect the

assimilation of skills, knowledge, and attitude on learning intravenous therapy, a focused group

discussion (FGD) was conducted. The items in the FGD were about instructional characteristics,

which include instructional methods, opportunity for practice, feedback and student perception

of instructor. Four senior students of the University of the Philippines College of Nursing (UPCN)

participated in the said discussion which was conducted at the UPCN Student Lounge.

General Impression

The participants generally believe that the instruction or learning style employed in

intravenous therapy was systematic and sufficient. They believe that the observational skills

checklist utilized in teaching IV therapy made the instructional method more organized. Guided

by the checklists, their professors can appropriately assess the students’ knowledge and skills

on IV therapy. The participants added that guidance and supervision from their clinical

instructors as they were performing the IV therapy skills is an important part of their learning.

They were provided with various modes of instruction such as lectures, videos,

demonstrations and practical examinations which they found effective. During practical

examinations, clinical instructors closely supervise them as they perform the IV therapy skills.

One participant stated that although the learning materials provided to them were sufficient, he

still had to do some research about IV therapy skills, particularly IV insertion. He added that

while lectures are reinforced by videos on the skills, they do not cover all of the skills in

intravenous therapy. The participants also believe that practicing with a mannequin is not

enough to truly develop the skill. They agreed that the skills are better appreciated, especially IV

insertion, when performed on an actual person. They all agreed that theoretically, the learning


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styles and instruction methods were effective and sufficient but they see that the practical

aspect of the teaching can still be improved.

What all of the participants found notable was how the ideal practices on IV therapy

differ from the practices in the actual clinical setting. One of the participants in the discussion

stressed the importance of knowing what practice is ideal and learning to adjust in the actual

setting, but still being guided by the right principles. The students must be flexible and adapt to

the demands of the actual setting where being practical is the principle followed rather than

being ideal.

Opportunities for Practice

They were able to appreciate the actual performance of IV therapy skills during their

clinical rotations. They said that exposure to such skills varies depending on the wards they are

having their clinical duties in but the initiative of the student also matters in gaining experience

on skills on intravenous therapy. The student must be resourceful enough to find cases and

patients where he or she could perform the IV skills. One participant said that the student must

have the initiative for professional growth. They see their opportunities for practice of IV therapy

skills as sufficient because they are able to perform them on actual patients for a number of

times. The various exposures facilitated their retention of skills and knowledge on IV therapy.

During the discussion, the participants also narrated their experiences on troubleshooting. They

admitted that when they first encountered problems in the patients’ peripheral lines such as

clogged IV tubing, presence of air and backflow of blood in the IV tubing and a leaking IV line,

they were unsure of what to do. One of them said that not knowing how to troubleshoot properly

gives room for medication errors because the student becomes anxious and even scared during

these instances. They see this as an important aspect of the teaching of IV therapy skills where

more focus must be given.


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Feedback

The participants said that their professors usually give them feedback whenever they

perform IV therapy skills or nursing skills in general. They view feedbacks as essential to

learning because these give them a picture of how they are doing, what aspects of the care or

skills they need to improve in and knowing the right thing to do so as not to jeopardize the

patient’s safety. Feedbacks are also a means of getting affirmations that they have done the

procedures or skills correctly. The participants added that when doing a skill for the first time,

supervision from the clinical instructor is vital and while doing the skill, getting immediate

feedback is a helpful guide because the student is given an opportunity to correct errors even

before committing them. They also see the clinical instructors’ feedbacks as a form of evaluation

of their performance. For them, self-assessment and feedback from the instructor are the

important aspects of improvement in clinical performance.

Recommendations

As mentioned above, the participants’ general impression of the instruction or learning

style employed in intravenous therapy was that it was systematic and sufficient, especially the

theoretical part. What they want to improve is the actual demonstration of the skills. They

believe that practicing with a mannequin is insufficient to develop the skills fully. They see

exposure and frequency of exposure to opportunities for intravenous therapy skills as important

factors in the retention of skills and knowledge on the subject matter. Thus, they consider the

performance of the skills to actual persons and having more of this opportunity as critical in

developing and retaining the skills and knowledge of the students. As for the teaching style,

one of the participants voiced that the professors should also alter their manner of giving

feedbacks. He believes that a feedback which is constructive in nature, rather than destructive,

motivates the student to perform better.


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Learning Framework

The learning framework (Figure 10) is similar to a path analysis that discusses the

correlations between variables in the conceptual framework. The straight black arrow lines

indicate the relationship between the five student attitudes and level of knowledge. Blue arrow

lines indicate the relationship of these student attitudes and level of skill. The curved black

arrow lines show the statistically significant correlations between the student attitudes.

For the correlations to the level of knowledge, only the learning style of the student was

positively correlated. However, the correlation coefficient of 0.130 only signified a very weak

direct relationship. It was also notable that self-perception has a stronger indirect relationship

with it because of its -0.549 correlation coefficient.

Only the learning style was negatively correlated with the level of skill, as shown in its

correlation coefficient of -0.402. The other four attitudes were positively correlated with the level

of skill, with learner satisfaction and motivation getting the top spots at 0.228 and 0.229,

respectively. The same pattern was observed with the level of knowledge. It was also interesting

to note that whenever an attitude has a positive relationship with the level of skill, it

consequently had a negative relationship with the level of skill. This was supported by the very

weak direct relationship between the levels of knowledge and skill at only 0.031.

Student attitude domains including motivation, self-perception, satisfaction, and

educational practices had a negative correlation with skill decay. This indicates that a decrease

in these student attitude domains will lead to an increase in skill decay. However, the correlation

is weak and is statistically insignificant. The figure below also shows that the level of skill has a

strong negative correlation with skill decay. This means that skill decay is less when the level of

skill on IVT is high.

However, the said domains of student attitudes should not be disregarded as factors that

affect retention and level of skills and knowledge because of possible sampling error due to the

small sample size.


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Figure 10. Learning Framework (similar to Path Analysis)

From the correlational procedures run among the various student attitudes, only two had

significant correlations at the 0.05 level of significance, at the least. Motivation and self-

perception had high direct correlations at 0.821. Also, self-perception is highly correlated with

learner satisfaction at a coefficient of 0.677.

Only broken arrow lines indicate the relationship of the environmental and instructional

characteristics because they were not quantified in this study. Therefore, statistical analysis was

impossible between these factors and the levels of knowledge and skill.


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CHAPTER V

DISCUSSION AND ANALYSIS

Skills

Based on the results using the observational checklists, 1(10%)out of the 10 students

performed hand hygiene before and after discontinuing an ongoing an intravenous infusion;

while none of them performed the hand washing for the other aspects of IVT skills. Intravenous

site inspection, checking skin test of the drug for IV push and drug incompatibilities, and

inspection of IV catheter in discontinuation of an IV infusion were performed by only 30% of the

total sample. The same number of students performed kinking of the tubing during drug

administration into an ongoing IV fluid. 20% of the sample explained the procedure and

performed documentation; checking of the present IV fluid and making of an IV label tag on the

soluset were done by the same number from the sample. Only 10% of the students correctly

prepared the heparin solution for a heplock IV push and checked IV sterility and integrity. In

contrast, there were procedures performed by all of the students. Basic procedures in

intravenous therapy were performed by all of the students as enumerated in the previous

chapter. Further analysis of the data of the samples was taken into account with the use of

descriptive statistics. Current level of their skills showed a mean score 50.00 (61.73%); mode of

48 (59.26%) out of 81; a median of 49 (60.49%) out of 81; and a standard deviation of 2.91.

When compared to the previous scores the students had in their laboratory exam in their

sophomore year, analyses showed a significant difference between their latest mean skill

scores and their mean skill score from their sophomore year.

Factors recognized by the researches may have contributed to such results. The setting

where the skills were observed and performed was perceived by the students as different from

the actual setting. As what they have stated during the focused group discussion, performing

the intravenous procedures on actual and real patients feels different when they are performed


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on a dummy. According to Murray, et. al. (2007), studies on simulated learning do not show

enough data whether the knowledge and skills gained through them are “actually translated

from educational and training settings into competence and proficiency within the clinical field”.

Evidence suggests that the effectiveness of mannequin-based learning for measuring

competence remains inconclusive (Murray, et. al, 2007). Also, there are differences between the

ideal setup and procedures from those observed and implemented in the clinical area. The

students do not comprehensively perform all the procedures included in the checklist once they

are in the clinical area.

Another factor that could have contributed to the decline in the scores is the retention

interval that led to the skill decay of the students. Because the students are assigned in different

wards, not all are given as much opportunities to perform some of the procedures in the area.

To add to that, though all of the procedures were introduced in their sophomore year, emphasis

on them were made in different year levels; some in the same year as they were taught, some a

year after. The non-practice of the procedure and the infrequent opportunities had an effect on

the deterioration of the students’ intravenous therapy skills. The results are consistent with a

previous study conducted by Bennett, et. al (1998) that showed a negative relationship between

the skill retention and nonuse and nonpractice interval. On the contrary, overlearning of the

intravenous therapy for those who were frequently exposed to the opportunity and the

procedure can be considered a determinant of their skill retention (Bennett, et al, 1998).

The said difference in the percentage mean scores of the students can be attributed to

the instructor’s technique during the initial assessment of the intravenous skills. As mentioned

by Bennett et al (1998) in the same study, guided and programmed instructions in performing

the procedures led to better retention of the skill; as compared to the assessment of the latest

skill score wherein there was no presence of any instructional guidance from the researchers to

the students.


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Knowledge

It was shown from the results of the pre-testing that the senior nursing students’ scores

ranged from 21 (70.00%) to 28 (93.33%) out of 30 items. It had a mean value of 23.90 (79.67%)

and a standard deviation of 5.97.

Generally, the students had a good score in the knowledge assessment. In a journal by

Essani & Ali (2011), they assessed the knowledge gaps among pediatric nurses and they have

found out that nurses without prior exposure or education to new medications will feel

inadequate or insecure about their expertise in that aspect of care. This lack of education or

exposure to certain aspects of intravenous therapy that resulted in inadequacy was expounded

in the study accomplished by Anderson et al. (2012). In their study, they employed a pre-test

and an educational intervention about IV administration of medications. After the said

interventions, they get the post-test scores of the samples and it was shown that there was a

significant increase in the knowledge scores of the samples.

Since the sample are senior nursing students and it is expected that they have

underwent several comprehensive lectures about IV therapy, it will follow that their knowledge

about this concept will increase which is reflected in their scores in the knowledge tool devised

by the researchers.

When the knowledge percentage of the samples were correlated to learning styles and

skill, a positive correlation was observed for both, 0.130 and 0.031, respectively. This would

mean that if the skill is improved there is about 0.031 chance that the knowledge also improved.

However, this finding runs inconsistent with the data at hand as the skill level of the samples

deteriorated from their skill level before. Despite this finding, we cannot discount the fact that

there are gaps especially in theory and practice as mentioned by Buncuan (2010) which may

have altered the result. These gaps were failure to apply the knowledge in daily practice, failure

to follow protocols and procedures of practice, and failure to link knowledge and practice. All

these were supported by the accounts given by the senior nursing students during the focus


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group discussion in which they stressed that they aren’t able to fully implement the ideal

practices in intravenous therapy due to constraints in resources. This might have been the

reason why the participants scored low in the skill assessment.

The correlation between the learning style and knowledge can still be further

substantiated by the positive correlation between the two predominant learning styles,

accommodative and convergent, and the knowledge scores. The prevalence of convergent style

in junior and senior nursing students is consistent with the findings of Salehi and Shanooshi

(2007), which revealed that junior and senior nursing students preferred convergent learning

style. Since this type of learning is leaning towards an abstract conceptualization, it would

require a knowledgeable student to take part in taking care of the client. The sample, being 4th

year students who underwent rigorous lectures on intravenous therapy, can be expected to take

liking on situations requiring abstract conceptualization. In other studies, Laschinger (1990)

noted the predominance of learning styles with concrete experimentation component among

nurses. Moreover, Cavanagh, Hogan and Ramgopal (1995) maintained that, together with the

concrete experimentation component, reflective observation was also used by many nursing

students. This is consistent with the accommodative learning style which ranked 2nd among the

preferred learning style of the sample. Advanced students have a greater incidence of concrete

learning styles than first year students suggesting increasing concreteness with exposure to

nursing education (Laschinger & Boss, 1984).

Attitudes


Results of the FGD showed positive impressions on the instruction methods employed in

teaching IV therapy, describing them as effective in facilitating learning. These include lecture

discussions, videos, and return demonstrations on dummy arms. This is consistent with result of

the learner satisfaction cluster in the attitudes survey. The highest-scoring item of the cluster

was the statement on the helpfulness of teaching methods of IV therapy. Blair (1988) identifies


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positive and optimistic teaching practices, when applied in the right context, as a way to

successful learning.

Self-perception

Confidence of the participants in developing practical skills on IV therapy is amplified by

increased opportunities for practicing IV therapy skills, as verbalized by the participants in the

FGD. In addition to that, the opportunities for practice in the actual setting are sufficient to

facilitate learning. The more practice in IV therapy in the actual setting, the higher the probability

that the certain skill will be retained. Hamilton stated that if a skill is not applied within two weeks

since its last demonstration, skill deterioration may occur, decreasing the possibility of retaining

the skill. The greater confidence the student has that he will develop the skill, the greater

initiative he demonstrates in looking for opportunities to practice the skill. And in turn, more

opportunities lead to higher probability of retaining the skill.


There are seven principles of learning, according to Jamison, Hovancsek and Clochesy

(2006), and these include the following: active learning; feedback; student-faculty interaction;

collaboration; high expectations; diverse ways of learning; time on task.

Good group dynamics was identified by the FGD participants as a one of the factors

that contribute to effective learning and retention of IV therapy skill. This was observed in the

attitudes survey, with the collaboration among nursing students in learning activities as highly

beneficial to learning. Jamison and colleagues (2006) identified collaboration as one of the

seven principles of learning. Good group dynamics, as described by the FGD participants

serves as a bridge toward collaboration among the members of the group.

Also, the FGD participants stated that feedback is helpful in correcting mistakes and

stimulates students to be more careful in future practice of the skill. Moreover, Nicholson (2010)

stated that encouraging and constructive feedback motivates the student to do better.


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Motivation

The participants showed high motivation in learning IV therapy skills. Blair (1988)

described motivation as the ability of an individual to perceive the importance of doing a task

and has a positive outlook that he or she will succeed on the given task. In the current study, the

highest scoring items are composed of the perceived importance and perceived usefulness of

learning IV therapy skills. On the other hand, the participants of the FGD stressed the

importance of the initiative of the student nurse in assuming responsibilities and performing

given tasks. They also stated that if the student will display a proactive attitude towards skills

performance, he or she will be able to utilize opportunities resulting in the learning and retention

of the IV therapy skill.

Learning Styles

The accommodative learning style has the dominance of the concrete experience

learning mode. In concrete learning styles, information is taken in mainly by the senses. The

learner deals with the tangible and the obvious. The learner wants to become actively involved

in the experience. An orientation toward the concrete experience learning mode emphasizes

feeling rather than thinking. In solving problems, this individual uses an intuitive and artistic

approach (Kolb, 1984). Aside from the accommodative learning style, divergent learning style

also makes use of concrete experience. However, only one participant in the current study

showed with this style. This may indicate that while concrete experience is used more by the

senior nursing students, active experimentation (component of accommodative) rather than

reflective observation (component of divergent) is preferred to be used in combination with

concrete experience when solving problems. Active experimentation enables the learner to plan

and be able to change the situation. The learner welcomes risks in order to achieve a goal.

(Clark, n.d.).

The convergent learning style is composed of the modes abstract conceptualization and

active experimentation. Abstract conceptualization involves forming abstract concepts. The


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learner, more than just experiencing the situation and reflecting on that experience, has

possessed and is using analytical skills to conceptualize that experience. In this learning mode,

the learner is “thinking” rather than “feeling” (concrete experience). Active experimentation, on

the other hand, as explained earlier, makes use of hands-on experiences and focuses on

“doing” rather than just observing. Another learning style that utilizes abstract conceptualization

is the assimilative learning style. Together with reflective observation, an individual with this

learning style “thinks” and “watches”. They come in contact with the experience and reflect on

the experience, aligning the concepts and ideas taught with the information observed.

Moreover, the assimilator learner believes that flow of ideas and thoughts should be logical

(Clark, n.d.).

Laschinger (1986) provided evidence of the predominance of a concrete student

learning style through her study about the learning styles and environmental press of nursing

students in two clinical nursing settings. Cavanaugh, Hogao and Ramgopal (1995) used Kolb’s

LSI in student from UK and revealed that more than half of their sample of 192 students was

predominantly concrete learners. These findings support Kolb’s theoretical tenet that concrete

learners tend to choose people-oriented professions. Another study previously done by Boss

and the same author (1984) showed that with the advancing year level, there is an increase in

the incidence of concrete learning styles. This may be due to the increased exposure to clinical

experiences where in the knowledge, skills and attitudes can be better put into practice. These

findings were quite inconsistent with the results of the current study as half of the students

preferred convergent learning style. Accommodative learning style, which made use of concrete

experience, only ranked second as to the preferred learning style, while divergent learning style

was preferred by only one participant. These findings may indicate that half of the senior nursing

students learn better when given hands-on experiences and provided with opportunities to

improve their existing knowledge to become more effective and efficient in learning. This can be

supported by a 2007 study by Salehi. Junior and senior nursing students’ preferred learning


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styles and discovered that they have a preference for thinking and problem analysis. These are

particular characteristics of convergent learning style. Moreover, the senior nursing students

preferred abstract conceptualization of knowledge which is a dominant mode in the said style.

Significant Correlations

Motivation and Self-perception showed correlation of 0.821 at 0.05 level of significance

(2-tailed). This indicates that these two student attributes affects each other. The study by Liu

(2010), with the aim of ascertaining whether there is any significant relationship between

academic self-concept (which is under self-perception) and learning motivation for students of

different proficiency levels, revealed that there is a high positive correlation between academic

self-concept and learning motivation, which they specified to learning foreign language. It also

indicates that the students with higher self-concept are more eager or motivated to learn. On the

other hand, Areepattamannil (2011) determined the relationship between academic self-concept

and academic achievement, and academic motivation and academic achievement. The Self-

determination theory (SDT) was used to discuss the relationship between academic motivation

and academic achievement. SDT is a “macro-theory of human motivation, emotion, and

development that takes interest in factors that either facilitate or forestall the assimilative and

growth-oriented processes in people.” (Niemiec & Ryan, 2009) In addition, SDT proposes the

effect of motivation in self-competence which is similar to self-concept in terms of performance

such as in academics, thus, leading to better academic performance. Bruinsma and Ahmed

(2006) proposed a model in self-concept, autonomic motivation and academic performance

through their study. The model proposes that there is positive relation between self-esteem and

self-concept. The optimism of students about themselves increases the feelings of competency

in specific domains such as academics. Also, there was a significant structural relation between

academic self-concept and autonomous motivation indicating that the more positive they see

themselves, the more motivated they are in fulfilling academic tasks (Bruinsma & Ahmed, 2006).

