Description
Hello! For this assignment, a poster is needed to be created based on two articles that I will provide. I will also be providing an EXAMPLE poster so that you can more or less use it as a reference and I will also post the instructions that I was provided below. If you have any questions, please feel free to reach out at any time, and thank you so much 🙂 !!! “This week, you will be using your two approved sources to complete your EBP project poster.Your poster should include:Explanation of the nursing issue significance with three statementsDescription of your position on the issue and three statements on how a nurse can impact this issueInclude only the two approved journal sources used in your Week 6 appraisals to support your position.After you submit your poster, you will be automatically assigned one peer review. You will review one of your classmate’s posters using the grading rubric. Please fill out the rubric and provide substantive feedback on your classmate’s poster.”
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NURS 350
Title
DESCRIPTION OF THE
ISSUE
NAME
In this section, you will discuss the issue.
This is a good place to get information
from your initial Week 3 paper where you
described the background and the
importance to nursing (APA citation).
Make 1-2 sentences about the background
and then the significance in bullet points
SIGNIFICANCE TO NURSING
•
•
•
Most newly graduated nurses will
join the workforce through a Nurse
Residency Program (APA citation)
Nurse Residency Programs focus
on evidence-based practice (APA
Citation)
Newly graduated nurses will need to
present evidence-based practice in
poster format (APA citation)
POSITION STATEMENT
DON’T USE “I” STATEMENTS, JUST
GIVE A SCHOLARLY EXPLANATION:
NEWLY GRADUATED NURSES
NEED TO BE ABLE TO USE AND
PRESENT EVIDENCE-BASED
PRACTICE TO CARE FOR PATIENTS
IN THE CURRENT HEALTHCARE
ENVIRONMENT
YOU CAN ADD A DESIGN OR CLIPART
BELOW. REMEMBER THAT YOU NEVER
TAKE IMAGES FROM A SOURCE WITHOUT
PERMISSION– ONLY APPROPRIATE
CLIPART
YOU CAN ADD A DESIGN OR CLIPART
HERE. REMEMBER THAT YOU NEVER
TAKE IMAGES FROM A SOURCE WITHOUT
PERMISSION– ONLY APPROPRIATE
CLIPART
How Nurses Can
Impact this Issue
• Make three bullet points
here from the
information you learned
from only the two
articles you used in
Week 6 Appraisals
• Be sure to cite the
source for each
intervention
• Make it scholarly – what
does the evidence say?
References
PUT YOUR REFERENCES HERE – TWO
ARTICLES FROM WEEK 6- IN APA
FORMAT
Received: 8 August 2022
| Revised: 29 May 2023 | Accepted: 5 June 2023
DOI: 10.1002/nop2.1914
S Y S T E M AT I C R E V I E W
Knowledge, risk assessment, practices, self-efficacy, attitudes,
and behaviour’s towards venous thromboembolism among
nurses: A systematic review
Khalid Al-Mugheed1
| Nurhan Bayraktar2
1
Adult Health Nursing, College of Nursing,
Riyadh Elm University, Riyadh, Saudi
Arabia
2
Nursing Department, School of Health
Sciences, Atılım University, Golbasi,
Ankara, Turkey
Correspondence
Khalid Al-Mugheed, Adult Health Nursing,
College of Nursing, Riyadh Elm University,
Riyadh, 12734, Saudi Arabia.
Email: [email protected]
Abstract
Aim: This study reviewed the literature on nurses’ knowledge, risk assessment practices, self-
efficacy, attitudes, and behaviours towards venous thromboembolism
(VTE).
Design: A systematic review following PRISMA guidelines.
Methods: CINAHL (via EBSCO), MEDLINE (via PubMed), and Web of Science were
electronic databases used to find studies published from 2010 to November 2020 in
English language. A Hoy critical appraisal checklist was used to assess the risk of bias
and methodologic quality.
Results: This study included fourteen studies conducted on 8628 Registered Nurses.
Nine of the fourteen studies examined nurses’ general knowledge level regarding VTE,
and five showed that most nurses had a good knowledge of VTE. Of the 14 studies,
six assessed nurses’ risk assessment knowledge regarding VTE, and three showed that
nurses had low knowledge of VTE risk assessment. Eleven studies assessed nurses’
practices concerning VTE prophylaxis; 5 of the 11 studies reported that nurses had
poor and unsatisfactory levels of VTE practice. Three of the 14 studies showed that
nurses had low self-efficacy and varied beliefs. The most frequent recommendations
were to create continuous educational programs and in-service training programs
(n = 11), followed by creating institutional protocols standardizing VTE (n = 6).
