What are the factors that influence the blood sampling practices of critical care nurses?
This report reflects on a period of study duration of second-year Masters in Science in Advanced Practice in Health and Social Care (Nursing) at City, University of London. This period has completed all the taught modules of the MSc degree before proceeding to the dissertation module, which has commenced last October 2016.
The Introduction to Research Methods and Applied Data Analysis was successfully completed last December 2015. The main aim of this module was to develop a thorough understanding of the principles, theory and epistemology of research and data analysis methods. The following learning outcomes were as follows:
- To demonstrate in-depth knowledge of methodological theory in Health Service Research.
- To demonstrate confidence in formulating research questions in qualitative and quantitative research projects.
- To recognise and critically appraise the elements of the research process and apply this writing a pragmatic research proposal.
- To critically assess association of variables and interventions by using quantitative and qualitative research methods.
- To critically synthesise data from quantitative and qualitative analysis.
- To competently disseminate research plans verbally and in writing.
The Pathophysiological Principles for Advanced Practice module was one of two core elective modules, which aimed to demonstrate a firm appreciation of underlying pathological processes. Through the generosity of the Florence Nightingale Foundation and NHS Professionals Ltd, this module has been well completed last May 2016.
This module covered the following topics namely: Genetics, Nutrition, Physiology of Aging, Cancer and Cell Regulation, Immunity, Homeostasis, Infection, Disorders of Neural Function, Thyroid, Heart, Lung, Kidneys and Diabetes. It offered an insight into the research process and how knowledge can be derived and applied. It allowed to approach complex issues systematically and make informed judgments using evidence-based knowledge, which can be communicated and implemented in clinical practice.
This report provides an updated progress on the research proposal development for the study entitled “What are the factors that influence the blood sampling practices of critical care nurses?” The research proposal development is still in progress. Once, it has been completed and approved by the university’s supervisor, all ethical permissions and approvals will be sought by January 2017.
The aim of this study is to identify the factors that influence the blood sampling practices of critical care nurses. The specific objectives will be the following:
- To describe current blood sampling practices in a single centre adult critical care unit
- To quantify the incidence of anaemia and RBC transfusion in critically ill patients.
- To assess if there is an association between blood sampling practices and nurse’s work experience.
- To assess if there is an association between blood sampling practices and nurse’s educational level.
- To identify current practice guidelines regarding blood sampling among critical care nurses.
This will be a cross-sectional, descriptive study that will be conducted over two weeks in May 2017 in a single centre adult medical-surgical Critical Care Unit in a tertiary care hospital in London. It will examine the blood sampling practices of critical care nurses.
Anaemia is common in critically ill patients admitted to the Intensive Care Unit (Corwin et al, 2004; Fowler and Berenson, 2003; Vincent et al, 2002). The aetiology of anaemia may be due to a single factor such a nutritional deficiency or its cause may be multifactorial. Its severity is influenced by one or more of the following events: frequent phlebotomy, sepsis, gastrointestinal bleeding, coagulation disorders, blood loss from vascular procedures, renal failure, nutritional deficiencies, bone marrow suppression and impaired erythropoietin response (McEnvoy and Shander, 2013; Harber et al, 2006).
Blood samples from critically ill patients are routinely collected via arterial and central venous access devices, by peripheral venepuncture or heal/finder prick (Macisaac et al, 2003). Several studies examined the magnitude of blood loss associated with routine phlebotomy indicate typical daily blood loss of approximately 41.1 mL and 377 mL per day (Barie, 2004; Fowler and Berenson, 2003; Vincent et al, 2002).
A primary treatment of anaemia in the critically ill has been red blood cell (RBC) transfusions. The decision to transfuse is usually based on patient factors such as volume status, acuteness of anaemia, severity of symptoms, age, and presence of comorbid conditions, and particularly cardiovascular disease (Sherk et al, 2000). Allogeneic RBC transfusion is associated with infectious risks include possible viral, bacterial, parasitic or prion transmission. In addition, packed RBC transfusions are associated with significant financial costs, worse clinical outcomes and transfusion errors (Kleinman, 2003). The cost of the first unit of blood transfusion is £170 and £162 for subsequent units according the National Institute for Health and Care Excellence (NICE, 2015) guidelines.
Several studies (Leslie et al, 2013; Chant et al, 2006; O’Hare and Chilvers, 2001) investigated the phlebotomy and arterial blood sampling practices in Intensive Care Unit (ICU). Monitoring of blood flow, acid-base status, oxygen transport, coagulation visceral organ function and the development of health-care associated infection are few of the many reasons for diagnostic blood testing (Barie, 2004).
A few nurse-led studies (Ullman et al, 2015; Andrews and Waterman, 2008, Andrews et al, 1999) examined the blood sampling practices in critical care which determined the need for nurses to make clinical decisions in regards to blood sample collection. There must be a balance between therapeutic surveillance, routine and clinical need (Andrews et al, 1999). In the recent study of Ullman et al (2015); have described the current blood sampling practice in adult, paediatric and neonatal ICUs in Australia. They have included the reason for blood sampling however rationale for an arterial blood gas (ABG) to be collected (i.e. change of ventilation settings, oxygen saturation (Sa02%), electrolytes, and haemoglobin status) was not included.
The scholar’s interest is the development of critical care nurse’s educational and professional development particularly, the decision-making skills in blood sampling collection in critically ill patients. Should the primary aim be identified in this research project, it will be the scholar’s responsibility as a researcher to help ICU teams and management examine current practice and provide evidence to drive nurses’ decision making processes. Integration of best research evidence with clinical expertise should be combined with understanding the patient’s value and needs to deliver safe, quality and cost-effective health care in the 21st century.
Further information about the research project will be available on completion of the study.