This is supported by the study done by the U.S. National Dropout Prevention Centre which


122

revealed that student with positive self-concept (high self-esteem) has a higher motivation in

learning. Also, the students will be more motivated to learn and eventually lead to a high

achievement in academics if they will have high regards of themselves (Yahaya, n.d.). In the

present study, the perception of the participants of being confident in developing the practice of

IV therapy skills as well as learning it is related to their motivation of developing the knowledge

and skills all the more as evidenced by their perception of IV Therapy as important and

beneficial/useful in their career as nurses.

Correlation analysis between self-perception and learner satisfaction revealed a

significant relationship between the two variables. Self-perception was assessed in the current

study through the attitudes survey dimension composite of self-concept and self-esteem.

Several studies on these two components showed their significant relationship with learner

satisfaction. A significant positive link between self-concept and self-esteem with learner

satisfaction were revealed in various studies (Persad, 1980; Anolik, 1980; Panori, et al., 1995;

Berkvam, n.d.; Letcher & Neves, n.d.; Sission, 2011).

Self-confidence, which is a component of self-esteem, greatly impacts satisfaction of

undergraduate business students (Letcher & Neves, n.d.). Sisson (2011), who analyzed the

relationship of self-esteem with student satisfaction, tackled the concept of self-esteem through

creating three types: performance, social and appearance. It was revealed that more than

appearance self-esteem, students with high performance self-esteem reported greater

satisfaction in the learning setting. The concept of mirroring of attitudes, wherein individuals

translate the dominant positive or negative feelings on to another object was also evident. If the

student has positive feelings about his performance, he or she is more likely, by extension, to

perceive the learning setting, in its entirety, as satisfactory.

In the case of the knowledge scores and learning styles, a pattern wherein the average

mean score was obtained by participants with accommodative and convergent learning styles

was observed. In the case of acquiring knowledge for IVT, the learner will be able to understand


123

the concepts when they themselves apply the concepts, for example, of IV medication

calculations by being exposed to exercises wherein they will be calculating for the dosage of the

drug. Moreover, when a student has an accommodative learning style, he learns better when

provided with “hands-on” situations (Learning-Theories Knowledge Base and Webliography,

n.d.). He is “feeling” and “doing”. Continuing from the abovementioned example, the learner is

able to feel the concept of IV drug calculation as he is given a situation where is he can clearly

perceive the things needed for calculation. At the same time, doing or performing the calculation

enables him to grasp better what he is sensing – he himself is calculating the dosage of the

drug. He is utilizing problem-solving and decision making skills as he figures out the correct

dosage calculation. A student with a convergent learning style when first confronted with the

concept of IV drug calculation utilizes his previous experiences of calculating and thinks on how

he can improve his calculation abilities. He is not merely feeling and/or reflecting on how to do

drug calculation; he is focused more on the improvement of his abilities to better carry out the

task.

The results of the skill score and learning style cross tabulation show that utilizing a

certain style does not positively influence skill retention. If the trend in the knowledge scores is

applied in this area, it can be observed that the scores of the participants with accommodative

and the convergent learning styles, when taken together, are scattered throughout the range of

scores, also including the highest and the lowest scores. These findings may mean that when it

comes to skill retention, factors other than learning style should be considered.

End Notes

Ahmed, W., & Bruinsma, M. (2006). A structural model of self-concept, autonomous

Anderson B., Crader M., Nix E & McDaniel M. (2012). Nursing behaviors related to Vancomycin

and Aminoglycoside administration. Research for Practice. 21:6. Retrieved March 23,

2013.


124

Anolik, S. A. (1980). The relationship between the self-concept and satisfaction with college

among younger and older students [Abstract]. College Student Journal, 14(2): 196-202.

Areepattamannil, S. (2011).Academic self-concept, academic motivation, academic

Bennett Jr., et al. (1998). Factors that influence skill decay and retention: quantitiative review

and analysis. Human Performance 11(1), 57-101. Retrieved from

http://www.owlnet.rice.edu/~ajv2/courses/12a_psyc630001/Arthur,%20Bennett,%20Stan

ush,%20&%20McNelly%20(1998)%20HP.pdf on March 27, 2013.

Berkvam, G. M. (n.d.). Nursing students’ perceptions of satisfaction and self-confidence with

high fidelity simulation. Retrieved on March 28, 2013 from

https://docs.google.com/viewer?a=v&q=cache:f6QDJNOL0l8J:www.nursinglibrary.org/vh

l/bitstream/10755/243258/1/Berkvam_Geraldine%2520M._51058.pdf+student+satisfacti

on+and+self+perception+learning&hl=en&gl=ph&pid=bl&srcid=ADGEESi1ptT22pDb72jP

_Kn2e7ZF_0tWxtT84fWjaKirYdYvM8hPzLEgeYZYHu0yZyZHcg37i_nWN-cHiUpyS22nQ

BI8xKi2m3KK77Cs3go4hAdhi1JPUncRiEtLlrYqyUBWE4Efr&sig=AHIEtbRjK9h7aJR18M

u8DdFiNVSTSFRAJA

Buncuan J. (2010). Bridging the gaps between education and practice in nursing: the

experience in Malaysia. 10th Asian Regional Congress of CICIAMS. Retrieved March 23,

2013.

Cavanagh, S. J., Hogan, K., & Ramgopal, T. (1995). The assessment of student nurse learning

styles using the Kolb learning styles inventory [Abstract]. Nurse Educ. Today, 15(3): 177-

183.

Clark, D. R. (n.d.). Kolb’s learning styles and experiential learning model. Retrieved on March

28, 2013 from http://www.nwlink.com/~donclark/hrd/styles/kolb.html.

Essani R., & Ali T. (2011). Knowledge and practice gaps among pediatric nurses at a tertiary

care hospital Karachi Pakistan. ISRN Pediatrics. Retrieved March 23, 2013.

http://www.nwlink.com/~donclark/hrd/styles/kolb.html


125

Kolb, D. (1984). Experiential Learning: experience as the source of learning and development.

Englewood Cliffs, NJ: Prentice Hall.

Laschinger, H. (1986, May). Learning styles of nursing students and environmental press

perceptions of two clinical nursing settings [Abstract]. Journal of Advanced Nursing.

11(3): 289-294.

Laschinger, H. K., & Boss, M. W. (1984). Learning styles of nursing students and career choices

[Abstract]. Journal of Advanced Nurses, 9(4):375-380.

Learning-Theories Knowledge Base and Webliography (n.d.). Experiential learning (Kolb).

Retrieved on March 28, 2013 from http://www.learning-theories.com/experiential-

learning-kolb.html.

Letcher, D. W., & Neves, J. S. (n.d.). Determinants of undergraduate business student

satisfaction. Research in Higher Education Journal. Retrieved on March 28, 2013 from

https://docs.google.com/viewer?a=v&q=cache:cHR14AENKEIJ:www.aabri.com/manuscr

ipts/09391.pdf+self+concept+and+student+satisfaction&hl=en&gl=ph&pid=bl&srcid=AD

GEESg8Y0lSE9Ut0CpAAA86Br900iInE94XPWaj28N9ryc0lfxpn74xl27soSqnQHL0ztG26

QZQqYSiQBPoXf8P5szTpNkPNtSvMjUE76VLb8x1XkTcan4YSz6_UDfPStJ6ASnsDr&si

g=AHIEtbQCjCxc5xlUhXeMEox5BEDIzinAXQ.

Motivation and academic performance in cross-cultural perspective. Electronic Journal of

Research in Educational Psychology. 10, 4 (3), 551-576

Murray, C. et.al. (2007). The use of simulation as a teaching and learning approach to support

practice learning. Nurse Education in Practice, 8: 5-8. Retrieved from


2013

Niemiec, C., & Ryan, R. (2009). Autonomy, competence, and relatedness in education.

University Technology Malaysia.

http://www.learning-theories.com/experiential-learning-kolb.html



126

Panori, S. A. Wong, E. H., Kennedy, A. L., & King, J. R., (1995). A pilot project on college

students’ satisfaction and self-concept [Abstract]. Psychological Reports. 77:255-258.

Persad, S. (1980). Relationship of classroom environment, teacher and student satisfaction and

student self-concept. Theses and Dissertations (Comprehensive) Paper 1603. Retrieved

on March 28, 2013 from http://scholars.wlu.ca/etd/1603.

Salehi, S. (2007). Nursing students’ preferred learning styles. Journal of Medical Education,

11(3):85-89.

Salehi, S., & Shahnooshi, E. (2007). Nursing students’ preferred learning style. IJNMR,

12(4):153-157.

Sisson, A. J. (2011, May). Self-esteem, communicator style and classroom satisfaction.

Retrieved on March 28, 2013 fromhttps://docs.google.com/viewer?a=v&q=cache:Z2Y

DeidozgYJ:https://scholarworks.iupui.edu/bitstream/handle/1805/2713/Sisson_Thesis_fo

rScholarworks.pdf%3Fsequence%3D1+self+concept+and+student+satisfaction&hl=en&

gl=ph&pid=bl&srcid=ADGEESjMgQWBl667AUj7SjoOIox8Uryh4N97NRbzbtcgaAJ9Vfv5

Vog4JUi479pdovFe6vlS04TWlZgV_0FbKdkZlYsO0N7NQpXdVNrU4nP_F_b5tJMktaJXB

a8IT1jcPiwHx65-b2&sig=AHIEtbSGpgvEHf5y5vcRVFbRYaV5oeV7JQ.

Yahaya, M., (n.d.). Self concepts and motivation to learn among students.


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CHAPTER VI

CONCLUSION AND RECOMMENDATIONS

Conclusion

The study aimed to explore the level of skills, knowledge, and attitudes and the factors

related to the retention of skills of senior nursing students on IVT. Initial pilot study revealed that

there was no relative retention of IVT skills among fourth year UPCN students. This direction

may change if sample size is increased. It can be concluded that the instructions employed in

intravenous therapy was systematic and sufficient from the thematic analysis and the

knowledge score. However, from the results of the item performance review and thematic

analysis, it can be said that focus must be given in teaching how to trouble shoot for problems

and complications of IVT to ensure patient safety.

The outcomes suggest that the there is a significant difference between the mean skill

scores of fourth year UPCN students from their sophomore year and their current mean skill

score. Learner attitude domains including motivation, self-perception, learner satisfaction, and

educational practices do not have a significant correlation with the level of knowledge and with

skill decay. As for the learning style, convergent types of learners have relatively higher

knowledge and skill scores.

One barrier to retention is the difference between the ideal practices on IV therapy from

the practices in the actual clinical setting. In addition, the infrequent opportunities and the

inadequacy of practice of the procedure in an actual setting had an effect on the deterioration of

the students’ IVT skills.

Recommendations

For the improvement of this study, the researchers suggest an increase in the sample

size and the use of probability sampling method to enhance representativeness of the target


128

population. The researchers strongly suggest that the whole population of UPCN senior

students be covered. This is to increase the power of the study and to decrease the sampling

error. The researchers also believe that this will possibly increase the value of the Cronbach’s

alpha for the knowledge assessment tool. Greater number of participants for the focus group

discussion is also suggested. Also, because of the limited sample and time constraints, the

researchers were not able to control the possible confounding variable general Grade Weighted

Average. Measures to control intrinsic factors such as matching may be used in future

researches.

It is known that there is already a validated IVT knowledge tool from the Association of

Nursing Service Administrators of the Philippines (ANSAP). However, the researchers did not

use this tool as it is not standardized and is not being used in the Philippine General Hospital. It

is highly recommended that the devised tool be checked with the ANSAP tool for convergent

validity.

The researchers suggest longer time allotment for this study as this involves time

constraints among the participants and the researchers. It is also imperative to acquire the

specific knowledge and skill score specific for IV therapy because this will be the basis of

comparison to evaluate the level of retention. In addition, there is still a possibility of

incongruence between their previous IV therapy skills scores retrieved from the Nursing

Fundamentals II (N11) faculty and the scores generated from the skills observation checklist

because of several factors including the inconsistency of conditions, and the different raters.

Therefore, it is suggested that succeeding studies adopt the use of pre-test and post-test to

ensure congruence.

It is also highly recommended to derive a valid and reliable IVT Skills Observation

Checklist Tool before utilizing pre-test and post-test as the said tool was only assumed to be

valid to ensure that the students were evaluated using the same tool and using the same


129

standards taught from their Nursing Foundations II course. Also, using the same instrument

previously used makes it possible to compare the skill scores of the student.

As for the skills assessment, it should be conducted in a single day to avoid confounders

that would affect the result that would be generated. Detailed written instructions should also be

provided to the participants instead of verbal instructions to ensure constancy. Completeness of

the materials needed for the skills observation should also be ensured.

Other factors perceived to affect learning and retention identified through the thematic

analysis such as anxiety, initiative for professional growth, and guidance and supervision from

clinical instructors may also be explored in future studies. Besides the focus group discussion

with the fourth year students, interviews with the professors and clinical instructors may also be

done to identify all perceived factors that affect retention of IVT skills, knowledge, and attitudes.

Finally, it would be optimal if the research would be done in a hospital setting because

the performance would be different if the procedure is done on an actual patient. However,

ethical concerns should still be addressed.


130

BIBLIOGRAPHY

Ahmed, W., & Bruinsma, M. (2006). A structural model of self-concept, Autonomous

Alexandrou, et al. (2012). Training of undergraduate clinicians in vascular access: an integrative

review. JAVA, 17(3), 146-158.

Anderson B., Crader M., Nix E& McDaniel M. (2012). Nursing behaviors related to Vancomycin

and Aminoglycoside administration. Research for Practice, 21:6. Retrieved March 23,

2013.

Anolik, S. A. (1980). The relationship between the self-concept and satisfaction with college

among younger and older students [Abstract]. College Student Journal, 14(2): 196-202.

Areepattamannil, S. (2011). Academic self-concept, academic motivation, academic

Arthur W., Bennett W., Stanush P., & McNelly T. (1998). Factors that influence skill decay and

retention: A quantitative review and analysis. 11(1), 57-101. Retrieved from

http://www.owlnet.rice.edu/~antonvillado/courses/09a_psyc630001/Arthur,%20Bennett,

%20Stanush,%20&%20McNelly%20(1998)%20HP.pdf

Artino, A. R. Jr. (n.d.). A review of the motivated strategies for learning questionnaire. Retrieved

from www.sp.uconn.edu/~aja05001/comps/documents/MSLQ_Artino.pdf on January 28,

2013.


(2001). Medication errors and adverse drug event in pediatric inpatients. American


Behrens, C.B., Dahlberg, L.L., Swahn, M.H., & Toal, S.B. (2005). Measuring violence-related

attitudes, behaviors, and influences among youths: A compendium of assessment tools.

2nd ed. Georgia: CDC

Bennett Jr., et al. (1998). Factors that influence skill decay and retention: quantitative review

and analysis. Human Performance 11(1), 57-101. Retrieved from http://www.owlnet.rice.


131

edu/~ajv2/courses/12a_psyc630001/Arthur,%20Bennett,%20Stanush,%20&%20McNelly

%20(1998)%20HP.pdf on March 27, 2013.

Berkvam, G. M. (n.d.). Nursing students’ perceptions of satisfaction and self-confidence with

high fidelity simulation. Retrieved on March 28, 2013 from https://docs.google.com

/viewer?a=v&q=cache:f6QDJNOL0l8J:www.nursinglibrary.org/vhl/bitstream/10755/2432

58/1/Berkvam_Geraldine%2520M._51058.pdf+student+satisfaction+and+self+perceptio

n+learning&hl=en&gl=ph&pid=bl&srcid=ADGEESi1ptT22pDb72jP_Kn2e7ZF_0tWxtT84f

WjaKirYdYvM8hPzLEgeYZYHu0yZyZHcg37i_nWNcHiUpyS22nQBI8xKi2m3KK77Cs3go

4h-Adhi1JPUncRiEtLlrYqyUBWE4Efr&sig=AHIEtbRjK9h7aJR18Mu8DdFiNVSTSFRAJA

Bulechek, G. M., Butcher, H. K., & Dochterman, J. M. (2008). Nursing interventions

classification. (5th ed., p. 483). Missouri: Mosby Elsevier.

Buncuan, J. (2010). Bridging the gaps between education and practice in nursing: the

experience in Malaysia. 10th Asian Regional Congress of CICIAMS. Retrieved March 23,

2013.

Cavanagh, S. J., Hogan, K., & Ramgopal, T. (1995). The assessment of student nurse learning

styles using the Kolb learning styles inventory [Abstract]. Nurse Educ. Today. 15(3): 177-

183.

Clark, D. R. (n.d.). Kolb’s learning styles and experiential learning model. Retrieved on March

28, 2013 from http://www.nwlink.com/~donclark/hrd/styles/kolb.html.

Cousins, D. H., Sabatier, B., Bengue, D., Schmitt, C., & Hoppe-Tichy, T. (2005). Medication

errors in intravenous drug preparation and administration: a multicentre audit in the UK,

Germany and France. Quality and Safety in Health Care, 14(3), 190-195. doi:

10.1136/qshc.2003.006676

Curran V., Aziz K., O’Young S., & Bessell C. (2004). Evaluation of the effect of a computerized

training simulator (ANAKIN) on the retention of neonatal resuscitation skills. Teach Learn

Med, 16: 157–64.

http://www.nwlink.com/~donclark/hrd/styles/kolb.html


132

Eastham, V. (n. d.). Learning Style Inventory (adapted from Kolb and McCarthy). Retrieved

from http://medialab.st-ndrews.ac.uk/documents/design_tips/kolblearningsurvey.pdf on

January 27, 2012.

Eliot, et al. (2005) Guidelines for conducting focus group discussions. Retrieved from

http://assessment.aas.duke.edu/documents/How_to_Conduct_a_Focus_Group.pdf on

February 6, 2013.

Engum, S. A., Jeffries, P., & Fisherb, L. (2003). Intravenous catheter training system: computer-

based education versus traditional learning methods. The American Journal of Surgery,

67-74.

Essani R., & Ali T. (2011). Knowledge and practice gaps among pediatric nurses at a tertiary

care hospital Karachi Pakistan. ISRN Pediatrics. Retrieved March 23, 2013.

Hadaway, L. (2005). Innovative staff education techniques. JAVA, 10 (4),193-198.


using two simulation methods for teaching Intravenous cannulation. Clinical Simulation

in Nursing Education, 2, 9-12.

Kolb, D. (1984). Experiential Learning: experience as the source of learning and development.

Englewood Cliffs, NJ: Prentice Hall.

Koob, J. J., & Funk, J. (2002). Kolb's Learning Style Inventory: Issues of reliability and validity.

Research on Social Work Practice, 12, 293.

Kozier B., Erb G., Berman A., Shirlee S. (2008). Fundamentals of nursing concepts, process,

and practice 8th edition. Prentice Hall.

Lasater, K. (2007). Clinical judgment development: Using simulation to create an assessment

rubric. Journal of Nursing Education, 46, 496-503.