Conclusions: Comprehensive educational programs and campaigns based on well-
established and standardized tools should be provided to nurses to improve their VTE
knowledge.
KEYWORDS
attitudes, behaviours, knowledge, practices, risk assessment, self-efficacy, venous
thromboembolism
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium,
provided the original work is properly cited.
© 2023 The Authors. Nursing Open published by John Wiley & Sons Ltd.
Nursing Open. 2023;10:6033–6044.
wileyonlinelibrary.com/journal/nop2
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6034
1
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AL-MUGHEED and BAYRAKTAR
I NTRO D U C TI O N
educated patients (Lavall & Costello, 2015). Implementing quality
nursing care is vital to drive improvements in patients’ clinical out-
Thromboembolic diseases have become a primary cause of death,
comes, nursing practice changes, and patient safety (Al-Mugheed
responsible for 1 in 4 deaths globally (Wendelboe & Raskob, 2016).
& Bayraktar, 2020; Al-Mugheed, Bani-Issa, Rababa, et al., 2022;
Venous thromboembolism (VTE) is one of these diseases and in-
Al-Mugheed, Bayraktar, Al-Bsheish, et al., 2022; Al-Mugheed,
cludes deep vein thrombosis (DVT) and pulmonary embolism
Bayraktar, Nashwan, et al., 2022).
(PE; Centers for Disease Control and Prevention, 2016; Di Nisio
Inadequate knowledge and practice are the causes most associ-
et al., 2016). VTE has been acknowledged as the main complication
ated with increased VTE prevalence worldwide (Silva et al., 2020).
among medical and surgical patients and is also known as the ‘silent
Several studies revealed inadequate knowledge of deep vein
killer’ of hospitalized patients (CDC, 2016).
thrombosis risks and poor practices concerning the preven-
The population-based estimates for thrombotic conditions are
tion of deep vein thrombosis (Ahmed et al., 2020; Al-Mugheed &
limited in many countries, especially those categorized as devel-
Bayraktar, 2018). Studies have also indicated that low self-efficacy
oping (Wendelboe & Raskob, 2016). A global study was conducted
and behaviours contribute to improving the quality of VTE patient
to explain the epidemiology of thromboembolic diseases, which
care (Silva et al., 2020; Yan et al., 2020). Increasing the knowledge
reported that the total incidence of these diseases has decreased
and improving the practices on VTE risks and prevention to avoid
in developed countries but is still rising in developing countries
complications are necessary; they may also help improve awareness
(Wendelboe & Raskob, 2016). In developed countries, VTE still
and prevent this essential public health problem. However, this is
significantly contributes to increased mortality and morbidity. For
the first systematic review examining relevant studies of nurses’
example, estimates suggest 60,000–100,000 Americans die from
knowledge, risk assessment, practices, self-efficacy, attitudes, and
thromboembolic conditions (CDC, 2016). In developing countries in
behaviours towards VTE prophylaxis. This review may help establish
Asia, the situation is not reassuring. A study has shown that, despite
appropriate nursing education and management strategies for VTE
the common belief that VTE is less common in Asian countries than
prevention and management.
in Western countries, the incidence rate of DVT in Asia was between
3% and 28% (Gerotziafas et al., 2018).
Venous thromboembolism can cause life-threatening complications, prolonged hospitalization, and increased care costs (Dawoud
et al., 2018; Lovely et al., 2020). According to the Centers for Disease
2
|
M E TH O D S
2.1 | Eligibility criteria
Control (CDC), DVT increases the possibility of post-
thrombotic
syndrome and PE, which affect an estimated 50% of DVT cases
The literature search for this systematic review was adopted based
(CDC, 2016). In the United States, the monthly cost of treatment
on the Preferred Reporting Items for Systematic Reviews and Meta-
for DVT is an estimated $700 to $1400, and non-pharmacological
Analyses checklist (PRISMA) guidelines. The inclusion criteria were:
prophylaxis is estimated to cost $465 to $875 per patient (Dawoud
et al., 2018).
