Hospital-Acquired Venous Thromboembolism as a Nursing Issue

Introduction

One of the significant health concerns healthcare facilities are yet to solve is hospital-acquired venous thromboembolism (HA-VTE). It has been estimated that approximately 70% of surgical and 50% of medical patients are affected (Assareh, Chen, Ou, Hillman, & Flabouris, 2016). This negative trend is associated with adverse patient outcomes, patient dissatisfaction, financial losses for healthcare units and patients, and other issues. Assareh et al. (2016) also note that VTE accounts for approximately 10% of hospital deaths, which makes it clear that urgent measures should be undertaken to solve the problem. It is acknowledged that the health condition under analysis is preventable, which makes healthcare practitioners pay specific attention to VTE prophylaxis. Recent research suggests that patients and nursing staff have certain knowledge regarding VTE and its prevention (Al-Mugheed & Bayraktar, 2018). However, it is also evident that nurses’ knowledge is characterized by various gaps that lead to a high incidence of HA-VTE. At the same time, patients’ insufficient awareness of the risk factors and prophylaxis results in their low adherence to the recommendations they receive.

The PICOT question guiding the present project is as follows: Can a one-month educational intervention provided to nurses, as compared to no training, lead to the reduction of the rate of HA-VTE in patients during a period of six months? This PICOT question is aimed at the existing gap in nurses’ knowledge and improving patient outcomes. The development of an effective intervention is based on the analysis of recent research on the matter. This paper includes a brief review of several studies that are closely linked to the PICOT question and aimed at addressing a serious gap in nursing practice.

Background and the Nursing Practice Problem

The scholarly articles under consideration dwell upon the awareness of patients and nurses of HA-VTE and its prevention, as well as their attitudes towards the matter. This information is necessary for the development of an efficient intervention program. The data provide insights into the most relevant aspects that need to be covered and training methods that can be employed to increase the adherence to the provided guidelines.

The knowledge of nursing professionals and patients have been in researchers’ lenses for a decade. For instance, Apenteng et al. (2016) examined patients’ perspectives regarding the disorder and existing prevention techniques and pointed at insufficient people’s knowledge on the matter and the lack of compliance with the provided prophylaxes procedures. Popoola et al. (2016) implemented quantitative research and examined patients’ preferences concerning a VTE educational intervention. Litchfield et al. (2016) identified certain gaps in nurses’ knowledge regarding VTE and its prevention that were associated with some demographic peculiarities of nursing practitioners. It is suggested that intervention programs should address the areas that are related to the understanding of the disorder, its prophylaxis, and training effective communication skills.

As far as the knowledge of nurses is concerned, Al-Mugheed and Bayraktar (2018) identified certain relation between nursing professionals’ descriptive characteristics and their awareness of VTE and its prophylaxis. This information can help in adjusting training programs to the peculiarities of the medical staff. An important addition to this information is the findings of Apenteng et al. (2016) who examined nurses’ perceptions of the role they play in HA-VTE incidence and prevention. These quantitative studies can be instrumental in advancing nursing practice by addressing the identified problem as the findings are generalizable and can be used to develop a training program for nurses. Qualitative data also provides important insights and broaden the scope of topics to be discussed and trained during nurses’ training sessions.

It is noteworthy that almost all of the peer-reviewed articles under analysis do not include research questions. Scholars outline the aims and the purpose of their studies, so it is possible to understand the research questions they attempted to address. Only Al-Mugheed and Bayraktar (2018) formulate three research questions:

  1. What is the current level of nurses’ knowledge concerning VTE, associated risk factors, and prophylaxis?
  2. What VTE-related procedures and practices do nursing professional use on a daily basis?
  3. What is the link between nursing practitioners’ demographic characteristics and the VTE-related procedures they utilize?

The provision of clearly established research questions could improve the articles. LoBiondo-Wood and Haber stress that the development of clear research questions facilitates the research process as authors can remain focused. The inclusion of such questions in the articles would help readers to identify the exact outcomes of the studies and evaluate the relevance of the methods the scholars employed. The research by Al-Mugheed and Bayraktar is an illustration of the benefits of the provision of research questions as each of the question represents a set of findings the researchers report.

Methods

The studies in question are characterized by the use of sound methodology, which makes the findings relevant and valuable. Surveys were employed as major data collection tools in quantitative studies implemented by Popoola et al. and Al-Mugheed and Bayraktar. These instruments ensure the coverage of a considerable sample, but the depth of the research is rather limited due to the focus on a set of closed-ended questions or scales. Nevertheless, surveys are regarded as valid tools that enable researchers to obtain generalizable data (LoBiondo-Wood & Haber, 2018). Qualitative studies conducted by Apenteng et al.  and Litchfield et al. were based on the utilization of interviews as the primary data collection method. This tool is instrumental in gaining in-depth insights into the issue. It is noteworthy that convenience sampling was a similar feature in all the studies under analysis. This sampling method is often regarded as the one associated with bias or the lack of generalizability. However, it is relevant for the research on people’s perceptions regarding VTE and its prevention as knowledgeable people were involved and shared their views.