Laschinger, H. (1986, May). Learning styles of nursing students and environmental press

perceptions of two clinical nursing settings [Abstract]. Journal of Advanced Nursing,

11(3): 289-294.




133

Laschinger, H. K., & Boss, M. W. (1984). Learning styles of nursing students and career choices

[Abstract]. Journal of Advanced Nursing, 9(4):375-380.

Laschinger, S., Medves, J., Pulling, C., McGraw, R., Waytuck, B., Harrison, M. B. (2008).

Effectiveness of simulation on health profession students’ knowledge, skills, confidence

and satisfaction. International Journal of Evidenced-Based Healthcare, 6, 278-302.

Learning-Theories Knowledge Base and Webliography (n.d.).Experiential learning (Kolb).

Retrieved on March 28, 2013 from http://www.learning-theories.com/experiential-

learning-kolb.html.

Letcher, D. W., & Neves, J. S. (n.d.). Determinants of undergraduate business student

satisfaction. Research in Higher Education Journal. Retrieved on March 28, 2013 from

https://docs.google.com/viewer?a=v&q=cache:cHR14AENKEIJ:www.aabri.com/manuscr

ipts/09391.pdf+self+concept+and+student+satisfaction&hl=en&gl=ph&pid=bl&srcid=AD

GEESg8Y0lSE9Ut0CpAAA86Br900iInE94XPWaj28N9ryc0lfxpn74xl27soSqnQHL0ztG26

QZQqYSiQBPoXf8P5szTpNkPNtSvMjUE76VLb8x1XkTcan4YSz6_UDfPStJ6ASnsDr&si

g=AHIEtbQCjCxc5xlUhXeMEox5BEDIzinAXQ.

Martelli, M. E. (2002). Intravenous fluid regulation. Gale Encyclopedia of Nursing and Allied

Health. Retrieved from http://www.healthline.com/galecontent/intravenous-fluid-

regulation

Merriam-Webster Dictionary. (2012). Merriam-Webster, Incorporated. Retrieved from

http://www.merriam-webster.com/info/copyright.htm



Motivation and academic performance in cross-cultural perspective. Electronic Journal of

Research in Educational Psychology. 10, Vol.4 (3), 551-576

Mundy, C. (2007). Innovative teaching strategies: educating student nurses on vascular access

management. JAVA, 12 (4), 232-236.




134

Murray, C., et.al. (2007). The use of simulation as a teaching and learning approach to support

practice learning. Nurse Education in Practice, 8: 5-8. Retrieved from


2013.

Niemiec, C., & Ryan, R. (2009). Autonomy, competence, and relatedness in Education.

University Technology Malaysia.

O’Neil H., Rivera N. (2011). Educational Psychology and human factor issues involved in

studying (or evaluating) degradation of skills. Powerpoint presentation on Skills

Deterioration Symposium held in Newport Beach, CA. Retrieved from

http://www.tatrc.org/conferences/MMVR_2011/ppt/ONeil-MMVR-CCC-2011.pdf of

Education. University Technology Malaysia

Panori, S. A., Wong, E. H., Kennedy, A. L., & King, J. R. (1995). A pilot project on college

students’ satisfaction and self-concept [Abstract]. Psychological Reports, 77:255-258.

Paolucci, H. & Albert, N. (2011). RN Knowledge of vascular access devices management.

JAVA, 16 (4), 221-225.

Persad, S. (1980). Relationship of classroom environment, teacher and student satisfaction and

student self-concept. Theses and Dissertations (Comprehensive) Paper 1603. Retrieved

on March 28, 2013 from http://scholars.wlu.ca/etd/1603.

Pintrich, R. R., & DeGroot, E. V. (1990). Motivational and self-regulated learning components of

classroom academic performance. Journal of Educational Psychology, 82, 33-40.

Polit, D.F. & Beck, C. T. (2008). Nursing Research: Generating and assessing evidence for

Nursing Practice (8th Ed.). Philadephia: Lippincott Williams & Wilkins.



Reinhardt, A. C., Mullins, I. L., Blieck, C. D., & Schultz, P. (2012). IV Insertion simulation:

confidence, skill, and performance. Clinical Simulation in Nursing, 8, 157-167


135

Rosenberg, Morris. (1989). Society and the adolescent self-image. Revised edition.

Middletown, CT: Wesleyan University Press.

Salehi, S. (2007). Nursing students’ preferred learning styles. Journal of Medical Education.

11(3):85-89.

Salehi, S., & Shahnooshi, E. (2007). Nursing students’ preferred learning style. IJNMR.

12(4):153-157.

Shamsuddin & Shafie (2012). Knowledge of nurses in the preparation and administration of

intravenous medications. Procedia Social and Behavioral Sciences. 60. 602-609.

Sisson, A. J. (2011, May). Self-esteem, communicator style and classroom satisfaction.

Retrieved on March 28, 2013 from https://docs.google.com/viewer?a=v&q=cache:Z2Y

DeidozgYJ:https://scholarworks.iupui.edu/bitstream/handle/1805/2713/Sisson_Thesis_fo

rScholarworks.pdf%3Fsequence%3D1+self+concept+and+student+satisfaction&hl=en&

gl=ph&pid=bl&srcid=ADGEESjMgQWBl667AUj7SjoOIox8Uryh4N97NRbzbtcgaAJ9Vfv5

Vog4JUi479pdovFe6vlS04TWlZgV_0FbKdkZlYsO0N7NQpXdVNrU4nP_F_b5tJMktaJXB

a8IT1jcPiwHx65-b2&sig=AHIEtbSGpgvEHf5y5vcRVFbRYaV5oeV7JQ.

The motivated strategies for learning questionnaire. Retrieved from https://docs.google.com/

viewera=v&q=cache:MaglRhIELmsJ:www.brazosport.edu/sites/CurrentStudents/Faculty/

RobertIrizarry/PSYC%25201300/MSL%2520Questionnaire.doc+msl+questionnaire&hl=

en&gl=ph&pid=bl&srcid=ADGEESgFPAny_AZWqpnqhUIjVJVKPMXvZEly0VQfmtv6jisK

Gm57j6Xm1w21yIw6b4xSIAJ2fOvkt3PDjlXDyfGFpL1QJxvXxY4GBXZx3OlpOE6TbNc8

NUFF1aNP0Uz3jqhsbljoH&sig=AHIEtbRTe_HhkNlbO64hcGDJ_bwXe-U9hQ on January

27, 2013.

Think Impact Solutions, LLC. Self-motivation assessment tool. Retrieved from

http://www.thinkimpactsolutions.com/images/Self-Motivation_Assessment_Tool_-

_Best.pdf on January 27, 2013.


136

Thorndike, R. M. (1997). Measurement and evaluation in psychology and education (6th Ed.).

New Jersey: Merrill, Prentice Hall.

University of Maryland. The Rosenberg Self-Esteem Scale. Retrieved from

http://www.bsos.umd.edu/socy/research/rosenberg.htm on January 28, 2013.

University of the Philippine Manila College of Nursing (2006). Competency-based BSN


Philippines Manila.

White, R. T., & Mayer, R. E., (1980). Understanding intellectual skills. Instructional Science 9,

101-127. doi: 10.1007/BF00120858


Edinburgh, 37:343–346. Retrieved from http://www.rcpe.ac.uk/journal/issue/journal_

37_4/Williams.pdf

Yahaya, M. (n.d.).Self concepts and motivation to learn among students.

Yu, J. (2008). A study of the influence of instructional innovation on learning satisfaction and




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APPENDIX I

Research Schedule (GANTT Chart) and Budget Allocation


138

Gantt Chart

Research Budget Allocation

NOVEMBER DECEMBER JANUARY FEBRUARY MARCH

ACTIVITY 12

- 1

6

19

- 2

3

26

- 3

0

3-

7

10

- 1

4

17

- 2

1

24

- 3

1

1 -

4

7 -

11

14

- 1

8

21

- 2

5

28

- 3

1

1

4 -

8

11

- 1

5

18

- 2

2

25

- 2

8

1

4 -

8

11

- 1

5

18

- 2

2

25

- 2

9

Research Topic Proposal

Conceptual Framework

Chapter 1

Chapter 2

Chapter 3

Tool/Instrument

Validity and Reliability Testing

Sampling

Data Collection

Data Collation

Data Analysis

Interpretation of Data

Submission

Presentation of Research

ITEM AMOUNT

Direct Expenses on Research - Reproduction of tools and letters ₱ 150.00 - Printing of proposals and packets of research instruments ₱ 300.00 - Printing and production of final research paper ₱ 800.00 - Poster and tarpaulin ₱ 200.00 - Medical supplies for IVT ₱ 200.00 - Token gifts for experts (for validity and reliability testing) ₱ 300.00 - Token for FGD participants ₱ 200.00

Personnel and Travel Expenses ₱ 0.00 TOTAL ₱ 2,150.00


139

APPENDIX II

Research Instruments Packet for Subjects Informed Consent

Intravenous Therapy Skills Observation Checklist

Socio-demographic Questionnaire

Intravenous Therapy Knowledge Assessment Examination

Intravenous Therapy Attitudes Survey

Focused Group Discussion Guide


140

University of the Philippines Manila The Health Sciences Center

COLLEGE OF NURSING Sotejo Hall, Pedro Gil Street, Ermita, City of Manila

Informed Consent

This informed consent form is for the senior nursing students enrolled in N121.1 (Intensive Hospital-based Nursing Experience) or N121.2 (Intensive Community-based Nursing Experience), and whom we are inviting to participate in our group’s research “Retention of Skills, Knowledge and Attitudes on Intravenous Therapy among Senior Nursing Students”. This informed consent form has two parts: (1) information sheet to share information about our study with you, and (2) certificate of consent for signatures if you choose to participate.

We are from Group V, currently enrolled in N199 course (Introduction to Nursing Research). We are undertaking a study about Intravenous Therapy (IVT), which is a competency highly expected from a nurse. We are going to give you information and invite you to be part of this research. This consent form may contain words that you do not understand. Please ask us to stop as we go through the information and we will take time to explain. If you have questions later, you can ask them to us or of another researcher.

We want to determine the current level of skills, knowledge and attitudes (SKA) of senior nursing students on IVT. We believe that you can help us by responding to our questionnaires, joining in our return demonstrations and participating in our focused group discussion. These will also help us evaluate the level of retention and describe the factors that are perceived and experienced by senior nursing students. Your experiences from second year to fourth year can contribute much to our understanding of retention of SKA on IVT among senior nursing students.

This research will involve your participation for about one and a half hour, and a fifteen-minute focused group discussion. We will ask you and others in the group not to talk to people outside the group about what was said in the group.

Your participation in this research is entirely voluntary. It is your choice whether to participate or not. The choice that you make will have no bearing on your status as a student or on any academically-related evaluations or reports. You may change your mind later and stop participating even if you agreed earlier. There will be no compensation on your participation in our study.

We will not be sharing information about you to anyone outside of the research team. The information that we collect from this research project will be kept private. Any information about you will have a code number on it instead of your name. Only the researchers will know what your number is. It will not be shared with or given to anyone.

If you have any questions, you can ask them now or later. If you wish to ask questions later, you may contact any of the following: 09273901505 or [email protected]. Respectfully yours, Noted by: Dan Louie Renz Tating, SN Prof. Vanessa M. Manila, MA-HPS, RN Leader, N199 Group V Research Adviser and Course Coordinator, N199

Certificate of Consent

I have read the foregoing information, or it has been read to me. I have had the opportunity to ask questions about it and any questions I have been asked have been answered to my satisfaction. I consent voluntarily to be a participant in this study.

Printed Name of Participant ___________________________________ Signature of Participant ___________________________________ Date (MM/DD/YY) ________________


141

COMPREHENSIVE INTRAVENOUS THERAPY SKILLS OBSERVATION CHECKLIST Condensed Version with Skills on Setting-up IV Infusion, Preparing and Administering IV Medications,

Changing an ongoing IV Infusion, and Discontinuing an ongoing IV Infusion

* adapted from UPCN Clinical Skills Checklist

Name (optional): ___________________________________________ Control Number: ____________ Please check the column that best corresponds to the performance of the student in each of the following steps.

Steps Performed Not

Performed

SETTING-UP AN IV INFUSION

1 Verify doctor’s order. Make I.V. label (patient’s name, room number, solution, drug incorporation, bottle sequence and duration)

2 Explain procedure to patient and/or significant others. Secure consent if necessary.

Assess patient’s vein; choose appropriate vein; location, size, condition.

3 Wash hands and maintain asepsis throughout the preparation and during the therapy.

4 Prepare necessary materials (IV tray with IV solution, administration set, IV cannula, antiseptic solution, cotton balls with alcohol, plaster, tourniquet, gloves, splint and IV stand).

5 Check the sterility and integrity of the IV solution and IV set and other devices.

6 Place IV label on IV bottle.

7 Open the seal of the IV solution. Disinfect port with cotton balls with alcohol.

8 Open administration set aseptically (IV set). Close the clamp.

9 Spike the container aseptically.

10 Fill drip chamber to at least half and prime the tubing aseptically.

11 Remove air bubbles if any and put back the cover of the distal end of the IV tubing.

PREPARING AND ADMINISTERING IV MEDICATIONS Preparing IV Medications in Syringes

12 Countercheck medication card against the written doctor’s orders.

13

Observe 10 R's when preparing medication (selected “rights”*): Right Medication Right Client * other rights not selected because either they are incorporated in other steps (ex: right dose, right documentation, right assessment), or they are not applicable (ex: right time, right route, right client education, right to refuse, right evaluation)

14 Wash hands before and after the procedure.

15

Check for skin test of drug for IV push. Check for drug-drug and drug-IV fluid incompatibility. Check for dosage computations.


142

Steps Performed Not

Performed

16 Prepare the necessary material for the procedure such as: right drug, right diluents needed IV injection tray, syringes, and needles.

Prepare the medications accordingly.

Administering via Injection Port

17 Check IV site (if infiltrated or out of vein; if there are signs of swelling, redness, phlebitis, do not give the drug).

18

Disinfect the Y-injection port of the IV administration set; pierce through the bull’s eyed rubber port.

Kink the tubing. Push IV drug slowly as ordered or as per manufacturer’s instructions.

19 Flush IV tubing after drug administration with IV fluid (aspirate IV fluid using same syringe and push IV fluid slowly).

Incorporating medications into Ongoing IV Fluid

20

Put down the bottle. Kink the tubing. Remove the administration set from the bottle aseptically. Disinfect the bottle’s rubber stopper: incorporate the right drug to the IVF bottle. Return the administration set to IVF bottle aseptically. Swirl bottle to mix the drug with the IVG and regulate the flow rate as ordered.

Administering via IV Push using Heplock port


22 Fill a tuberculin syringe with Heparin solution. (0.1 cc heparin plus 0.9 cc normal saline)

23 Fill the 2 2.5 cc syringes with isotonic solution or normal saline 1 cc each.

24 Swab injection port with alcohol or iodophor swab. Insert saline syringe into port. Saline syringe is also used to check the patient of the infusion set. If so. Administer saline via IV Push.

25 Insert medication into injection port. Inject medication into the vein, timing the flow rate according to doctor’s order.

26 Insert the saline syringe and flush the line.

27 Insert heparin syringe; to prevent the formation of clot in the catheter

28 Remove syringe and return the cover of the injection port aseptically

Incorporating medications into Soluset and administering medications via Soluset

29 Check IV site (if infiltrated or out of vein; if there are signs of swelling, redness, phlebitis, do not give the drug)

30 Check present IV fluid label, level, and incorporated medicine in the soluset or IV bottle.

31

Add desired IVF diluent into soluset by opening the clamp on the bottle then close the clamp after.

Disinfect rubber injection port of the soluset. Incorporate the drug. Mix gently.

32 Open the clamp of the airway at the soluset.

33 Regulate flow rate of IVF infusion (if to run for 30 min or 1 hour).

34 Place IV label on soluset indicating drug administered.


143

Steps Performed Not

Performed

After administering medications: 35 Dispose sharps and other waste according to HICU guidelines.

36 Document procedure in the patient’s chart.

CHANGING AN ONGOING IV INFUSION

37 Verify written doctor’s order. Countercheck IV label, bottle number or bottle sequence, type, amount, additives (if any), duration of infusion.

38 Explain the procedure to the patient. Assess the IV site for redness, swelling and pain.

39 Wash hands before and after procedure.

40 Prepare necessary materials (IV solution, IV label, disinfectant, IV tray).

41 Check the sterility and integrity of the IV.

42 Calibrate new IV bottle according to the duration of the infusion.

43 Open rubber port of IV solution to follow. Disinfect rubber port of IV solution.

44 Close the clamp or kink tubing. Spike the container aseptically.

45 Regulate the flow rate based on duration of infusion. Remove air bubbles (if any).

46 Discard all waste material according to HICU guidelines.

47 Document accordingly and endorse to incoming shift.

DISCONTINUING AN ONGOING IV INFUSION 48 Verify written doctor’s order to discontinue IV including IV medicines.

49 Assess and inform the patient of the order.

50 Prepare necessary materials: IV trays or injection tray, cotton balls with alcohol, plaster, antiseptic solution.


52 Don gloves.

53 Close IV clamp of the IV tubing.

54 Moisten adhesive tapes around the IV catheter using cotton balls with alcohol. Remove plaster gently.

55 Get cotton ball with alcohol and without applying pressure remove IV cannula. Apply pressure using dry cotton ball or then apply plaster.

56 Inspect IV catheter for completeness.

57 Discard all waste material including the IV cannula according to HICU guidelines.

58 Document time or removal, status of insertion site and integrity of IV catheter and endorse to incoming shift.

Thank you for evaluating the subject! - The Researchers

Evaluated by: _______________________________________ Date: _____________________

Name of Rater over Signature


144

SOCIO-DEMOGRAPHIC QUESTIONNAIRE

Name (optional): ___________________________________________ Control Number: ____________

Student Number: _____________________________ Sex: M F Age: _____

Current Academic Standing (Over-all GWA as of 1st semester, AY 2012-13): _______________________

Grade in N 11: _____________

Batch (year entered UPCN): __________ Regular Delayed, number of years: _____

Please check all the areas you have rotated in starting from your sophomore year

__ W1 __W6 __W11 __SOJR __CENICU

__ W2 __W7 __W14A __CI __PICU

__ W3 __W8 __W14B __IMU __ER

__ W4 __W9 __W15 __Neo ICU __PACU

__ W5 __W10 __Burn __Neuro ICU __Others:

Please indicate the year level and subject (Ex: 3rd year, N105) the following IV Therapy skills have been

(1) introduced or demonstrated, (2) emphasized in practice, and (3) fully appreciated.

When introduced (lecture)/ demonstrated (laboratory)

When emphasized in practice (clinical)

When fully appreciated in

practice

Setting-up IV Infusion

Changing an IV Infusion

Discontinuing an IV Infusion

Administering medications through IV Push

Administering medications through Heplock

Incorporating medications into IV Fluid

Incorporating medications into Soluset

Thank you for responding to this questionnaire!