• Studies using the cross-sectional design, randomized controlled
Although VTE is a potentially life-threatening condition, it is pre-
trial or quasi-experimental study design, and pre-post-test design;
ventable (Khalafallah et al., 2016; Xu et al., 2018). Several organiza-
• Studies examining knowledge, risk assessment, practices, self-
tions have developed VTE prevention guidelines to decrease VTE
efficacy, attitudes, and behaviours towards VTE prophylaxis;
mortality and enhance prevention. The primary pharmacological
• Studies conducted on nurses; and
and non-
pharmacological preventive practices recommended in
• Studies using self-reports or observation methods for data
these guidelines are graduated compression stockings, intermittent
collection.
pneumatic compression, and anticoagulation therapy (CDC, 2016;
National Institute for Health and Care Excellence, 2018). Recently,
The exclusion criteria from this review were the following:
the Centers for Disease Control and Prevention has developed three
main strategies to promote VTE: strengthening monitoring, best
• Studies that combined nurses and other health care providers;
practices, and increased education about VTE (CDC, 2016).
• Studies published as a short report or review studies;
Nurses have essential roles in preventive measures (Al-Mugheed,
Bani-Issa, Rababa, et al., 2022; Al-Mugheed, Bayraktar, Al-Bsheish,
et al., 2022; Al-Mugheed, Bayraktar, Nashwan, et al., 2022).
• Studies with low quality, such as conference proceedings, dissertations, and theses; and
• Studies non English language.
Appropriate prophylaxis is the more effective way to decrease
prolonged hospitalizations, medical costs, and VTE (Al-Mugheed
& Bayraktar, 2018; Xu et al., 2018). A Canadian study showed
2.2 | Search strategy
that nurses were the most suitable healthcare providers to assess
DVT prophylaxis daily (Lloyd et al., 2012). Another study showed
Two independent researchers executed literature searches based on
that DVT’s morbidity and mortality rates decreased after nurse’s
the consultation of a specialist health sciences librarian in advanced
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AL-MUGHEED and BAYRAKTAR
literature search techniques. CINAHL (via EBSCO), MEDLINE (via
et al., 2016; Gaston & White, 2013; Lau et al., 2017; Lee et al., 2014;
PubMed), and Web of Science were electronic databases used to
Ma et al., 2018; Oh et al., 2016; Silva et al., 2020; Songwathana
find the studies published from 2010 to November 2020. The Web
et al., 2011; Walker et al., 2010; Yan et al., 2020). Seven studies
of Science search strategy was initially adapted to match other iden-
used self-reports (Amira et al., 2018; Antony et al., 2016; Gaston
tified electronic databases. Keywords listed in Table 1 were com-
& White, 2013; Lee et al., 2014; Ma et al., 2018; Oh et al., 2016;
bined with Boolean operators, including AND, OR.
Songwathana et al., 2011). Most studies used convenience sampling
and a cross-sectional, descriptive design, see Table 1.
2.3 | Selection of studies and data extraction
3.2 | Nurses’ general knowledge of VTE
Two independent researchers inspected abstracts and titles; then,
the full text was reviewed regarding eligibility criteria. If the text
Except for five studies (Amira et al., 2018; Elder et al., 2016; Gaston
matched, it was coded as ‘include’. Disagreements regarding the
& White, 2013; Songwathana et al., 2011; Walker et al., 2010), all
study’s inclusion were resolved between study authors by consen-
others examined nurses’ general knowledge level regarding VTE.
sus. Studies with appropriate data were included in the system-
The level of knowledge in most studies was classified as good, high,
atic review. The required data included study characteristics (year
average, and satisfactory (Al-Mugheed & Bayraktar, 2018; Antony
of publication, data collection method, participants, and sampling
et al., 2016; Lee et al., 2014; Ma et al., 2018; Silva et al., 2020).
method), level of knowledge, risk assessment, attitudes, behaviours,
The remaining studies characterized the level of knowledge as un-
self-efficacy, practice, and recommendations of VTE.
satisfactory, not optimistic, and fair (Ahmed et al., 2020; Amira
et al., 2018; Oh et al., 2016; Yan et al., 2020). The overall results
2.4 | Quality assessment and abstraction
showed that most nurses had good knowledge levels regarding VTE.