Results

The results of the studies under consideration indicate that an effective nurse training intervention addressing the existing gaps and ensuring the development of the skills necessary to provide proper patient education on VTE is needed. Apenteng et al.  state that although patients have the information regarding the risk of development of VTE, they do not fully understand possible outcomes, which leads to their low compliance with given guidelines. Patients are also poorly informed about the peculiarities and benefits of non-pharmacological prophylaxis of the disorder.

Popoola et al. explored patients’ preferences concerning some aspects of an intervention and claimed that patients wanted to be taught on the specifics of VTE, its symptoms, risk factors, and prevention. It was found that patients preferred doctor-patient interaction and were willing to receive additional materials on the areas mentioned above. The analysis of the two articles suggests that patients lack knowledge on certain topics, but they are also interested in receiving more information on these areas. These topics should be covered in an educational intervention for nurses, as it is essential to ensure that nursing professionals have the necessary knowledge to pass it to patients.

The need to include these aspects in nurse training is also evident after the review of the findings of the other two articles under analysis. Al-Mugheed and Bayraktar state that although nurses have general knowledge on VTE and the processes that take place in a human body, practitioners have a limited understanding of risk factors, prophylaxis, and associated procedures. Litchfield et al.  provide helpful insights into the gaps in nurses’ knowledge and skills necessary for improving patient outcomes associated with VTE prevention. The researchers argue that nursing professionals do not understand the role nurses can and should play in VTE prophylaxis (Litchfield et al., 2016). It is also found that nurses need to improve their communication skills to increase patients’ adherence to recommendations regarding VTE prophylaxis. Therefore, it is clear that apart from raising nurses’ awareness of VTE prophylaxis and risk factors, nursing practitioners need training to improve their communication and leadership skills. Nurses should take up the responsibility associated with educating patients on VTE and motivating them to adhere to the provided recommendations.

The findings reported by Al-Mugheed and Bayraktar can contribute to the development of an effective training program for nurses. The researchers found that nurses with a Bachelor’s degree or higher and those who have working experience of 6-10 years are more knowledgeable as compared to less experienced peers. The former group also use more diverse practices to ensure the best patient outcomes. Hence, it is possible to conclude that new nurses and those who do not have a degree need more training.

Ethical Considerations

The studies in question were implemented in accordance with ethical standards, and the corresponding approvals were received. For example, Apenteng et al. (2016) obtained the approval of the Oxfordshire REC B Research Ethics Committee. Al-Mugheed and Bayraktar (2018) gained the approval of the ethics committee of the Near East University. Litchfield et al. (2016) received approval from the National Research Ethics Service. The researchers noted that they followed the existing standards of data management and ensured the confidentiality of participants’ information. The scholars also note that participants provided written consent that is necessary when involving humans in research.

Conclusion

On balance, it is necessary to state that HA-VTE has become a substantial burden associated with financial losses and adverse patient outcomes. Research shows that patients tend to be informed about the risk of the development of VTE and prevention measures but display low compliance with the given recommendations. It has also been found that nurses have gaps regarding the health care issues and its prevention, which is specifically the case with practitioners having no degree and limited working experience. Researchers note that patients would prefer receiving information concerning VTE and its prophylaxis. It is also clear that nurses need training to improve their communication and leadership skills. The reviewed articles can serve as the background of the development of a nurse training program aimed at decreasing the incidence rate of HA-VTE. The articles provide quantitative and qualitative data that shed light on different facets of the issue, which can be instrumental in developing training sessions for nursing professionals.

References

Al-Mugheed, K. A., & Bayraktar, N. (2018). Knowledge and practices of nurses on deep vein thrombosis risks and prophylaxis: A descriptive cross-sectional study. Journal of Vascular Nursing, 36(2), 71-80. doi:10.1016/j.jvn.2018.02.001

Apenteng, P. N., Fitzmaurice, D., Litchfield, I., Harrison, S., Heneghan, C., Ward, A., & Greenfield, S. (2016). Patients’ perceptions and experiences of the prevention of hospital-acquired thrombosis: A qualitative study. BMJ Open, 6(12), 1-7. doi:10.1136/bmjopen-2016-013839

Assareh, H., Chen, J., Ou, L., Hillman, K., & Flabouris, A. (2016). Incidences and variations of hospital acquired venous thromboembolism in Australian hospitals: a population-based study. BMC Health Services Research, 16(1). doi: 10.1186/s12913-016-1766-y

Litchfield, I., Fitzmaurice, D., Apenteng, P., Harrison, S., Heneghan, C., Ward, A., & Greenfield, S. (2016). Prevention of hospital-acquired thrombosis from a primary care perspective: A qualitative study. British Journal of General Practice, 66(649), e593-e602. doi:10.3399/bjgp16x685693

LoBiondo-Wood, G., & Haber, J. (2018). Nonexperimental designs. In G. LoBiondo-Wood & J. Haber (Eds.), Nursing research: Methods and critical appraisal for evidence-based practice (pp. 180-198). St. Louis, MO: Elsevier Health Sciences.

Popoola, V. O., Lau, B. D., Shihab, H. M., Farrow, N. E., Shaffer, D. L., Hobson, D. B., … Haut, E. R. (2016). Patient preferences for receiving education on venous thromboembolism prevention – a survey of stakeholder organizations. PLOS ONE, 11(3), 1-10. doi:10.1371/journal.pone.0152084