- The Researchers


145

INTRAVENOUS THERAPY KNOWLEDGE ASSESSMENT EXAMINATION

Name (optional): ___________________________________________ Control Number: ____________

Please underline the letter of your answer. 1. What is the priority goal/s of a nurse treating a patient with fluid and electrolyte imbalance?

A. fluid balance B. oxygenation C. risk prevention D. all of the above 2. Which of the following pairs of intravenous solutions and their classification are mismatched?

A. 0.9% NaCl – Isotonic B. 5% dextrose in 0.45% NaCl – Isotonic C. 0.45% NaCl – Hypotonic D. 5% dextrose in normal saline – Hypertonic

3. Which of the following intravenous solutions provide free water and treat cellular dehydration? A. isotonic solutions B. hypotonic solutions C. hypertonic solutions D. volume expanders

4. Which of the following intravenous solutions expand vascular volume by drawing fluid out of the intracellular compartment into the vascular compartment?

A. isotonic solutions B. hypotonic solutions C. hypertonic solutions D. volume expanders 5. Which of the following are useful guidelines in selecting a vein for venipucture?

I. use proximal veins of the arm first II. use client’s dominant arm whenever possible III. vein selected must be easily palpated and soft and full IV. avoid veins in areas of flexion such as the antecubital fossa A. I and II B. II and III C. III and IV D. none

6. Which of the following statements is incorrect regarding the initiation of IV Therapy? I. avoid hand veins, they must be a last choice II. use the smallest gauge cannula for the therapy III. dangle the arm to encourage deep vein filling IV. stabilize the client’s arm with your non-dominant arm A. I and II B. II and III C. III and IV D. none

7. Which of the following causes phlebitis? A. vein irritation from catheter B. chemical irritation from medicines C. infection from improper aseptic technique D. all of the above

8. What may happen when a foreign object is not removed in the IV tubing? A. circulatory overload B. pulmonary embolism C. speed shock D. pulmonary edema

9. Which of the following IV Therapy complication may possibly lead to the other? I. air embolism II.circulatory overload III.speed shock IV. pulmonary edema A. I and II B. I and III C. II and IV D. III and IV

10. Which of the following are the goals of parenteral fluid therapy? A. provide water, electrolytes and nutrients to meet daily requirements B. replace water and correct electrolyte deficits C. administer medications and blood products D. all of the above

11. All of the following interventions should be done when there is infiltration except for? A. elevate the affected extremity B. discontinue IV infusion C. apply cold compress D. none of the above

12. Which of the following should be done in case pulmonary edema occurs? A. place the patient in a flat position B. regulate the IV to keep vein open C. discontinue the IV infusion D. secure tourniquet above the venipuncture site


146

13. You are regulating the IV fluid of your patient when you notice that there was about 5mL of air trapped in the tubing. Which of the following statements can be done? A. tap the tubing until the bubbles rise into the drip chamber B. withdraw the air from the accessory port using a syringe C. both A and B D. none of the above

14. You noticed that blood backed up at the IV tubing upon ambulation of the patient .What should be done? A. increase the height of the pole during ambulation B. elevate the extremity of the patient C. discontinue the ongoing IV infusion D. refer to the physician

Please write your answer on the blanks below.

1. What is the flow rate of an intravenous solution of 3 L infused in 24 hours? Express your answer in mL/h. ___________________________

2. What is the flow rate if a liter of intravenous solution is to be infused in 8 hours using an administration set with drip factor of 20 drops/ml? Express in drops/min. ___________________________

3. An IV solution of 1000mL of D5W NaCl is to infuse over 8 hours. The IV set drop factor is 15 gtts/mL. How many drops per minute should the client receive? ___________________________

4. A 3 and a half year old male patient with a weight of 15kg is to be given 300 mg Cefuroxime. Does the dose ordered fall within the recommended range? Answer with yes or no. (Recommended dose range for 2 to 12 years is 10 – 30mg/kg). If yes, how many mL of the reconstituted solution should be withdrawn? (Preparation: Powder which when reconstituted with 1.8ml water for injection, gives a solution of 250mg in 2ml.) ___________________________

5. A 4 month old infant with a weight of 6.5kg is to be given 7.5 mg Furosemide IV. Does the dose ordered fall within the recommended range? Answer with yes or no. (Recommended dose range age 1 month to 2 years is 1 – 2mg/kg bd) If yes, how many mL of the medication should be withdrawn? (Preparation: Ampoules containing 20mg in 2ml.) ___________________________

Indicate whether the following statements are True or False. Write your answer on the blanks below.

1. Hands washing should be performed before preparation of IV antibiotic solution. __________ 2. It is not necessary to check expiry date for a medication that is recently indented from pharmacy.

__________ 3. ‘cc’ or ‘ml’ is the dosage expression for IV insulin. __________ 4. Preparation of IV Hydrocortisone solution does not require hands hygiene. __________ 5. Any reconstituted IV medications can still be used if it is less than 48 hours from the date of reconstitution

or preparation. __________ 6. Patient’s armband and IV catheter should be inspected for phlebitis or extravasations during

administration of IV cytotoxic drugs. __________ 7. Medication administered intramuscularly acts rapidly than if administered intravenously. __________ 8. KCl injection should be administered as slow bolus injection over 3 minutes during emergency such as

ventricular fibrillation. __________ 9. IV Ceftriaxone can be administered simultaneously with solution containing Calcium Gluconate via a Y-

site, at a slower rate of 5mg/min. __________ 10. Medications that are classified as High Alert Medication include Noradrenaline and Insulin. __________ 11. When an emergency happens such as hypocalcaemia tetany, 10% CaCl 210 ml should be administered in

1– 2 minutes. __________

Thank you for taking time to answer this examination! - The Researchers


147

INTRAVENOUS THERAPY ATTITUDES SURVEY

Name (optional): ___________________________________________ Control Number: ____________ Please check the column that best describes your agreement or disagreement with the following statements below. Example: Statement: IV Therapy is being taught to students of UP College of Nursing. Your Rating: Strongly Agree (check column under “Strongly Agree”)

Statements Strongly Disagree

Disagree Neutral Agree Strongly

Agree

1 The teaching methods used in teaching IV therapy skills are helpful

2 the class on IV therapy skills provides a variety of learning materials

3 I enjoy the format in which the class on IV therapy skills is offered

4 the teaching materials in the class on IV therapy skills motivate me to study on IV Therapy

5 the way IV therapy skills is taught is consistent with the way I like to learn

6 I am confident that I am developing the knowledge needed to become a competent health professional

7 I am confident that I am developing the practical skills needed to become a good health professional

8 I did well on the tests in this class on IV therapy skills

9 I take a positive attitude in performing intravenous therapy on patients.

10 I am satisfied with how I perform intravenous therapy.

11 I am an active learner

12 I rely on feedbacks given to me

13 I like to collaborate with my classmates during learning

14 I prefer more diverse ways of learning

15 The time dedicated on a task usually affects my performance

16 When working on my goals, I put forth my best effort and work even harder if I’ve encountered a setback.

17 I tend to put my best effort so that I feel proud of my work.

18 It is important for me to learn IV therapy.

19 I am very interested in learning what IV therapy is all about.

20 I think it is useful for me to learn IV therapy.


148

Look at the four statements in each row. Decide and rank them (1 to 4) according to how they refer to you. Below each word, write 4 if it describes your learning style appropriately, or 1 if it describes you the least. Please do not make ties in each row. Example: Statements in each row: Competent, Caring, Compassionate, Careless Ranking (in decreasing order): Caring, Competent, Compassionate, Careless Rating: 4 under the word “Caring”, 3 under the word “Competent”,

2 under the word “Compassionate”, and 1 under the word “Careless”

Statements

1 Involved tentative discriminating practical

2 Receptive Impartial analytical relevant

3 feeling watching thinking doing

4 accepting aware evaluating risk-taker

5 intuitive questioning logical productive

6 concrete observing abstract active

7 present-oriented reflecting future-oriented practical

8 experience observation conceptualization experimentation

9 intense reserve rational responsible

Thank you for taking time to answer this survey!

- The Researchers


149

FOCUSED GROUP DISCUSSION GUIDE INSTRUCTIONAL METHODS:

What is your general impression or assessment to the instruction or teaching style employed in IV Therapy?

What methods were employed in teaching IV Therapy? Do you think they were effective? Why?

What do you best appreciate in these methods or styles? OPPORTUNITY FOR PRACTICE:

How were you able to practice IV Therapy?

Do you think it was sufficient? Why?

What are your perceived barriers and enabling opportunities in learning IV Therapy?

FEEDBACK:

How was your performance on IV Therapy given feedback?

How did it help?


150

APPENDIX III

Research Instruments Packet for Validity and Reliability Testing Cover Letters

Content Validity Forms

Inter-rater Reliability Form


151

University of the Philippines Manila


Sotejo Hall, Pedro Gil Street, Ermita, City of Manila February 8, 2013 <Name of Evaluator-Expert> <Position or Designation> <Name of Institution> University of the Philippines Manila <Address of Institution> <Name of Evaluator-Expert>: Good day! Our group is currently enrolled in N199: Introductory Nursing Research in the UP College of Nursing. The title of our research study is "Retention of Intravenous Therapy Knowledge, Skills and Attitudes among Senior Nursing Students." In order to accomplish our research goals, a validity testing of the instruments for gathering necessary information should be accomplished. In this regard, our group would like to request your expertise and assistance in testing the validity of our research instruments. Attached are the copies of the said instruments and the forms that will be needed to be filled up in the validity testing process. There are instructions in each form that will guide you through the process. Our group is expected to submit the results of the validity testing at the end of February. In the event that you decide to assist us in our study, our group shall coordinate with you in order to provide you the most convenient schedule. If you wish to learn of the results of our research, we may send you a summary of our findings once they have been completed. For any inquiries, please do not hesitate to contact us at 09273901505 or at [email protected] The information that you will provide us will be kept private and confidential. Our findings shall be used only for academic and research purposes. Thank you very much for your favorable response regarding this request. Respectfully yours, Noted by: Dan Louie Renz Tating, SN Prof. Vanessa M. Manila, MA-HPS, RN Leader, N199 Group V Research Adviser and Course Coordinator, N199


152

University of the Philippines Manila


Sotejo Hall, Pedro Gil Street, Ermita, City of Manila March11, 2013 <Name of Evaluator-Expert> <Position or Designation> <Name of Institution> University of the Philippines Manila <Address of Institution> <Name of Evaluator-Expert>: Good day! We would like express our gratitude for your cooperation in the validity testing of our instruments for

our research entitled "Retention of Intravenous Therapy Knowledge, Skills and Attitudes in Senior

Nursing Students" in our course N199: Introductory Nursing Research in the UP College of Nursing.

In this regard, we would like to request foryour assistance and expertise in IV therapy in the second

round of testing the validity of our research instruments. Attached are the copies of the said

instruments and the forms that were revised based on the suggestions given by all the experts we

consulted.Our group is expected to submit the results of the validity testing by the third week of March.

If you wish to learn of the results of our research, we may send you a summary of our findings once they

have been completed. For any inquiries, please do not hesitate to contact us at 09273901505 or at

[email protected].

The information that you will provide us will be kept private and confidential. Our findings shall be used

only for academic and research purposes.

We hope for your favourable response regarding this request. Thank you very much!

Respectfully yours, Noted by: Dan Louie Renz Tating, SN Prof. Vanessa M. Manila, MA-HPS, RN Leader, N199 Group V Research Adviser and Course Coordinator, N199


153

INTRAVENOUS THERAPY KNOWLEDGE ASSESSMENT EXAMINATION

Instructions: Please review each item carefully, taking into consideration the highlighted dimensions of

the construct “Intravenous Therapy Knowledge”. Write Y or N under the column “Clarity of Wording” to

measure that dimension of the item. Rate the “Relevance” of each item to the specified dimension by

checking the appropriate column: 4 for relevant, 3 for moderately relevant, 2 for somewhat relevant or

1 for not relevant. For the last column “General Recommendation”, please indicate Ret to retain the

item exactly as worded, Rev to make major/minor revisions to the item, or Drop to discard the item

entirely from the pool. You may also write your Remarks about the item appropriateness, etc. in the

same column.

Item Clarity of Wording (Y or N)

Relevance to Dimension of Construct General Recommendation (Ret, Rev, Drop)

and Remarks

4 Relevant

3 Moderately

relevant

2 Somewhat

relevant

1 Not

relevant

MULTIPLE CHOICE QUESTIONS

The following questions are about Fluid and Electrolyte Imbalances.

1

Mrs. Simpson lost large amounts of water from excessive urination last week. Looking at her serum test results, the osmolality was increased. What kind of fluid imbalance is this in relation to water? A. isotonic loss B. isotonic gain C. hyperosmolar loss D. hypo-osmolar loss

2

Which of the following laboratory data indicate an electrolyte imbalance? A. Na = 140 mEq/L B. K = 3.0

mEq/L C. Ca = 9.0 mg/dL

D. Cl = 100 mEq/L

The following question is about Assessment and Planning in Fluid and Electrolyte Imbalances.

3

What is the priority goal/s of a nurse treating a patient with fluid and electrolyte imbalance? A. fluid balance B. oxygenation C. risk prevention D. all of the above

The following questions are about IV Solutions.

4

Which of the following pairs of intravenous solutions and their classification are mismatched? A. 0.9% NaCl – Isotonic B. 5% dextrose in 0.45% NaCl – Isotonic C. 0.45% NaCl – Hypotonic D. 5% dextrose in normal saline – Hypertonic


154



and Remarks

4 Relevant

3 Moderately

relevant

2 Somewhat

relevant

1 Not

relevant

5

Which type of intravenous solution is indicated to increase blood volume following severe loss of blood or plasma? A. isotonic solutions B. hypotonic solutions C. hypertonic solutions D. volume expanders

6

Which of the following intravenous solutions provide free water and treat cellular dehydration? A. isotonic solutions B. hypotonic solutions C. hypertonic solutions D. volume expanders

7

Which of the following intravenous solutions expand vascular volume by drawing fluid out of the intracellular compartment into the vascular compartment? A. isotonic solutions B. hypotonic solutions C. hypertonic solutions D. volume expanders

The following items are about Venipuncture Sites.

8

Which of the following are useful guidelines in selecting a vein for venipucture? I. use proximal veins of the arm first II. use client’s dominant arm whenever possible III. vein selected must be easily palpated, soft and full IV. avoid veins in areas of flexion such as the antecubital fossa A. I and II B. II and III C. III and IV D. none

9

Which of the following are incorrect regarding the initiation of IV therapy? I. Avoid hand veins, they must be a last choice II. Use the smallest possible gauge cannula III. Dangle the arm to encourage


155



and Remarks

4 Relevant

3 Moderately

relevant

2 Somewhat

relevant

1 Not

relevant

deep vein filling IV. Stabilize the client’s arm with your non-dominant arm A. I and II B. II and III C. III and IV D. none

The following questions are about IV Equipment.

10

A standard IV administration set contains all of the following, except: A. butterfly needle B. roller clamps C. spike connector for fluid containerD. IV tubing

11

Which of the following pairs of intravenous equipment and its use are mismatched? A. insertion spike – inserted into fluid bag B. drip chamber – predicts fluid amount delivery C. roller clamp – controls the rate of flow D. injection ports – ensures sterility of the line

The following questions are about Monitoring of IV infusions and Complications.

12

Which of the following does not affect flow rate of an intravenous fluid? A. forearm position B. height of IV bottle C. infiltration D. temperature

13

Which of the following causes phlebitis? A. vein irritation from catheter B. chemical irritation from medicines C. infection from improper aseptic technique D. all of the above

14

Which of the following pairs of terminologies and its definition are mismatched? A. septicemia – systemic infection B. infiltration – leakage of IV solution into tissue C. extravasation – leakage of chemical to vein D. phlebitis – vein inflammation


156



and Remarks

4 Relevant

3 Moderately

relevant

2 Somewhat

relevant

1 Not

relevant

15

What may happen when a foreign object is not removed in the IV tubing? A. circulatory overload B. pulmonary embolism C. speed shock D. pulmonary edema

16

Which of the following IV therapy complication may possibly lead to the other? I. air embolism II. circulatory overload III. speed shock IV. pulmonary congestion

A. I and II B. I and III C. II and IV D. III and IV

The following questions are about the Purposes of IVT.

17

Which of the following are the goals of parenteral fluid therapy? A. provide water, electrolytes and nutrients to meet daily requirements B. replace water and correct electrolyte deficits C. administer medications and blood products D. all of the above

The following questions are about Troubleshooting IVT Problems.

18

All of the following interventions should be done when there is infiltration except for? a. Elevate the affected extremity b. Discontinue IV infusion c. Apply cold compress d. None of the above

19

Which of the following should be done in case pulmonary edema occurs? a. Place the patient in a flat position b. Regulate the IV to keep vein open c. Discontinue the IV infusion d. Secure tourniquet above the venipuncture site


157



and Remarks

4 Relevant

3 Moderately

relevant

2 Somewhat

relevant

1 Not

relevant

20

You are regulating the IV fluid of your patient when you notice that there was about 5mL of air trapped in the tubing. Which of the following statements can be done? a. Tap the tubing until the bubbles rise into the drip chamber b. Withdraw the air from the accessory port using a syringe c. Both a and b d. None of the above

21

You noticed that blood backed up at the IV tubing upon ambulation of the patient .What should be done? a. Increase the height of the pole during ambulation b. Elevate the extremity of the patient c. Discontinue the ongoing IV infusion d. Refer to the physician

PROBLEM SOLVING

The following problems are about IV Medications and Fluid Regulation Calculation.

1

What is the flow rate of an intravenous solution of 3 L infused in 24 hours? Express your answer in mL/h. (125mL/hr)

2

What is the flow rate if a liter of intravenous solution is to be infused in 8 hours using an administration set with drip factor of 20 drops/ml? Express in drops/min. (42drops/min)

3

An IV solution of 1000mL of D5W NaCl is to infuse over 8 hours. The IV set drop factor is 15 gtts/mL. How many drops per minute should the client receive? (31-32drops/min)

4

A 3 and a half year old male patient with a weight of 15kg is to be given 300 mg Cefuroxime. Does the dose ordered fall within the recommended range? Answer with yes or no. (Recommended


158



and Remarks

4 Relevant

3 Moderately

relevant

2 Somewhat

relevant

1 Not

relevant

dose range for 2 to 12 years is 10 – 30mg/kg.) If yes, how many mL of the reconstituted solution should be withdrawn? (Preparation: Powder which when reconstituted with 1.8ml water for injection, gives a solution of 250mg in 2ml.) (Yes; 2.4mL)

5

A 4 month old infant with a weight of 6.5kg is to be given 7.5 mg Furosemide IV. Does the dose ordered fall within the recommended range? Answer with yes or no. (Recommended dose range age 1 month to 2 years is 1 – 2mg/kg bd) If yes, how many mL of the medication should be withdrawn? (Preparation: Ampoules containing 20mg in 2ml.) (Yes; 0.7mL)

TRUE OR FALSE

The following statements are about IV Medication Preparation

1 Hands washing should be performed before preparation of IV antibiotic solution. (True)

2

It is not necessary to check expiry date for a medication that is recently brought from the pharmacy. (False)

3 ‘cc’ or ‘ml’ is the dosage expression for insulin delivered via IV drip. (False)

4 Preparation of IV Hydrocortisone solution does not require hand hygiene (False)

5

Any reconstituted IV medications can still be used if it is less than 48 hours from the date of reconstitution or preparation. (False)

The following statements are about IV Medication Administration.