In Al-Mugheed and Bayraktar’s (2018) study, most nurses had numerous correct answers regarding the definition and causes of VTE.
The Hoy critical appraisal checklist assessed the risk of bias and meth-
In one study, half of the nurses answered questions correctly regard-
odologic quality. The main reasons to use it were that it is an easily
ing the initial diagnostic test of VTE (Silva et al., 2020). In Antony
applied tool based on an exhaustive literature review and items that
et al. (2016), nurses correctly answered items regarding VTE’s
showed high interrater agreement (Al-Mugheed, Bani-Issa, Rababa,
pathophysiology, signs, and symptoms. In contrast, Oh et al. (2016)
et al., 2022; Al-Mugheed, Bayraktar, Al-Bsheish, et al., 2022; Al-
found that nurses had low correct answering rates regarding VTE
Mugheed, Bayraktar, Nashwan, et al., 2022; Hoy et al., 2012). The
diagnosis; only 15% correctly knew a CT scan as the initial diagnostic
Hoy critical appraisal checklist includes a 10-item checklist with two
test for PE, see Table 2.
domains: External validity (target sample, frame of the sample, sampling method, and nonresponse bias minimal) and internal validity
(data collected, case definition, validity and reliability of study in-
3.3 | Nurses’ knowledge of risk assessment VTE
strument, and data collection mode). Two assessors assessed each
paper for bias risk, and discussions resolved any discrepancies.
Of the 14 studies, six assessed nurses’ risk assessment knowledge regarding VTE (Al-Mugheed & Bayraktar, 2018; Gaston &
3
|
R E S U LT S
3.1 | Study characteristics
White, 2013; Lee et al., 2014; Ma et al., 2018; Oh et al., 2016; Silva
et al., 2020). The risk assessment level was classified as high, good,
inadequate, low, and poor. In half of these studies (n = 3), nurses
had low knowledge regarding VTE risk assessment (Al-Mugheed &
Bayraktar, 2018; Lee et al., 2014; Oh et al., 2016). One study reported
A total of 3511 articles were identified from the initial search in
high risk assessment knowledge after attending to education (Gaston
four different electronic databases. After the deletion of dupli-
& White, 2013). Specific items demonstrating low risk assessment
cates, 1978 studies were addressed for further screened. After
knowledge were identified; more than half of nurses had low cor-
reading the abstract and full texts, 1952 articles were excluded.
rect answers regarding hormone replacement therapy, surgery, and
Full-text articles assessed for eligibility included 26 articles. Twelve
cancer as risk factors for VTE (Al-Mugheed & Bayraktar, 2018; Oh
studies were excluded for the following reasons: mixed popula-
et al., 2016). In another study, nurses correctly answered 10% loss of body weight
162 (9.2)
20 (7.9)
0.50
ASA > 2
912 (51.2)
169 (66.8)
< 0.0001
1642 (93.2)
228 (90.1)
0.30
Patient origin, no. (%)
Home
Referring emergency room
67 (3.8)
13 (5.1)
Referring hospital inpatient
47 (2.7)
10 (4.0)
Skilled nursing facility
6 (0.3)
2 (0.8)
Malignancy
587 (33.3)
135 (53.4)
Inflammatory bowel disease
254 (14.4)
46 (18.2)
Other/not reported
921 (52.3)
72 (28.5)
Diagnosis, no. (%)
< 0.0001
Perioperative factors
Emergency case, no. (%)
Operative time, mean (SD), min
66 (3.8)
10 (4.0)
0.87
188.4 ± 108.6
190.5 ± 99.7
0.77
ASA, American Society of Anesthesiologists physical status classification; BMI, body mass index; COPD, chronic obstructive
pulmonary disease; SIRS, systemic inflammatory response syndrome.
www.mdedge.com/jcomjournal
Vol. 27, No. 4 July/August 2020 JCOM 179
Ambulation and Postoperative VTE
Table 3. Pre-intervention and Postintervention Ambulation Project Venous Thromboembolism Rates
Pre-intervention, No. (%)
(n = 590)
Postintervention, No. (%)
(n = 253)
P Value
Ambulation POD 0
215 (36.4)
93 (36.8)
0.93
Ambulation POD 1
279 (47.3)
189 (74.7)
< 0.01
Ambulation POD 2
296 (50.2)
209 (82.6)
< 0.01
DVT rate
39 (2.2)
1 (0.4)
0.05
PE rate
13 (0.7)
0 (0)
0.2
Total VTE rate
48 (2.7)
1 (0.4)
0.02
DVT, deep venous thrombosis; PE, pulmonary embolism; POD, postoperative day; VTE, venous thromboembolism.
decreased rates of VTE.11,15 However, this is the first
study to our knowledge demonstrating that creation of an
ambulation protocol alone is associated with a decrease
in VTE.