6

Patient’s armband and IV catheter should be inspected for phlebitis or extravasations during administration of IV cytotoxic drugs. (True)


159



and Remarks

4 Relevant

3 Moderately

relevant

2 Somewhat

relevant

1 Not

relevant

7

Medication administered intramuscularly acts rapidly than if administered intravenously. (False)

8

KCl injection should be administered as slow bolus injection over 3 minutes during emergency such as ventricular fibrillation. (False)

9

IV Ceftriaxone can be administered simultaneously with solution containing Calcium Gluconate via a Y-site, at a slower rate of 5mg/min. (False)

10 Medications that are classified as High Alert Medication include Noradrenaline and Insulin. (True)

11

When an emergency happens such as hypocalcaemia tetany, 10% CaCl 210 ml should be administered in 1– 2 minutes. (False)

Thank you for taking time to review our IVT Knowledge Assessment Examination!

- The Researchers

Evaluated by: _______________________________________ Date: _____________________ Name of Evaluator-Expert over Signature


160

INTRAVENOUS THERAPY ATTITUDES SURVEY

Instructions:Please review each item carefully, taking into consideration the highlighted dimensions of the construct “Intravenous Therapy Attitudes”. Rate the “Relevance” of each item to the specified dimension by checking the appropriate column: 5 for being a “for” the attitude statement, 3 for being a “neutral” statement towards the attitude, 1 for being an “against” for the attitude statement or 4 or 2 for moderate degrees of being “for” or “against” the attitude, respectively. For the last column “General Recommendation”, please indicate Ret to retain the item exactly as worded, Rev to make major/minor revisions to the item, or Drop to discard the item entirely from the pool. You may also write your Remarks about the item clarity, appropriateness, etc. in the same column.

Statements

Relevance to Dimension of Construct General Recommendation

(Ret, Rev, Drop) and Remarks

5 “For”

4 3

“Neutral” 2

1 “Against”

The following items will be rated by the subjects using a 5-step Likert Scale.

The following statements are about Learner Satisfaction.

1 The teaching methods used in teaching IV therapy skills are helpful

2 the class on IV therapy skills provides a variety of learning materials

3 I enjoy the format in which the class on IV therapy skills is offered

4 the teaching materials in the class on IV therapy skills motivate me to study on IV Therapy

5 the way IV therapy skills is taught is consistent with the way I like to learn

The following statements are about Self-efficacy, Self-reliance, and Self-esteem.

6 I am confident that I am developing the knowledge needed to become a competent health professional

7 I did well on the tests in this class on IV therapy skills

8 I know how to get help when I do not understand class material

9 I know how to use the class material effectively for learning the IV venipuncture content

10 I am able to perform intravenous therapy as well as most other student nurses

11 I take a positive attitude in performing intravenous therapy on patients.

12 I am satisfied with how I perform intravenous therapy.

The following statements are about Educational Practices and Learning Styles.

13 I am an active learner

14 I rely on feedbacks given to me

15 I like to collaborate with my classmates


161

Statements

Relevance to Dimension of Construct General Recommendation

(Ret, Rev, Drop) and Remarks

5 “For”

4 3

“Neutral” 2

1 “Against”

during learning

16 I prefer more diverse ways of learning

17 The time dedicated on a task usually affects my performance

The following items are about Motivation.

18 I experience pleasure and satisfaction while learning new concepts.

19 The most satisfying thing for me in classes is trying to understand the content as thoroughly as possible.

20 I prefer course material that really challenges me so that I can learn new things.

21 When working on my goals, I put forth my best effort and work even harder if I’ve encountered a setback.

22 I tend to put my best effort so that I feel proud of my work.

23 I think I will be able to use what I learn in IV therapy in settings other than nursing.

24 It is important for me to learn IV therapy.

25 I am very interested in learning what IV therapy is all about.

26 I think it is useful for me to learn IV therapy.

27 Understanding IV therapy is very important to me.

Thank you for taking time to review our IVT Attitudes Survey!

- The Researchers



162

FOCUSED GROUP DISCUSSION GUIDE Instructions: Please review each item carefully. Write Y or N under the column “Clarity of Wording” to

describe the factor related to the item. Rate the “Relevance” of each item to the factor by checking the

appropriate column: 4 for relevant, 3 for moderately relevant, 2 for somewhat relevant or 1 for not

relevant. For the last column “General Recommendation”, please indicate Ret to retain the item exactly

as worded, Rev to make major/minor revisions to the item, or Drop to discard the item entirely from the

pool. You may also write your Remarks about the item clarity, appropriateness, etc. in the same column.

Item

Relevance to the Factor General Recommendation (Ret, Rev, Drop)

and Remarks

4 Relevant

3 Moderately

relevant

2 Somewhat

relevant

1 Not

relevant

The following items are about Instructional Characteristics.

1

INSTRUCTIONAL METHODS: What is your general impression or assessment to the instruction or teaching style employed in IV Therapy?

2 What methods were employed in teaching IV Therapy? Do you think they were effective? Why?

3 What do you best appreciate in these methods or styles?

4 OPPORTUNITY FOR PRACTICE: How were you able to practice IV Therapy?

5 Do you think it was sufficient? Why?

6 What are your perceived barriers and enabling opportunities in learning IV Therapy?

7 FEEDBACK: How was your performance on IV Therapy given feedback?

8 How did it help?

Thank you for taking time to review our Focused Group Discussion Guide!

- The Researchers



163

COMPREHENSIVE INTRAVENOUS THERAPY SKILLS OBSERVATION CHECKLIST Condensed Version with Skills on Setting-up IV Infusion, Preparing and Administering IV Medications,

Changing an ongoing IV Infusion, and Discontinuing an ongoing IV Infusion

* adapted from UPCN Clinical Skills Checklist


Steps Performed Not

Performed


1 Verify doctor’s order. Make I.V. label (patient’s name, room number, solution, drug incorporation, bottle sequence and duration)

2 Explain procedure to patient and/or significant others. Secure consent if necessary.

Assess patient’s vein; choose appropriate vein; location, size, condition.

3 Wash hands and maintain asepsis throughout the preparation and during the therapy.

4 Prepare necessary materials (IV tray with IV solution, administration set, IV cannula, antiseptic solution, cotton balls with alcohol, plaster, tourniquet, gloves, splint and IV stand.)

5 Check the sterility and integrity of the IV solution and IV set and other devices.

6 Place IV label on IV bottle.

7 Open the seal of the IV solution. Disinfect port with cotton balls with alcohol.

8 Open administration set aseptically (IV set). Close the clamp.

9 Spike the container aseptically.

10 Fill drip chamber to at least half and prime the tubing aseptically.

11 Remove air bubbles if any and put back the cover of the distal end of the IV tubing.

PREPARING AND ADMINISTERING IV MEDICATIONS Preparing IV Medications in Syringes

12 Countercheck medication card against the written doctor’s orders.

13

Observe 10 R's when preparing medication (selected “rights”*): Right Medication Right Client * other rights not selected because either they are incorporated in other steps (ex: right dose, right documentation, right assessment), or they are not applicable (ex: right time, right route, right client education, right to refuse, right evaluation)

14 Wash hands before and after the procedure.

15

Check for skin test of drug for IV push. Check for drug-drug and drug-IV fluid incompatibility. Check for dosage computations.


164

Steps Performed Not

Performed

16 Prepare the necessary material for the procedure such as: right drug, right diluents needed IV injection tray, syringes, and needles.

Prepare the medications accordingly.

Administering via Injection Port


18

Disinfect the Y-injection port of the IV administration set; pierce through the bull’s eyed rubber port.

Kink the tubing. Push IV drug slowly as ordered or as per manufacturer’s instructions.

19 Flush IV tubing after drug administration with IV fluid (aspirate IV fluid using same syringe and push IV fluid slowly).

Incorporating medications into Ongoing IV Fluid

20

Put down the bottle. Kink the tubing. Remove the administration set from the bottle aseptically. Disinfect the bottle’s rubber stopper: incorporate the right drug to the IVF bottle. Return the administration set to IVF bottle aseptically. Swirl bottle to mix the drug with the IVG and regulate the flow rate as ordered.

Administering via IV Push using Heplock port


22 Fill a tuberculin syringe with Heparin solution. (0.1 cc heparin plus 0.9 cc normal saline)

23 Fill the 2 2.5 cc syringes with isotonic solution or normal saline 1 cc each.

24 Swab injection port with alcohol or iodophor swab. Insert saline syringe into port. Saline syringe is also used to check the patient of the infusion set. If so. Administer saline via IV Push.

25 Insert medication into injection port. Inject medication into the vein, timing the flow rate according to doctor’s order.

26 Insert the saline syringe and flush the line.

27 Insert heparin syringe; to prevent the formation of clot in the catheter


Incorporating medications into Soluset and administering medications via Soluset

29 Check IV site (if infiltrated or out of vein; if there are signs of swelling, redness, phlebitis, do not give the drug)

30 Check present IV fluid label, level, and incorporated medicine in the soluset or IV bottle.

31

Add desired IVF diluent into soluset by opening the clamp on the bottle then close the clamp after.

Disinfect rubber injection port of the soluset. Incorporate the drug. Mix gently.

32 Open the clamp of the airway at the soluset.

33 Regulate flow rate of IVF infusion (if to run for 30 min or 1 hour).

34 Place IV label on soluset indicating drug administered.


165

Steps Performed Not

Performed

After administering medications: 35 Dispose sharps and other waste according to HICU guidelines.

36 Document procedure in the patient’s chart.


37 Verify written doctor’s order. Countercheck IV label, bottle number or bottle sequence, type, amount, additives (if any), duration of infusion.

38 Explain the procedure to the patient. Assess the IV site for redness, swelling and pain.


40 Prepare necessary materials (IV solution, IV label, disinfectant, IV tray).

41 Check the sterility and integrity of the IV.

42 Calibrate new IV bottle according to the duration of the infusion.

43 Open rubber port of IV solution to follow. Disinfect rubber port of IV solution.

44 Close the clamp or kink tubing. Spike the container aseptically.

45 Regulate the flow rate based on duration of infusion. Remove air bubbles (if any).

46 Discard all waste material according to HICU guidelines.

47 Document accordingly and endorse to incoming shift.

DISCONTINUING AN ONGOING IV INFUSION 48 Verify written doctor’s order to discontinue IV including IV medicines.


50 Prepare necessary materials: IV trays or injection tray, cotton balls with alcohol, plaster, antiseptic solution.


52 Don gloves.

53 Close IV clamp of the IV tubing.

54 Moisten adhesive tapes around the IV catheter using cotton balls with alcohol. Remove plaster gently.

55 Get cotton ball with alcohol and without applying pressure remove IV cannula. Apply pressure using dry cotton ball or then apply plaster.

56 Inspect IV catheter for completeness.

57 Discard all waste material including the IV cannula according to HICU guidelines.

58 Document time or removal, status of insertion site and integrity of IV catheter and endorse to incoming shift.

Thank you for evaluating the subject! - The Researchers




166

APPENDIX IV

Original UPCN Skills Laboratory Checklists Setting-up an Intravenous Infusion

Changing an ongoing Intravenous Infusion Discontinuing an ongoing Intravenous Infusion

Administering medications via IV Push using injection port Administering medications via IV Push using heplock port

Incorporating medications into Intravenous Fluid Incorporating medications into Soluset


167

INTRAVENOUS THERAPY SKILLS OBSERVATION CHECKLIST Setting-up an Intravenous Infusion


Steps Performed Not Performed

1 Verify doctor’s order and make I.V. label

2

Explain procedure to patient and/or significant others and asses patient’s

vein; choose appropriate vein; location, size, condition, secure consent if

necessary.

3 Washes hands and maintains asepsis throughout the preparation and during

the therapy.

4

Prepare necessary materials (IV tray with IV solution, administration set, IV

cannula, antiseptic solution, cotton balls with alcohol, plaster, tourniquet,

gloves, splint and IV stand.)

5 Check the sterility and integrity of the IV solution and IV set and other

devices

6 Place IV label on IV bottle (patient’s name, room number, solution, drug

incorporation, bottle sequence and duration)

7 Open the seal of the IV solution and disinfect port with cotton balls with

alcohol

8 Open administration set aseptically (IV set) and close the clamp

9 Spike the container aseptically

10 Fill drip chamber to at least half and prime the tubing aseptically

11 Remove air bubbles if any and put back the cover of the distal end of the IV

tubing (get ready for IV insertion).




168

INTRAVENOUS THERAPY SKILLS OBSERVATION CHECKLIST Changing an ongoing Intravenous Infusion



1 Verify written doctor’s order; countercheck IV label, bottle number or bottle

sequence, type, amount, additives (if any), duration of infusion

2 Explain the procedure to the patient and asses the IV site for redness, swelling

and pain.

3 Wash hands before and after procedure

4 Prepare necessary materials (IV solution, IV label, disinfectant, IV tray)

5 Check the sterility and integrity of the IV

6 Calibrate new IV bottle according to the duration of the infusion

7 Open and disinfect rubber port of IV solution to follow

8 Close the clamp or kink tubing and spike the container aseptically

9 Regulate the flow rate based on duration of infusion. Remove air bubbles (if

any)

10 Discard all waste material according to HICU guidelines

11 Document accordingly and endorse to incoming shift




169

INTRAVENOUS THERAPY SKILLS OBSERVATION CHECKLIST Discontinuing an ongoing Intravenous Infusion



1 Verify written doctor’s order to discontinue IV including IV medicines


3 Prepare necessary materials: IV trays or injection tray, cotton balls with alcohol,

plaster, antiseptic solution

4 Wash hands before and after procedure

5 Don gloves (optional)

6 Close IV clamp of the IV tubing

7 Moisten adhesive tapes around the IV catheter using cotton balls with alcohol.

Remove plaster gently.

8 Get cotton ball with alcohol and without applying pressure remove IV cannula

then apply pressure using dry cotton ball or dressing then apply plaster

9 Inspect IV catheter for completeness

10 Discard all waste material including the IV cannula according to HICU guidelines

11 Reassure patient.

12 Document time or removal, status of insertion site and integrity of IV catheter

and endorse to incoming shift




170

INTRAVENOUS THERAPY SKILLS OBSERVATION CHECKLIST Administering medications via IV Push using injection port



1 Countercheck medication card against the written doctor’s orders

2 Observe 10 Rs when preparing and administering medication

3 Explain procedure to patient ( the name of medicine and action interaction

of medication to patient care) before administering.

4 Wash hands before and after the procedure (use gloves especially for

chemotherapeutic drugs)

5 Check IV site (if infiltrated or out of vein; if there are signs of swelling,

redness, phlebitis, do not give the drug)

6 Check for skin test of drug for IV push, drug-drug, drug- IV fluid

incompatibility, dosage (computation)

7 Prepare the necessary material for the procedure such as: right drug, right

diluents needed IV injection tray, syringes, and needles.

8

Disinfect the injection port of the diluent (if in vial) and the drug. Aspirate

the right amount of diluents and dilute the drug (if the drug needs to be

diluted)

9

Aspirate the right drug dose, disinfect the Y-injection port of the IV

administration set; pierce through the bull’s eyed rubber port; kink the

tubing; push IV drug slowly as ordered or as per manufacturer’s instructions.

Observe precautionary measures during drug administration

10 Flush IV tubing after drug administration with IV fluid (aspirate IV fluid using

same syringe and push IV fluid slowly).

11 Regulate IV fluid infusion as ordered (if needed)

12 Discard sharps and other waste according to HICU guidelines



171

INTRAVENOUS THERAPY SKILLS OBSERVATION CHECKLIST Administering medications via IV Push using heplock port



1 Counter check medication card against the written doctor’s order


3 Explain procedure to patient ( the name of medicine and action interaction o

medication to patient care) before administration

4 Wash hands before and after the procedure ( use gloves especially for

chemotherapeutic drugs)

5 Gather equipment such as IV tray, Heparin solution, Normal saline diluents,

3 pieces 2.5 cc syringes

6 Prepare medication to be administered e.g. antibiotic, and draw it up into a

syringe

7 Fill a tuberculin syringe with Heparin solution. Heparin solution is usually

prepared with 0.1 cc heparin plus 0.9 cc normal saline

8 Fill the 2 2.5 cc syringes with isotonic solution or normal saline 1 cc each

9

Swab injection port with alcohol or iodophor swab. Insert saline syringe into

port. Take not: some drugs are incompatible with heparin. Saline syringe is

also used to check the patient of the infusion set. If so. Draw 2 syringes with

2 2.5 cc saline solution and use one syringe at a time.

10 Insert medication into injection port. Inject medication into the vein, timing

the flow rate according to doctor’s order or drug manufacturer’s instruction

11 Insert the saline syringe and flush the line

12 Observe patient for any adverse reactions

13 Insert heparin syringe; Rationale: Heparin should prevent the formation of

clot in the catheter




172

INTRAVENOUS THERAPY SKILLS OBSERVATION CHECKLIST Incorporating medications into Intravenous Fluid





3 Explain procedure to patient ( the name of medicine and action

interaction of medication to patient care) before administration

4 Wash hands before and after the procedure (use glove especially for

chemotherapeutic drugs.)

5 Check IV site ( if infiltrated or out of vein; if there are signs of welling,

redness, phlebitis , do not give the drug



7 Prepare the necessary materials for the procedure such as: injection tray,

syringes needed right drug to be incorporated either vial or ampule

8 Disinfect injection port of the vial and aspirate the drug aseptically

9

Put down the bottle, kink the tubing remove. Remove the administration

set from the bottle aseptically. Disinfect the bottle’s rubber stopper:

incorporate the right drug to the IVF bottle; return the administration set

to IVF bottle aseptically; swirl bottle to mix the drug with the IVG and

regulate the flow rate as ordered

10 Observe and reassure the patient

11 Document in the patient’s chart

12 Disposed sharps and other waste according to HICU guidelines




173

INTRAVENOUS THERAPY SKILLS OBSERVATION CHECKLIST Incorporating medications into Soluset





3 Explain procedure to patient ( the name of medicine and action

interaction of medication to patient care) before administration

4 Wash hands before and after the procedure (use glove especially for

chemotherapeutic drugs.)

5 Check IV site ( if infiltrated or out of vein; if there are signs of welling,

redness, phlebitis , do not give the drug



7 Prepare the necessary material for the procedure such as: right drug,

right diluents needed IV injection tray, syringes, and needles.

8

Check present IV fluid label, level, and incorporated medicine in the

soluset or IV bottle. If with incorporate medicine, check for drug-drug

incompatibility. If the ongoing IV fluid in the soluset it is be consumed in

6-8 hours ask from the doctor and order for IVF to be used solely for

drug administration.

9

Aspirate prepared right drug with correct dose; add desired IVF diluent

into soluset by opening the clamp on the bottle then close the clamp

after, disinfect rubber injection port of the soluset and incorporate the

drug. Mix gently

10 Open the clamp o f the airway at the soluset

11 Regulate flow rate of IVF infusion ( if to run for 30 min) or 1 hour

12 Place IV label on soluset indicating drug administered

13 Document in patient’s chart the drug administered

14 If incorporated medicine is consumed, clamp airway of soluset; add IVF

and regulate flow rate of IVF as ordered. Remove IV labels from soluset

15 Document in patient’s chart and Kardex ( of changes in IV rate/time due)

16 Observed patients for any untoward effect




174

APPENDIX V

Initial Pool of Items IVT Knowledge Assessment Examination

IVT Attitudes Survey


175

MULTIPLE CHOICE QUESTIONS

1. Mrs. Simpson lost large amounts of water due to her hospitalization last week. Looking at her

serum test results, the results show increased osmolality of the serum. What kind of fluid

imbalance is this, in relation to water?

A. isotonic loss B. isotonic gain C. hyperosmolar loss D. hypo-osmolar loss

2. What is seen in fluid sequestration in the bowel, in interstitial space, in inflamed tissue or in

potential spaces such as the peritoneal cavity?

A. fluid volume deficit B. fluid volume excess C. third spacing D. overhydration

3. Which of the following laboratory data indicate an electrolyte imbalance?

A. Na = 140 mEq/L B. K = 3.0 mEq/L C. Ca = 9.0 mEq/L D. Cl = 100 mEq/L

4. Which of the following are not important assessment interview data for intravenous therapy?

A. medications B. food intake C. past medical history D. none of the above

5. Which of the following need a primary care provider’s order for assessment of fluid and

electrolyte balance?

A. daily weights B. vital signs C. fluid intake-output D. none of the above

6. Select which of the following physical assessment findings suggest imbalance in fluid and

electrolytes.

I. diaphoretic II.swollen eyelids III.moist mucosa IV. Crackles

A. I, II and III B. II, III and IV C. I, III and IV D. I, II and IV

7. Which of the following measures are reflective of the status of fluid and electrolyte balance?

A. hematocrit B. electrolyte levels C. urine specific gravity D. all of the above

8. What is the priority goal/s of a nurse treating a patient with fluid and electrolyte imbalance?

A. fluid balance B. oxygenation C. risk prevention D. all of the above

9. Which of the following NIC’s are not directly related to fluid and electrolyte balance?

A. electrolyte mg’t B. nutritional support C. fluid monitoring D. none of the above

10. Which of the following pairs of intravenous solutions and their classification are mismatched?

A. 0.9% NaCl – Isotonic B. 5% dextrose in 0.45% NaCl – Isotonic

C. 0.45% NaCl – Hypotonic D. 5% dextrose in normal saline – Hypertonic

11. Which of the following intravenous solutions better increase blood volume following severe loss

of blood or plama among others?

A. isotonic solutions B. hypotonic solutions C. hypertonic solutions D. volume expanders

12. Which of the following intravenous solutions provide free water and treat cellular dehydration?


13. Which of the following intravenous solutions draw fluid out of the compartments into the

vascular compartments, which expand vascular volume?


14. Which of the following are not nutrient solutions?

A. glucose in water B. cellulose in water C. dextrose in 0.45% NaCl D. D5W

15. In which situations are larger veins preferred for infusions?

A. infusions that need to be given rapidly B. solutions that could be irritating

C. both A and B D. neither A nor B


176

16. Why are the metacarpal, basilic and cephalic veins commonly used for infusions?

A. radius and ulna act as natural splints B. client has less freedom of arm movements

C. both A and B D. neither A nor B

17. Which of the following are useful guidelines in selecting a vein for venipucture?

I. use proximal veins of the arm first

II. use client’s dominant arm whenever possible

III. vein selected must be easily palpated and soft and full

IV. avoid veins in areas of flexion such as the antecubital fossa

A. I and II B. II and III C. III and IV D. none

18. Which of the following statements are false regarding IV starts?

I. avoid hand veins, they must be a last choice

II. use the smallest gauge cannula for the therapy

III. limit your insertion attempts to 2

IV. stabilize the client’s arm with your non-dominant arm

A. I and II B. II and III C. III and IV D. none

19. An intravenous solution must not be:

A. sterile B. cloudy C. in good condition D. unused

20. A standard IV administration set contains all of the following, except:

A. self-sealing septum B. clamps C. spike connector D. secondary ports

21. Which of the following pairs of intravenous equipment and its use are mismatched?

A. insertion spike – inserted into fluid bag B. drip chamber – predicts fluid amount delivery

C. clamp – controls the rate of flow D. injection ports – ensures sterility of the line

22. Which of the following does not affect flow rate of an intravenous fluid?

A. forearm position B. height of IV bottle C. infiltration D. temperature

23. Which of the following causes phlebitis?

A. vein irritation from catheter B. chemical irritation from medicines

C. infection from improper aseptic technique D. none of the above

24. Which of the following pairs of terminologies and its definition are mismatched?

A. septicemia – systemic infection B. infiltration – leakage of IV solution into tissue

C. extravasation – leakage of chemical to vein D. phlebitis – vein inflammation with thrombus

25. What may happen when an air bubble or a foreign object is not removed in the IV tubing?

A. circulatory overload B. pulmonary embolism

C. speed shock D. pulmonary edema

26. Which of the following leads to the other?

I. air embolism II.circulatory overload III.speed shock IV. pulmonary edema

A. I and II B. I and III C. II and IV D. III and IV

27. It is a systemic reaction to a foreign substance given too rapidly into the bloodstream. What is

it?

A. speed shock B. circulatory overload C. air embolism D. pulmonary edema

28. Which of the following are directly proportional to the flow of an IV infusion?

A. viscosity of fluid B. diameter of tubing C. length of tubing D. none of the above

29. Which of the following does not belong to the group, in terms of its coverage and severity?


177

A. hematoma B. needle obstruction C. fluid overload D. clotting

30. Which of the following are the goals of parenteral fluid therapy?

A. provide water, electrolytes and nutrients to meet daily requirements

B. replace water and correct electrolyte deficits

C. administer medications and blood products

D. all of the above

31. Why are pure, electrolyte-free water never administrated by IV?

A. they don’t have dextrose, which is needed by red blood cells

B. they rapidly enter red blood cells and cause them to rupture

C. they rapidly extract water from red blood cells and cause them to shrink

D. none of the above

PROBLEM SOLVING QUESTIONS

1. What is the flow rate of an intravenous solution of 3 L infused in 24 hours? Express your answer

in mL/h. ___________________________

2. What is the regulation that a nurse computes if a liter of intravenous solution is to be infused in

8 hours using an administration set with drip factor of 20 drops/ml? Express your answer in

drops/min. ___________________________

3. Calculate the flow rate of a set calibrated at 15 gtt/mL that is used to infuse 80 mL in 50 min.

___________________________

4. The doctor orders a liter of D5W to infuse over 10 hr. At the end of 8 hr you notice that there

are 500 mL left in the bag. What would the new flow rate be if the set calibration is 10 gtt/mL?

___________________________

5. An IV of 1000 mL D5 1/4 NaCl with 20 mEq KCl is ordered to run at 25 mL/hr using a microdrip

set. What will be the flow rate? ___________________________

6. The client is prescribed 1200mL of D5W solution to be administered over a 10 hour period. The

sol’n is to be infused via pump. At what hourly rate should the pump be set to deliver the

prescribed amount? ___________________________

7. An IV solution of 1000mL of D5W NaCl is to infuse over 8 hours. The IV set drop factor is 15

gtts/mL. How many drops per minute should the client receive?

___________________________

8. A 3 and a half year old male patient with a weight of 15kg is to be given 300 mg Cefuroxime.

Compute for dose and recommended range. Preparation: Powder which when reconstituted

with 1.8ml water for injection, gives a solution of 250mg in 2ml. Recommended dose range for 2

to 12 years is 10 – 30mg/kg tds. ___________________________

9. A 4 month old infant with a weight of 6.5kg is to be given 7.5 mg Furosemide IV. Compute for

dose and recommended range. Preparation: Ampoules containing 20mg in 2ml. Recommended

dose range age 1 month to 2 years is 1 – 2mg/kg bd. ___________________________

TRUE OR FALSE QUESTIONS

1. Hands washing with antiseptic or alcohol rub should be performed before preparation of IV

antibiotic solution. __________


178

2. It is not necessary to check expiry date for a medication that is recently indented from

pharmacy. __________

3. ‘cc’ or ‘ml’ is the dosage expression for IV insulin. __________

4. The Cefoperazone vial top should be swabbed with alcohol swabs prior to reconstitution with

NaCl 0.9%. __________

5. Preparation of IV Hydrocortisone solution does not require hands cleaning using antiseptic or

alcohol rub. __________

6. Any reconstituted IV medications can still be used if it is less than 48 hours from the date of

reconstitution or preparation. __________

7. When 6ml of IV Noradrenaline (4mg/ml) is diluted with 50ml of 5% dextrose saline, the final

concentration of Noradrenaline infusion solution in μg/ml is 480μg/ml. (1mg=1000μg).

__________

8. IV antibiotics are stable when diluted using NaCl 0.9% or NaCl 3%. __________

9. Patient’s armband and IV catheter should be inspected for phlebitis or extravasations during

administration of IV cytotoxic drugs. __________

10. Medication administered intramuscularly acts rapidly than if administered intravenously.

__________

11. KCl injection should be administered as slow bolus injection over 3 minutes during emergency

such as ventricular fibrillation. __________

12. IV Ceftriaxone (Rocephine®) can be administered simultaneously with solution containing

Calcium Gluconate via a Y-site, at a slower rate of 5mg/min. __________

13. Slow bolus IV injection means administration of intravenous medication in 1 minute.

__________

14. Medications that are classified as High Alert Medication include Noradrenaline and Insulin.

__________

15. When an emergency happens such as hypocalcaemia tetany, 10% CaCl 210 ml should be

administered in 1– 2 minutes. __________

16. Intravenous medication which requires maximum infusion rate of 120μg/hour should be infused

at a constant rate of 4μg/min for the first 1 hour. __________

LIKERT-SCALE QUESTIONS

1. the teaching methods used in teaching IV therapy skills are helpful

2. the class on IV therapy skills provides a variety of learning materials

3. I enjoy the format in which the class on IV therapy skills is offered

4. the teaching materials in the class on IV therapy skills are motivating

5. the way IV therapy skills is taught is consistent with the way I like to learn

6. I am confident that I am developing the knowledge needed to become a good health

professional

7. I am confident that I am developing the practical skills needed to become a good health

professional

8. I am confident that I am mastering the IV content

9. I did well on the tests in this class on IV therapy skills


179

10. I know how to get help when I do not understand class material

11. I know how to use the class material effectively for learning the IV venipuncture content

12. In the kinds of things we do in school, I am at least as good as other people in my classes.

13. I often feel worthless in school.

14. I am an important person in my classes.

15. I am able to do/perform intravenous therapy as well as most other student nurses

16. I take a positive attitude toward myself in performing intravenous therapy on patients.

17. On the whole, I am satisfied with how I perform intravenous therapy.

18. I am an active learner

19. I rely on feedbacks given to me

20. The faculty affects my interaction with them

21. I like to collaborate with my classmates during learning

22. I have high expectations for myself

23. I prefer more diverse ways of learning

24. The time dedicated on a task usually affects my performance

25. I experience pleasure and satisfaction while learning new big things

26. The most satisfying thing for me in classes is trying to understand the content as thoroughly as

possible.

27. I prefer course material that really challenges me so that I can learn new things.

28. When working on my goals, I put forth my best effort and work even harder if I’ve encountered

a setback.

29. I tend to put my best effort so that I feel proud of my work.

30. I think I will be able to use what I learn in IV therapy in settings other than nursing.

31. It is important for me to learn IV therapy.

32. I am very interested in learning what IV therapy is all about.

33. I think it is useful for me to learn IV therapy.

34. I like IV therapy as a subject matter.

35. Understanding IV therapy is very important to me.

36. I know that I will be able to learn IV therapy.

37. I am certain I can understand the ideas surrounding IV therapy.

RANKING QUESTIONS

__ Active Learning __ Feedback __ Collaboration __ Student-faculty interaction

__ High Expectations __ Time on Task __ Diverse Ways of Learning


180

APPENDIX VI

Qualitative Analysis of Content Validity of the

IVT Knowledge Assessment Examination Test Blueprint for the Items in the Examination

N11 Course Objectives focused on IVT


181

TEST BLUEPRINT FOR INTRAVENOUS THERAPY (IVT) KNOWLEDGE ASSESSMENT EXAMINATION

CLASSIFICATION OF QUESTION

CONTENT AREAS

A. Assessment & Planning (3%)

B. IV Solutions (10%)

C. Venipuncture Site (7%)

D. Monitoring (23%)

Recall (10%)

Tonicity of solutions 1 item (#3)

Understand (30%)

Plasma expanders 1 item (#4)

Factors affecting flow rate Causes of phlebitis 2 items (#7, 8)

Analysis (20%)

Type of IV solution & classification 1 item (#2)

Coverage and severity of IVT complications 1 item (#9)

Apply (37%)

Priority goal setting 1 item (# 1)

Guidelines for selecting veins Key concepts in starting IVT 2 items (#5, 6)

Interventions for infiltration Interventions for an air trapped in an IV tubing Actions on backflow of blood in IV tubing 3 items (# 11, 13, 14)

Synthesis (3%)

Complications of IVT 1 item (#12)

No. of items 1 3 2 7

Total time for test: 30 minutes


182

CLASSIFICATION OF QUESTION

CONTENT AREAS Total

E. Purposes of IVT (3%)

F. Calculations (17%)

G. IV Medication Preparation (17%)

H. IV Medication Administration (20%)

Recall (10%)

Dosage expression 1 item: True or False (#3)

Examples of high alert medications 1 item True or False (#10)

3

Understand (30%)

Goals of parenteral fluid therapy 1 item (#10)

Importance of handwashing/hand hygiene Importance of checking expiry date 3 items True or False (#1, 2, 4)

Administration of cytotoxic drugs Comparison of IV & IM Infusion Rate Administration of CaCl 2 items True or False (#6, 7)

9

Analysis (20%)

Reconstituted IV medications 1 item True or False (# 5)

Use of slow bolus injection Administration: Y site Emergency IV drugs 3 items True or False(#8, 9, 11)

6

Apply (37%)

Flow Rate computation IV regulation Pedia Dose computation 5 items (Write answer on the blank) (#1-5)

11

Synthesis (3%)

1

No. of items 1 5 5 6 30


183

OBJECTIVES OF NURSING FOUNDATIONS II COURSE FOCUSING ON INTRAVENOUS THERAPY

OBJECTIVES ITEMS

SKA Analysis of Professional Responsibilities: Assesses with client their conditions to identify existing and potential nursing problems (Skills) 1. Common manifestations of general physiologic problems/alterations in fluid and electrolyte balance 2. Factors related to problems/alterations in fluid and electrolyte balance Plans and Implements with clients appropriate nursing interventions for nursing diagnoses (Skills) 1. Implements planned interventions for individual client (other nursing interventions appropriate for general physiologic problems) (Knowledge) 1. Nursing interventions for meeting clients’ needs for fluid and electrolyte balance (specifically setting up IV systems, calculating/regulating flow of IVF/ terminating IV systems)

Test I: #1 Test I: #1-4, 10; Test II: #1-5; Test III: #1-11 Test I: #5-10; Test II: #1-5; Test III: #1-11 Test 1: #10; Test II: #1-5; Test III: #1-11

Professional Competencies; Terminal Competencies Given a client in stress/crisis situation with specific problems in fluid and electrolyte balance 1. Assesses the client’s problems (fluid and electrolyte balance) based on: - Physical Assessment 2. Implements planned interventions for individual client (other nursing interventions appropriate for general physiologic problems)

Test I: #1, 6-9 Test I: #5-10; Test II: #1-5; Test III: #1-11

Instruction Design Given relevant questions related to administration of medicine 1. Identifies the components of a legal medication order 2. Computes for the correct dosage of drug (IV) 3. Describes the steps in preparing the drug (IV) 4. Demonstrates administration of medication (IV) in terms of: - purpose - route and site of administration

Test II: #4-5 Test II: #1-4 Test III: #1-5 Test I: #1, 5-10; Test III: #6-11


184

- standard procedure - precautions to be observed before, during and after Given simulated situations 1. Demonstrates the correct procedures of administering parenteral fluids/medications (including IV Therapy

and blood transfusions) Given a selected client with specific health needs in fluid and electrolytes 1. Takes a thorough physical assessment 2. Describes the general manifestations specific to fluids and electrolytes 3. Demonstrates the following procedures on fluids and electrolytes: - Calculating and regulating the flow of intravenous fluids - Preparing IV infusion set-up - Assisting in IV insertion - Starting and discontinuing IVF

Test I: #1-14; Test II: 1-5; Test III: #1-11 Test I: #1, 5, 10 Test I: #1 Test II: #1-5; Test III: #1-11

RECORDS AND REPORTS Given clinical records 1. Utilizes a record system to document patient data on appropriate forms and according to institutional policies (e.g. problem-oriented record): - therapeutic sheet - nurses’ notes

Found in skills checklist.

* Most objectives are also addressed using the skills checklist utilized in the study.