Analysis of pre-intervention data demonstrated a
strong association between ambulation and an absence
of VTE. No patient who ambulated on PODs 0, 1, and 2
developed a VTE. Based on those results, we moved forward with creating the ambulation protocol. While ambulation stayed stable on POD 0, there were 60% and 65%
increases on PODs 1 and 2, respectively. Nurses cited
late arrival to the floor for second and third start cases
as the primary difficulty in getting patients to ambulate
more on POD 0.
We believe the key to the success of the ambulation
protocol was its multidisciplinary nature. Certainly, the
easiest way to create an ambulation protocol is to change
the postoperative orders to state patients must walk 4
times per day. However, if the nursing staff is unable or
unwilling to carry out these orders, the orders serve little
purpose. In order to make lasting changes, all stakeholders in the process must be identified. In our case,
stakeholders included surgery and nursing leadership,
surgeons, nurse practitioners, nurses, medical assistants, physical therapists, patient care technicians, and
patients. This is where we utilized kaizen, a core principle
of Lean methodology that empowers employees at the
level of the work being carried out to propose ideas for
improvement.16 From the beginning of the patient experience, the health care practitioners who were carrying out
each step of the process were best able to identify the
problems and create solutions. In addition, stakeholders
180 JCOM July/August 2020
Vol. 27, No. 4
were given regular updates regarding how their efforts
were increasing ambulation rates and the results at the
end of the study period.
This study also demonstrates that, in a health care
system increasingly focused on both quality and cost,
significant improvements in quality can be made without increasing cost or resource utilization. Early in the
process, it was proposed that the only way to increase
the ambulation rate would be to increase the number
of physical therapists, nurses, and nursing assistants.
However, after identifying the root causes of the problem,
the solutions had more to do with improving workflow
and fixing problem areas identified by the staff.
In addition to having a positive effect on the outcome
studied, collaborative projects such as this between
physicians and nurses may lead to increased nursing
job satisfaction. A meta-analysis of 31 studies identified
nurse-physician collaboration and autonomy as 2 factors
that correlate most strongly with nursing satisfaction.17 A
Cochrane review also suggests that practice-based interprofessional collaboration may lead to improved health
care processes and outcomes.18
This study has several limitations. Pre-intervention
ambulation rates were abstracted from institution-specific
NSQIP data, and missing data were excluded from analysis. Also, due to the retrospective collection of the preintervention data, the distance of ambulation could not be
quantified. The bar for ambulation is low, as patients were
only required to get out of bed and walk 1 step. However,
we feel that getting out of bed and taking even 1 step is
substantially better than complete bedrest. It is likely that
once patients cross the threshold of taking 1 step, they
www.mdedge.com/jcomjournal
Reports From the Field
are more likely to ambulate. An area of future study may
be to more precisely define the relationship between the
quantity of ambulation in steps and its effect on VTE.
Finally, we acknowledge that while there is no direct
increase in costs, implementing an ambulation protocol
does take time from all who participate in the project.
6.
7.
Conclusion
Creation of an ambulation protocol is associated with a
decrease in postoperative VTE rates in colorectal surgery
patients. A multidisciplinary approach is critical to identify
the underlying problems and propose effective solutions.
Further studies are required to better correlate the distance of ambulation and its effect on VTE. However, this
study shows that even a minimum of 1 step is associated
with decreased VTE rates.
8.
9.
10.
11.
Corresponding author: Aneel Damle, MD, MBA, Colon & Rectal
Surgery Associates, 3433 Broadway St. NE, Suite 115, Minneapolis,
MN 55413; [email protected].
12.
Financial disclosures: None.
13.
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Vol. 27, No. 4 July/August 2020 JCOM 181
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