185

APPENDIX VII

Data Tables from Validity and Reliability Testing Inter-rater Reliability for IVT Skills Observation Checklist

First Round of Content Validity IVT Knowledge and Attitudes Tools Second Round of Content Validity for IVT Knowledge and Attitudes Tools


186

INTER-RATER RELIABILITY (SKILLS OBSERVATION CHECKLIST)

STEPS

PERFORMANCE (0 or 1) INTER-RELIABILITY VALUES >80%? SUBJECT 1 SUBJECT 2

R1 R2 R3 R1 R2 R3 S1 S1 AVE


1A 1 1 1 1 1 1 1 1 1 Y

1B 1 1 1 1 1 1 1 1 1 Y

2A 1 1 1 1 1 0 1 0.67 0.83 Y

2B * 1 1 1 1 0 0 1 0.33 0.67 N

3 1 1 1 1 1 1 1 1 1 Y

4 * 1 1 0 1 1 0 0.67 0.67 0.67 N

5 1 1 1 1 1 0 1 0.67 0.83 Y

6 1 1 1 1 1 1 1 1 1 Y

7A 1 1 1 1 1 0 1 0.67 0.83 Y

7B 0 0 0 0 0 0 1 1 1 Y

8A * 0 1 1 0 1 1 0.67 0.67 0.67 N

8B 1 1 0 1 1 1 0.67 1 0.83 Y

9 * 0 1 1 0 1 1 0.67 0.67 0.67 N

10 1 1 1 1 1 0 1 0.67 0.83 Y

11 1 1 1 1 1 1 1 1 1 Y

PREPARING IV MEDS IN SYRINGES

12 1 1 1 1 1 1 1 1 1 Y

13A 1 1 1 1 1 1 1 1 1 Y

13B 0 1 1 0 1 0 0.67 0.33 0.5 N

14 1 1 1 1 1 1 1 1 1 Y

15A 1 1 0 1 1 0 0.67 0.67 0.67 N

15B 1 1 1 1 1 1 1 1 1 Y

15C 1 1 1 1 1 1 1 1 1 Y

16A 1 1 1 1 1 1 1 1 1 Y

16B 1 1 1 1 1 1 1 1 1 Y

ADMINISTERING VIA INJECTION PORT

17 1 1 1 1 1 0 1 0.67 0.83 Y

18A 1 1 1 1 1 1 1 1 1 Y

18B * 1 0 0 1 0 0 0.33 0.33 0.33 N

18C 1 1 1 1 1 1 1 1 1 Y

19 0 0 0 0 0 0 1 1 1 Y

INCORPORATING MEDS INTO ONGOING IV FLUID

20A 1 1 1 1 1 1 1 1 1 Y

20B * 1 0 0 1 0 0 0.33 0.33 0.33 N

20C 0 0 0 0 0 0 1 1 1 Y

20D 0 1 1 0 0 0 0.67 1 0.83 Y


187

STEPS



20E 0 0 0 0 0 0 1 1 1 Y

20F * 1 0 1 1 0 1 0.67 0.67 0.67 N

ADMINISTERING VIA HEPLOCK PORT

21 1 1 0 0 0 0 0.67 1 0.83 Y

22 1 1 1 1 1 1 1 1 1 Y

23 1 1 1 1 1 1 1 1 1 Y

24A * 1 1 1 1 0 0 1 0.33 0.67 N

24B 1 1 1 1 1 1 1 1 1 Y

25 1 1 1 1 1 1 1 1 1 Y

26 1 1 1 1 1 1 1 1 1 Y

27 1 1 1 1 1 1 1 1 1 Y

28 1 1 1 1 1 1 1 1 1 Y

INCORPORATING MEDS INTO SOLUSET

29 * 1 1 1 1 0 0 1 0.33 0.67 N

30 1 1 1 1 1 1 1 1 1 Y

31A 1 1 1 1 1 1 1 1 1 Y

31B * 1 1 1 0 0 1 1 0.33 0.67 N

31C 1 1 1 0 1 1 1 0.67 0.83 Y

32 * 0 1 0 1 1 0 0.33 0.67 0.5 N

33 * 1 1 0 0 1 1 0.67 0.67 0.67 N

34 0 0 0 0 0 0 1 1 1 Y

AFTER ADMINISTERING MEDS

35 * 0 1 0 0 1 0 0.33 0.33 0.33 N

36 0 0 0 0 0 0 1 1 1 Y


37A 1 1 1 1 1 1 1 1 1 Y

37B 1 1 0 1 1 1 0.67 1 0.83 Y

38A 0 0 0 0 0 0 1 1 1 Y

38B 0 0 0 0 0 0 1 1 1 Y

39 * 0 0 1 0 0 0 0.33 1 0.67 N

40 * 1 1 0 1 1 0 0.67 0.67 0.67 N

41 * 1 1 0 1 1 0 0.67 0.67 0.67 N

42 1 0 1 0 0 0 0.67 1 0.83 Y

43A 1 1 1 1 1 1 1 1 1 Y

43B * 1 1 0 1 0 0 0.67 0.33 0.5 N

44A 1 1 1 1 1 0 1 0.67 0.83 Y

44B 1 1 1 1 1 1 1 1 1 Y

45 * 1 1 0 1 0 1 0.67 0.67 0.67 N

46 0 0 0 0 0 0 1 1 1 Y


188

STEPS



47 0 0 0 0 0 0 1 1 1 Y

DISCONTINUING AN ONGOING IV INFUSION

48 1 1 1 1 1 1 1 1 1 Y

49 0 0 0 0 0 0 1 1 1 Y

50 * 1 0 0 1 1 0 0.33 0.67 0.5 N

51 1 1 1 0 0 0 1 1 1 Y

52 0 0 0 0 0 0 1 1 1 Y

53 1 1 1 1 1 1 1 1 1 Y

54 * 1 0 1 0 1 1 0.67 0.67 0.67 N

55A 1 1 1 1 1 1 1 1 1 Y

55B 1 1 1 1 1 1 1 1 1 Y

56 0 0 0 1 1 0 1 0.67 0.83 Y

57 * 1 1 0 1 1 0 0.67 0.67 0.67 N

58 0 0 0 0 0 0 1 1 1 Y

AVERAGE 0.88 0.84 0.86

* These steps had inter-rater reliability values less than 80%. These were clarified and discussed further with the raters.


189

FIRST ROUND OF CONTENT VALIDITY (KNOWLEDGE TOOL)

ITEMS

RESULTS

CLARITY AVE

>80%? RELEVANCE

AVE RANKING RET REV DROP

MC: MULTIPLE CHOICE

1 0.66667 N 3.5 33 4 2 0

2 0.66667 N 3.166666667 43 4 2 0

3 0.83333 Y 3.666666667 17 5 0 1

4 0.66667 N 3.166666667 42 4 1 1

5 0.66667 N 2.833333333 48 3 2 1

6 0.83333 Y 3.333333333 39 4 2 0

7 0.83333 Y 3.333333333 39 5 1 0

8 1 Y 3.666666667 18 5 1 0

9 0.66667 N 3.2 38 4 2 0

10 1 Y 3.666666667 17 5 1 0

11 0.5 N 3.5 29 1 1 0

12 1 Y 3.833333333 5 6 0 0

13 0.83333 Y 3.833333333 6 5 1 0

14 0.5 N 2.833333333 40 2 1 2

15 0.83333 Y 3.166666667 34 4 2 0

16 0.5 N 3.166666667 34 3 2 1

17 1 Y 3.833333333 6 6 0 0

18 0.83333 Y 3.666666667 16 4 2 0

19 0.6 N 3 34 2 3 0

20 0.5 N 3.5 25 3 3 0

21 1 Y 3.5 25 2 2 0

22 1 Y 3.666666667 15 5 0 1

23 1 Y 3.833333333 6 6 0 0

24 0.83333 Y 3.5 24 5 0 1

25 1 Y 3.833333333 6 6 0 0

26 0.8 N 3.75 12 3 1 1

27 0.66667 N 3.4 25 4 2 0

28 1 Y 3 27 5 0 1

29 0.5 N 2.75 28 3 2 1

30 1 Y 4 1 6 0 0

31 0.83333 Y 3 26 5 0 1

PS: PROBLEM SOLVING

1 1 Y 4 1 6 0 0

2 1 Y 4 1 6 0 0

3 0.83333 Y 3.6 15 5 1 0

4 0.83333 Y 3.4 21 5 1 0


190

ITEMS

RESULTS

CLARITY AVE

>80%? RELEVANCE

AVE RANKING RET REV DROP

5 0.66667 N 3.6 15 4 2 0

6 0.66667 N 3.6 15 4 2 0

7 0.83333 Y 3.833333333 3 5 1 0

8 0.5 N 3.8 6 3 3 0

9 0.5 N 3.8 6 3 3 0

TF: TRUE OR FALSE

1 0.83333 Y 3.833333333 3 5 1 0

2 0.83333 Y 3.833333333 3 4 1 1

3 0.83333 Y 3.666666667 5 5 0 1

4 1 Y 3.5 10 5 1 0

5 0.66667 N 3.666666667 5 4 2 0

6 1 Y 3.666666667 5 6 0 0

7 1 Y 3.5 8 6 0 0

8 0.83333 Y 3.6 7 4 1 0

9 1 Y 4 1 6 0 0

10 1 Y 3.666666667 4 6 0 0

11 1 Y 4 1 6 0 0

12 1 Y 3.666666667 3 6 0 0

13 1 Y 3.5 3 6 0 0

14 1 Y 3.833333333 1 6 0 0

15 1 Y 3.8 1 5 0 0

16 0.83333 Y 3.166666667 1 5 0 1


191

FIRST ROUND OF CONTENT VALIDITY (ATTITUDES TOOL)

ITEMS RESULTS

RELEVANCE MEDIAN RESULT? RET REV DROP

LS: LEARNER SATISFACTION

1 4.5 FOR 6 0 0

2 4.5 FOR 5 0 2

3 4.5 FOR 5 0 1

4 4.5 FOR 6 0 2

5 5 FOR 5 0 1

SELF-PERCEPTION

6 5 FOR 5 0 0

7 5 FOR 6 0 0

8 3 NEUTRAL 3 0 3

9 4 FOR 5 0 1

10 4 FOR 3 0 0

11 4 FOR 4 0 1

12 3 NEUTRAL 1 0 3

13 1 AGAINST 2 0 0

14 3.5 NEUTRAL 3 0 2

15 4 FOR 4 0 1

16 5 FOR 5 0 1

17 5 FOR 5 0 0

EDUC: EDUCATIONAL PRACTICES AND LEARNING STYLES

18 5 FOR 6 0 0

19 4 FOR 5 0 1

20 3 NEUTRAL 2 0 2

21 4 FOR 5 0 1

22 3 NEUTRAL 3 0 4

23 5 FOR 5 0 0

24 4.5 FOR 5 0 0

MOTIV: MOTIVATION

25 4.5 FOR 4 0 0

26 4 FOR 4 0 0

27 4 FOR 5 0 1

28 5 FOR 5 0 0

29 5 FOR 5 0 0

30 5 FOR 4 0 0

31 5 FOR 6 0 0

32 5 FOR 6 0 0

33 5 FOR 6 0 0

34 3.5 NEUTRAL 5 0 2


192

ITEMS RESULTS

RELEVANCE MEDIAN RESULT? RET REV DROP

35 5 FOR 5 0 1

36 3 NEUTRAL 4 0 3

37 3 NEUTRAL 3 0 2

RANK: RANKING ACCORDING TO IMPORTANCE

1 5 FOR 3 0 0

2 5 FOR 3 0 1

3 5 FOR 3 0 1

4 4 FOR 3 0 0

5 4 FOR 3 0 1

6 4 FOR 3 0 1

7 5 FOR 3 0 0

LEARN: MODE OR STYLE OF LEARNING

1 5 FOR 1 0 0

2 5 FOR 1 0 0

3 5 FOR 1 0 0

4 5 FOR 1 0 0


193

SECOND ROUND OF CONTENT VALIDATION (KNOWLEDGE TOOL)

ITEMS

RESULTS

CLARITY AVE

>80%? RELEVANCE

AVE RET REV DROP

MC: MULTIPLE CHOICE

1 * 1 Y 3.857142857 6 1 0

2 * 1 Y 4 7 0 0

3 0.71429 N 4 5 2 0

4 1 Y 4 6 1 0

5 * 0.85714 Y 4 6 1 0

6 0.85714 Y 4 6 1 0

7 1 Y 4 7 0 0

8 0.85714 Y 4 6 1 0

9 0.85714 Y 4 6 1 0

10 * 0.85714 Y 3.571428571 6 1 0

11 * 0.85714 Y 3.857142857 5 2 0

12 * 1 Y 4 6 1 0

13 1 Y 4 6 1 0

14 * 1 Y 4 6 1 0

15 1 Y 4 7 0 0

16 0.85714 Y 3.857142857 6 1 0

17 1 Y 3.714285714 6 1 0

18 0.85714 Y 4 6 1 0

19 1 Y 4 6 0 1

20 1 Y 4 6 1 0

21 0.85714 Y 4 6 1 0

PS: PROBLEM SOLVING

1 1 Y 4 7 0 0

2 1 Y 4 7 0 0

3 1 Y 4 7 0 0

4 1 Y 4 7 0 0

5 1 Y 4 7 0 0

TRUE OR FALSE

1 1 Y 4 6 1 0

2 0.85714 Y 4 6 1 0

3 1 Y 4 6 1 0

4 1 Y 3.714285714 6 0 1

5 1 Y 4 7 0 0

6 0.85714 Y 4 6 1 0

7 1 Y 4 7 0 0

8 1 Y 4 7 0 0


194

ITEMS

RESULTS

CLARITY AVE

>80%? RELEVANCE

AVE RET REV DROP

9 1 Y 4 7 0 0

10 1 Y 4 7 0 0

11 0.85714 Y 4 6 1 0

* These items were omitted from the final IVT knowledge assessment examination administered to the subjects on the bases of their relevance average rating and the number of experts suggesting to drop these items. ** The relevance average of each item was ranked and the top of 14 multiple choice items, top 5 problem solving items, and top 11 true or false items were taken and was included in the final IVT Knowledge Assessment Exam. The average Content Validity Index for the tool was 0.978


195

SECOND ROUND OF CONTENT VALIDATION (ATTITUDES TOOL)

ITEMS RESULTS

RELEVANCE MEDIAN

RESULT? RET REV DROP

LS: LEARNER SATISFACTION

1 5 FOR 7 0 0

2 5 FOR 7 0 0

3 5 FOR 7 0 0

4 5 FOR 6 1 0

5 5 FOR 7 0 0

SELF-: SELF-ESTEEM, SELF RELIANCE, SELF-EFFICACY

6 ** 5 FOR 7 0 0

7 5 FOR 7 0 0

8 * 5 FOR 7 0 0

9 * 5 FOR 6 1 0

10 * 5 FOR 7 0 0

11 5 FOR 6 0 1

12 5 FOR 7 0 0

EDUC: EDUCATIONAL PRACTICES AND LEARNING STYLES

13 5 FOR 7 0 0

14 5 FOR 6 0 1

15 5 FOR 7 0 0

16 5 FOR 7 0 0

17 5 FOR 7 0 0

MOTIV: MOTIVATION

18 * 5 FOR 6 1 0

19 * 5 FOR 7 0 0

20 * 5 FOR 7 0 0

21 5 FOR 7 0 0

22 5 FOR 7 0 0

23 * 5 FOR 6 0 1

24 5 FOR 7 0 0

25 5 FOR 7 0 0

26 5 FOR 7 0 0

27 * 5 FOR 7 0 0

* These items were omitted from the final IVT attitudes survey administered to the subjects on the bases of their relevance rating and the number of experts suggesting to drop these items. ** This item was re-used to become another item by revising the statement from knowledge to “practical skills”. ***The top 5 items for each domain were taken to be part of the final IVT Attitudes Survey. The average Content Validity Index for the tool was 0.973


196

APPENDIX VIII

Data Tables and Statistical Printouts from Pre-testing Socio-demographic Profile of Subjects

Results of IVT Skills Observation Results of IVT Knowledge Assessment

Results of Attitudes Survey Statistical Printout of the Computation of T-test of paired means

Statistical Printout of the Computation of T-test of independent means


197

SOCIO-DEMOGRAPHIC PROFILE OF SUBJECTS

NO.

Sex (1-male;

2- female) Age GWA

N11 Skills Score

(over 25)

Year Entered UPCN

Status (1-regular;

2- irregular)

1 1 20 2.00 23 2009 1

2 1 21 2.10 23 2009 1

3 2 20 1.99 24 2009 1

4 2 19 2.34 24 2009 1

5 2 20 1.75 23 2009 1

6 1 20 1.91 23 2009 1

7 1 20 1.97 21 2009 1

8 2 20 2.00 23 2009 1

9 1 21 2.00 22 2009 1

10 2 20 1.88 23 2009 1


198

RESULTS OF SKILLS OBSERVATION

SETTING-UP PREPARING IV MEDS

NO. 1A 1B 2A 2B 3 4 5 6 7A 7B 8A 8B 9 10 11 12 13A 13B 14 15A 15B 15C 16A 16B

1 1 0 0 1 0 1 0 0 1 1 1 1 1 1 1 1 1 0 0 0 0 1 1 1

2 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 1 1 0 0 0 0 1 1 1

3 1 0 0 0 0 0 1 1 1 1 1 0 1 0 1 1 1 1 0 1 1 1 1 1

4 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 1 1 1

5 1 1 1 1 0 1 1 1 1 1 1 1 0 1 1 1 1 1 0 1 0 1 1 1

6 1 0 1 1 0 1 1 0 1 0 0 1 0 1 1 1 1 1 0 0 0 1 1 1

7 1 1 1 1 0 1 1 1 1 1 0 1 0 1 1 1 1 1 0 0 0 1 1 1

8 1 1 0 0 0 1 1 1 1 0 0 1 0 1 1 1 1 1 0 0 0 1 1 1

9 1 1 1 0 0 1 1 1 0 0 0 1 0 1 1 1 1 1 0 1 1 1 1 1

10 1 0 0 0 0 1 1 0 1 0 0 1 0 1 1 1 1 0 0 0 0 1 1 1

INJECTION PORT INCORPORATING INTO ONGOING IVF ADMIN VIA HEPLOCK PORT

NO. 17 18A 18B 18C 19 20A 20B 20C 20D 20E 20F 21 22 23 24A 24B 25 26 27 28

1 1 1 1 1 1 1 1 1 0 1 1 1 0 1 1 1 1 1 0 1

2 0 1 1 1 1 1 0 0 0 0 1 0 0 1 1 1 1 1 0 1

3 0 0 1 1 1 1 1 1 0 1 0 0 0 1 1 1 1 1 0 1

4 0 1 1 1 1 1 0 1 1 1 1 0 0 1 1 1 1 1 0 1

5 1 1 1 1 0 0 0 0 0 0 0 1 0 1 1 1 1 1 1 1

6 1 1 1 1 0 1 1 1 1 1 1 1 0 0 1 0 1 0 0 1

7 0 1 1 1 1 0 0 0 0 0 0 0 0 0 1 1 1 1 1 0

8 0 1 1 1 1 1 0 1 1 1 0 0 0 1 1 1 1 1 0 0

9 0 1 1 1 1 1 0 0 1 0 1 0 1 1 0 1 1 1 1 1

10 0 1 1 1 0 1 0 0 1 0 1 0 0 1 1 1 1 1 1 1


199

INCORPORATING AND ADMIN VIA SOLUSET

AFTER-CARE

NO. 29 30 31A 31B 31C 32 33 34 35 36

1 0 0 1 1 1 1 1 0 1 1

2 0 0 1 1 1 0 1 0 1 1

3 0 0 1 0 1 1 1 1 1 0

4 0 0 1 1 1 1 1 0 1 0

5 1 1 1 1 1 1 1 1 1 1

6 0 1 1 1 1 1 1 0 1 1

7 0 0 1 1 1 0 0 0 0 0

8 0 0 1 1 0 1 0 0 1 0

9 0 0 1 1 1 0 1 0 1 0

10 0 0 1 1 1 1 1 0 1 1

CHANGING ONGOING IVF DISCONTINUING ONGOING IVG

NO.

37A

37B

38A

38B

39

40

41

42

43A

43B

44A

44B

45

46

47

48

49

50

51

52

53

54

55A

55B

56

57

58

1 1 0 0 0 0 0 0 0 1 1 1 1 1 0 0 1 0 0 0 1 1 0 1 1 0 0 0

2 1 1 0 0 0 1 0 0 1 1 1 0 1 1 0 1 1 0 1 0 1 1 1 1 1 1 0

3 1 1 0 0 0 1 0 0 0 0 1 1 1 1 0 1 0 0 0 1 1 1 1 0 0 1 0

4 1 1 0 0 0 0 0 0 1 1 1 1 1 1 0 1 0 0 0 0 1 1 1 1 0 1 0

5 1 1 1 1 0 1 1 0 1 1 1 1 1 1 1 1 1 1 0 0 1 1 1 1 1 1 1

6 1 1 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 0 0 1 1 0 1 1 0 1 1

7 1 1 1 0 0 1 0 0 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 1 0 1 0

8 1 0 0 0 0 1 0 0 0 0 0 1 1 0 0 1 0 1 0 1 1 1 1 1 0 0 0

9 1 0 0 0 0 1 0 0 0 0 1 1 1 0 0 1 0 1 0 1 1 1 1 1 0 0 0

10 1 1 0 0 0 1 0 0 0 1 1 1 0 1 1 1 0 1 0 0 1 1 1 1 1 1 1


200

NO.

TOTAL SETTING-UP

PREPARING AND ADMINISTERING IV MEDS TOTAL CHANGING IVF

TOTAL DISCONTINUING IVF

TOTAL SKILLS PREPS

INJ PORT

IVF INCORP HEPLOCK SOLUSET

AFTER CARE

GRAND TOTAL

1 10 5 5 5 7 5 2 29 6 5 50

2 11 5 4 2 6 4 2 23 8 9 51

3 8 8 3 4 6 5 1 27 7 6 48

4 11 6 4 5 6 5 1 27 8 6 52

5 13 7 4 0 8 8 2 29 13 10 65

6 9 6 4 6 4 6 2 28 5 7 49

7 12 6 4 0 5 3 0 18 7 8 45

8 9 6 4 4 5 3 1 23 4 7 43

9 9 8 4 3 7 4 1 27 5 7 48

10 7 5 3 3 7 5 2 25 8 9 49


201

RESULTS OF KNOWLEDGE ASSESSMENT

NO. MC 1

MC 2

MC 3

MC 4

MC 5

MC 6

MC 7

MC 8

MC 9

MC 10

MC 11

MC 12

MC 13

MC 14

PS 1

PS 2

PS 3

PS 4

PS 5

1 0 1 1 0 1 0 1 1 1 1 1 0 0 1 1 1 0 1 1

2 1 1 0 1 1 1 1 1 0 1 0 1 1 1 1 1 1 0 1

3 0 1 0 1 1 0 1 1 1 1 0 1 0 1 1 1 1 1 1

4 1 1 1 1 1 1 1 1 1 1 0 0 1 1 1 1 1 1 1

5 1 1 1 1 1 0 1 1 0 1 1 0 1 1 1 1 1 0 1

6 0 1 1 1 1 1 1 1 1 1 0 0 0 1 1 1 1 1 1

7 0 1 0 1 1 0 1 1 1 1 0 0 0 1 1 1 1 1 1

8 1 1 1 1 0 1 1 1 0 1 1 0 1 1 1 1 1 1 0

9 0 0 0 1 0 0 1 1 1 1 1 0 0 1 0 1 1 1 0

10 0 1 1 1 1 0 0 1 1 1 0 1 1 1 1 1 1 0 0

NO. TF 1

TF 2

TF 3

TF 4

TF 5

TF 6

TF 7

TF 8

TF 9

TF 10

TF 11

TOT MC

TOT PS

TOT TF

KNOWLEDGE SCORE PERCENTAGE

1 1 1 1 1 1 1 1 1 1 1 1 9 4 11 24 64.86486486

2 1 1 1 1 0 1 1 1 1 1 0 11 4 9 24 64.86486486

3 1 1 1 1 1 1 1 1 1 1 1 9 5 11 25 67.56756757

4 1 1 1 1 1 1 1 1 1 1 1 12 5 11 28 75.67567568

5 1 1 1 1 1 1 1 0 0 1 0 11 4 8 23 62.16216216

6 1 1 1 1 1 1 1 0 1 0 0 10 5 8 23 62.16216216

7 1 1 1 1 1 1 1 1 1 1 0 8 5 10 23 62.16216216

8 1 1 1 1 1 1 1 1 0 1 0 11 4 9 24 64.86486486

9 1 1 1 1 1 1 1 1 1 1 1 7 3 11 21 56.75675676

10 1 1 1 1 1 1 1 1 1 1 1 10 3 11 24 64.86486486


202

RESULTS OF ATTITUDES SURVEY

SATISFACT. SELF- EDUC PRACTICES MOTIVATION

NO. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

1 5 4 4 4 3 4 5 3 5 4 4 5 4 4 4 5 5 5 5 5

2 5 4 4 4 4 4 4 3 4 4 4 5 5 5 4 4 4 5 4 5

3 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4

4 4 4 3 3 3 4 4 4 4 4 4 4 4 4 5 4 3 5 4 5

5 5 5 5 5 5 5 5 4 5 5 5 5 5 3 4 5 5 5 5 5

6 4 4 4 3 4 5 5 3 4 4 4 4 4 4 5 5 5 5 5 5

7 4 4 4 4 4 4 4 4 4 4 4 3 4 4 4 4 4 4 4 4

8 5 5 5 5 5 5 5 4 5 5 5 4 5 4 5 5 5 5 5 5

9 5 5 5 5 2 5 5 5 5 5 5 5 5 5 4 5 5 5 5 5

10 4 4 3 3 2 4 4 4 4 2 5 4 5 5 4 4 4 4 4 4

SET 1 SET 2 SET 3 SET 4 SET 5 SET 6 SET 7 SET 8 SET 9

NO. A B C D A B C D A B C D A B C D A B C D A B C D A B C D A B C D A B C D

1 3 2 1 4 4 1 3 2 1 2 4 3 2 3 4 1 1 4 3 2 3 2 1 4 3 1 2 4 4 2 1 3 2 1 4 3

2 4 2 1 3 4 1 2 3 1 2 3 4 3 4 2 1 2 1 3 4 4 3 1 2 3 1 2 4 4 3 2 1 2 1 3 4

3 3 2 1 4 2 1 3 4 2 1 4 3 4 2 3 1 1 2 4 3 3 4 2 1 1 3 4 2 3 2 4 1 2 1 3 4

4 3 2 1 4 3 1 2 4 1 3 2 4 3 1 4 2 1 4 3 2 3 2 1 4 3 1 2 4 4 3 2 1 2 1 3 4

5 4 2 1 3 4 1 2 3 2 3 1 4 2 3 4 1 1 2 4 3 3 1 2 4 4 2 1 3 4 1 2 3 2 1 3 4

6 3 2 1 4 4 1 2 3 1 4 3 2 4 3 2 1 2 3 1 4 4 3 2 1 4 3 1 2 4 3 2 1 1 4 2 3

7 4 2 1 3 4 1 3 2 2 4 1 3 2 3 4 1 1 3 2 4 3 4 2 1 4 1 3 2 3 4 2 1 2 1 4 3

8 4 2 1 3 2 1 4 3 1 2 3 4 4 3 2 1 2 3 4 1 2 3 1 4 1 3 4 2 4 1 3 2 2 1 4 3

9 3 2 1 4 3 1 4 2 2 3 4 1 2 3 4 1 1 2 3 4 2 1 4 3 2 3 4 1 3 2 4 1 2 1 4 3

10 4 2 1 3 2 1 3 4 2 1 3 4 4 2 3 1 4 1 3 2 2 3 1 4 2 3 4 1 4 2 1 3 1 2 3 4


203

TOTAL FOR ATTITUDES CONCEPTS

Predominant LS NO. SATISFAC. SELF-

ED. PRAC. MOTIV.

1 20 21 21 25 3

2 21 19 23 22 2

3 20 20 20 20 3

4 17 20 21 21 3

5 25 24 22 25 2

6 19 21 21 25 1

7 20 20 19 20 4

8 25 24 23 25 3

9 22 25 24 25 3

10 16 18 23 20 2


204

Statistical Printout of the Computation of T-test of independent means

Group Statistics

SEX N Mean Std. Deviation Std. Error Mean

K Male 5 23.00000000 1.224744871 .547722558

Female 5 24.80000000 1.923538406 .860232527

S Male 5 48.6000 2.30217 1.02956

Female 5 51.4000 8.26438 3.69594

Independent Samples Test

Levene's Test for

Equality of Variances

t-test for Equality of Means

F Sig. t df Sig. (2-

tailed)

Mean

Difference

Std. Error

Difference

95% Confidence Interval of the

Difference

Lower Upper

K

Equal

variances

assumed

.751 .411 -1.765 8 .116 -1.800000000 1.019803903 -4.151672017 .551672017

Equal

variances not

assumed

-1.765 6.785 .122 -1.800000000 1.019803903 -4.226996672 .626996672

S

Equal

variances

assumed

2.690 .140 -.730 8 .486 -2.80000 3.83667 -11.64737 6.04737

Equal

variances not

assumed

-.730 4.617 .501 -2.80000 3.83667 -12.91364 7.31364


205

Statistical Printout of the Computation of T-test of paired means

Paired Samples Test

Paired Differences t df Sig.

(2-tailed) Mean Std.

Deviation

Std. Error

Mean

95% Confidence Interval

of the Difference

Lower Upper

Sophomore year &

Senior year 24.19600 5.85637 1.85195 20.00661 28.38539 13.065 9 .000

Paired Samples Statistics

Mean N Std. Deviation Std. Error Mean

Sophomore year

Senior year

74.1960 10 2.83693 .89712

50.0000 10 5.90668 1.86786


206

APPENDIX IX

Transcription of Focused Group Discussion


207

Transcription of Focus Group Discussion

Moderator: Magandang araw po. Mga 3rd year students po kami na nagsasagawa ng research

about skill retention and levels of knowledge and attitude on intravenous therapy among senior

nursing students. Thank you po sa pag-accept nyo sa aming invitation para maging bahagi

nitong focused group discussion. Simulan ko na pong magtanong. Ano po yung general

impression nyo or assessment sa instruction/teaching style na employed dito sa UPCN

regarding IV therapy?

Student 1: Detailed at organized..kasi may checklist pang sinusundan. Kailangan every step,

magagawa mo kasi kung hindi, magfefail ka.

Student 2: May differences kasi talaga yung ideal tsaka yung actual na pag nandun ka na sa

area..na minsan masyadong mahaba yung checklist. Hindi mo na din nasusunod lahat-lahat.

Student 3: Pero ayun nga, yung sa teaching naman mismo, okay sya. Kasi ayun nga, diba may

guide nga. Tapos may return demo pa. Tapos per station, may mga CI dun na nagbabantay.

Pag kulang pa yung ginawa mo, papaulitin ka pa.

Student 2: May exams pa na practical talaga.

Student 4: Sa clinical rotation pa, nasusupervise nila.

Moderator: Ano po yung mga methods na ginamit sa pagtuturo ng IV therapy?

Student 2: Lecture, demo at return demo, actual.

Moderator: Lahat po ba kayo nakapag-IV insertion?

Student 3: Tinry.

Student 2: Kay Ma’am Batalla. Lahat kasi ng dumaan sa kanya, nagpapasession talaga sya.

Moderator: Sa tingin nyo po effective yung ganun na style?

Student 1: Oo. Kasi iba talaga yung sa dummy na sa malutong nyang balat. Tapos dun talaga

sa tao..iba talaga yung feeling.

Student 2: Tsaka iba yung naexperience mo sya before mo gawin sa area. Less yung anxiety

mo na baka magkamali ka.


208

Student 3: Tsaka iba yung ginagawa nya sayo. Para alam mo rin yung feeling na kapag

kinakabitan ka.

Moderator: Dun po sa pagtuturo, natry rin po ba yung videos?

Student 1: Yes..lagi naman may videos.

Student 2: Though hindi sa lahat ng concepts.

Student 3: Ako nagsearch ako before.

Student 2: Oo. Kasi sa N11, pag hindi mo masyadong gets, magsearch ka nalang ng videos.

Student 4: Yung ibang procedures, oo. Pero sa IV therapy parang wala akong maalala.

Student 2: Sa insertion, alam ko meron.

Moderator: Diba may practical exam rin po sa lab..sa IV skills? So lahat po ba nagawa nyo ng

maayos? Or meron po bang kinakabahan? Aside dun sa anxiety sa exam mismo.

Student 2: Feeling ko yun naman talaga eh.. kasi yung anxiety sa exams coming from yung fact

na binabantayan ka at ginegradean ka habang ginagawa mo. Pero kasi iba yung anxiety na

ginagawa mo lang sya sa dummy at sa ginagawa mo sya sa actual na tao.

Student 3: Siguro kasi parang ang rigid dun ng practical kasi step by step talaga nung time na

yun. Napaka-ideal.

Moderator: Sa tingin nyo po ba yung ideal, dapat na nating palitan?

Student 3: Hindi naman. Kasi as much as possible, yun yung sundin nyo..ideal talaga.

Student 2: Actually maganda..natuturo muna sayo yung ideal tapos mag-aadjust ka nalang pag

nasa area ka. Hindi ibig sabihin na hindi mo na gagawin yung ideal pero as much as possible,

alam mo rin.

Moderator: So sa tingin nyo po, itong methods and practive, sapat naman para matutunan nyo

yung IV therapy skills?

Students: Yes.

Moderator: Meron po ba kayong recommendations?


209

Student 2: In terms of kasi sa lecture, okay na talaga. Nasasayo nalang din sa area kung

hihingin mo sa CI mo na bigyan ka ng experience na ganun.

Student 3: Samin kasi may mga wards na maraming opportunities na mag-IV insertions. Sa iba

naman, wala masyado.

Student 2: Tapos kunwari wala sa patient mo, pwede ka naman magrequest.

Student 4: Pag may ganung opportunity, kukunin mo lang sya.

Student 3: Or ako, tulad ko..nag iinsist talaga ako na ako yung mag-iinsert. Yung sa iba, meron

silang mga nurse na pinagtatry talaga. Kaya mas nagiging tested din sila.

Student 2: Minsan kasi, takot ka. Pero minsan sa dami ng ginagawa, kunwari sa ER, ibibigay

sayo pero tutulungan ka rin naman nila.

Moderator: May feedback po bang binibigay sa inyo yung mga prof?

Student 4: Usually. Kasi kailangan mo malaman kung ano yung parati mong nagagawa at hindi,

kung saan ka pa kailangan mag-improve. Para next time na kaharap mo yung patient mismo,

alam mo na yung dapat tsaka hindi dapat gawin.

Moderator: Sa clinical setting naman, meron pa rin bang feedback? Kunwari nagkamali ka.

Student 3: Kasi pag yung first time mo sa actual patient, sasamahan ka. So after ng paggawa

ng procedure, magcocomment sya sayo.Kakausapin ka nya.

Student 1: Minsan before ka magkamali, pipigilan ka na nya.

Student 2: Basta kung first time mo, sabihin mo talaga.

Student 4: Kasi kailangan supervised..tsaka ma-ensure yung patient safety.

Moderator: Paano po nakakatulong yung pag-feedback nila sa inyo?

Student 3: Kasi malalaman mo talaga kung saan ka nagkamali, kung saan ka nagkulang.

Student: Parang bukod sa sariling perception mo kung ano yung mali mo, meron pang ibang tao

na magsasabi sayo.

Moderator: Comments? Suggestions?Sa tingin nyo po ba na-retain nyo yung mga natutunan

nyo nung N11?


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Student 3: Kasi kailangan mo talaga gawin yun kaya aaralin mo ulit.

Student 1: Expected sayo na ma-retain mo talaga.

Student 2: Kasi sa dami ng clinical experience namin..

Moderator: Sa tingin nyo po ano yung mga factors na nakaka-affect dun sa pagretain nyo ng IV

skills?

Student 1: Frequency.

Student 4: Exposure.

Student 2: Sa pagtuturo, sa tingin ko. Kasi si Ma’am Batalla pinapagawa nya talaga yung

insertion. Maganda kasi parang kasama na talaga sya sa practice mo. So maganda kung isama

talaga nila yun earlier. Parang ang useful nya kung 3rd year palang meron na.

Student 1: Yung sa teaching style nila, more on sa pano sila magfeedback..na hindi sya

degrading or destructive criticism. Kumbaga, sana constructive sya in a way na mamomotivate

ka na ayusin sya at hindi matakot na gawin. Kasi dun sa kung pano nila nadedeliver yung

teaching pati dun sa quality ng tinuturo nila, okay naman.

Student 3: Yun nga..yung sa sarili mo rin kasi kung willing ka din na magvolunteer ng

magvolunteer.

Student 1: Yung initiative mo for professional growth.

Student 2: Dun sa IV therapy preparation, usually kasi dun nagkakaroon ng errors pag bago pa.

Feeling ko kasi wala kami gaanong practice dun.

Student 3: Yung sa IV meds, sa ideal kasi..sa PGH, walang soluset, ganun.

Student 4: Maganda rin kasi siguro kung, kunwari ideal IV administration..Diba usually pag

antibiotic, soluset. Maganda rin sana kung maging aware din yung mga students kung pano

mag troubleshoot. Paano mo sya maaadminister ng hindi IV push.

Student 2: Kasi yung troubleshooting, yun yung hindi masyadong naturo samin. Sa ward

nalang. Kailangan mo talaga gawan ng paraan.

Student 1: Minsan yung tinuturo dito, bawal mo sya gawin. Pero pagdating sa PGH, kailangan

mo na syang gawin. Katulad nung pagkink ng tubing. Kasi minsan may konting plug,


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hindiinaadvise na magpush ka. Pero yung nurses, makikita mo na kinkink nila yung line para

kahit papano mapush ng konti kaysa naman tanggalin mo tapos mag-iinsert ka ulit ng iba.

Student 2: Ako may experience na feeling ko hindi naturo satin. Yung IV line nya, yung IB

tubing..hino-hook lang. Nagleleak sya so ang kailangan mo gawin, palitan sya. Kasi kailangan

mo talaga isipin kung anong gagawin. Kung hindi, magbabackflow yung blood. Hindi naturo

satin yung mga ganung klaseng troubleshooting.

Student 4: Ang unang mangyayari sayo, magpapanic ka kasi madedelay yung meds. So

nadadagdagan pa yung medication errors.

Student 1: Ngayon din naexperience ko sa ward na may ibang klase ng soluset na first time ko

na-encounter. So yun siguro kakulangan na rin. Kasi nga kulang tayo sa funds, hindi napapakita

lahat nung advanced na klase ng tubings.

Student 2: Yun actually yung maganda..yung maintroduce yung mga bagong types kasi hindi

nga available sa PGH.

Student 1: What if you work sa other hospitals. Magaling ka magcompromise pero hindi ka

magaling gumamit ng advanced na gamit.

Moderator: Sa calculation naman po?

Student 2: Every exam naman ata, meron na. Pag matagal na, magegets mo na.

Moderator: May mga gusto pa po ba kayong idagdag?

Student 1: Wala naman na ata. Kayo ba?

Student 3: Wala na..

Moderator: Ayun lang naman po. Thank you po ulit sa pagparticipate sa focus group discussion

namin.

IV Therapy

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