Proposal writing

3- Brief Introduction:

3.1 Theoretical basis

Intravenous medications are considered the basic building block of treatment in most hospitals and medical centers, especially in acute care settings where prompt medical intervention is considered extremely important(Cooper et al., 2020; Palmer, 2016). The importance of intravenous medications lies in their rapid therapeutic effect, which reflects the inability to do without them in cases of pain management, palliative therapy, antibiotics, etc. (McCarthy & Avent, 2020; Schwenk et al., 2018).

Medication errors are considered among the most important risk factors that affect a patient’s life(Hajibabaee et al., 2014). In recent years, medication errors and their categories have been defined in different ways(Al-Worafi, 2020). Medication errors have been attributed to various reasons, including the poor quality of health organizations’ methods of care and high costs (Jolivot et al., 2016), which have caused patients to lose confidence in the services provided by health hospitals.

The National Coordinating Council for Medication Error defines medication errors as any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer. Such events may be related to professional practices, health care products, procedures, and systems, including prescribing, order communication, product labeling, packaging, and nomenclature, compounding, dispensing, distribution, administration, education, monitoring, and use (NCCPMERP, 2024). Notably, medication errors may occur at any stage (Tariq et al., 2024), but most of them involve administration errors (Sutherland et al., 2020).

Therefore, medication administration is considered one of the most important roles played by nursing (Rohde & Domm, 2018), which in turn directly affects patient health (Hanson & Haddad, 2024). With the continuous development of the health system and the significant increase in patients’ needs, a clear light has been shed on the extent of nurses’ competence in this field, and the extent of their knowledge together with their level of training is valued globally(Wondmieneh et al., 2020).

Problem statement

Despite the important role that nursing staff play in administering intravenous medications and the presence of diverse nursing experiences, most of the nursing groups expressed anxiety during the administration of intravenous medications(Savva et al., 2022). They attributed this to a lack of self-confidence due to the destabilization of their knowledge and their lack of training, which enhances their skills (Luokkamäki et al., 2021). Additionally, a segment of them expressed their fear and refusal to engage in any experience of giving complex intravenous medication because the blamed system nurses if something wrong happened to the patient (Alzoubi et al., 2023). This highlights the urgent need to understand their requirements and measure the extent of the obstacles through which they can benefit from their level of expertise in administering various medications(Tsegaye et al., 2020).

Study hypotheses

Null Hypothesis (H0): There is no significant association between training needs, practice behaviors, and obstacles faced by nurses in the preparation and administration of intravenous medications.

Alternative Hypothesis

(H1): Obstacles faced by nurses in the preparation and administration of intravenous medications

are positively correlated with training needs

(H2): Practice behavior among nurses in the preparation and administration of intravenous medications is positively correlated with training needs.

(H3): The relationships among training needs, practice behaviors, and obstacles are influenced by individual patient factors, such as age, experience level, education, postgraduate courses, and knowledge of the English language.

Importance of the study

This study aims to identify the gap between the level of nursing knowledge and practices for providing intravenous medications by examining educational needs, practices, and obstacles facing nursing. Another important benefit that lies in benefiting from the results is establishing an educational program centered on the actual needs that will be obtained. In addition, the data can also be used to improve nurse competence, which will improve patient safety, especially in high-risk procedures such as intravenous medication administration.

This research provides basic insights into the challenges facing nurses working in a tertiary hospital setting in Palestine, which will help hospitals understand these barriers and develop appropriate plans to overcome them.

Objectives

Main objective

 To investigate the multifaceted relationships among training needs, practice behaviors, and obstacles faced by nurses in the preparation and administration of IVM.

Specific objectives

1. To assess the level of training among nurses involved in the preparation and administration of intravenous medications.
2. To evaluate the common behaviors and practices of nurses during the administration of intravenous medications.
3. To explore the obstacles and challenges faced by nurses while ensuring safe preparation and administration of intravenous medication.
4. Investigating how nurses practice and behavior and identify challenges may have an impact on medication error during preparation and administration
5. The factors included staff shifts, the availability of the internet in the workplace, and educational qualifications that contribute to the difficulties faced by nurses in intravenous medication preparation and administration.

4. Literature review

The literature reveals that medication errors are caused by patient complex status (Kiekkas et al., 2011), the large volume of medications that are administered in regular prescriptions changes, the patient’s weight fluctuations, which primarily affect the medication’s needed dosage, possible drug interactions, and the many ways in which the drugs are supplied (Moyen, Camiré, & Stelfox, 2008).

Furthermore, Westbrook et al. (2011) reported that 69.7% of IV administrations had at least one clinical error, with serious errors primarily involving incorrect administration rates; in response to this issue, (Hajebi et al., 2010) reported that the knowledge of nurses improved significantly after an educational program.

Vijayakumar et al. (2014) highlighted the importance of nursing training, which includes enhanced training, strict adherence to IV guidelines, and the use of infusion control devices.

In contrast, an Iranian study focused on the necessity of awareness of obstacles to safe medication administration and advocated improving strategies to enhance safety in hospitals (Soltanian et al., 2016).

Moreover, (Mostafa et al., 2020) reported that while nurses possess foundational knowledge, gaps remain in their practical application and attitudes toward medication safety.

(Hamdan, Albqoor, & Shaheen, 2022) reported that education is essential for safe medication administration, in addition to continuous monitoring and evaluation, which are necessary to reduce errors.

In conclusion, addressing the gap between training needs, practice behaviors, and obstacles faced by nurses in the Preparation and Administration of Intravenous Medications is considered necessary to facilitate the development of appropriate policies and protocols to increase the safety of drug administration and identify the training needs of nursing staff to reach the most important point, which is enhancing patient safety.

5- Materials and methods

5.1 Methodology

Study Design and Setting

The design of the study will be a quantitative descriptive and cross‐sectional study that provides a detailed picture of nurses’ training needs, practices, and behaviors and the obstacles they face in the preparation and administration of intravenous medication. This study provides strong insight into what future training for nurses may need to improve the process of intravenous mediation and administration at An-Najah National University Hospital, a large tertiary hospital, the first accredited medical center by Joint Commission International (JCI) and the only teaching ‎hospital in Palestine, providing education and training to future and current health ‎professionals. ‎ Hospitals always have 131 beds with almost full occupancy.

The hospital has 267 nurses working in 18 inpatient and outpatient units and is an important referral center for patients from both the West Bank and Gaza.

 Target population

An-Najah National University Hospital nurses will be enrolled in this study on the basis of the specified criteria for inclusion and exclusion.

Inclusion and exclusion criteria

The inclusion criterion will include full-time and in-duty nurses. The following nurses were excluded from the study: part-time nurses, outpatient clinic nurses, central sterile supply department nurses, operating room nurses and nurses who were on maternity leave, unpaid leave, or long medical leave.

Sample size and sampling technique

Stratified random sampling will be used in this study. The specialty of the nurse and the administrative structure of the departments play important roles in selecting the sample, as this method plays the best role in ensuring the validity of the distribution of participation in this study.

• Data collection

The survey uses an empirical research method to explore the traits of a specific population (Di Muzio et al., 2017; Di Muzio et al., 2016). This is a useful method of collecting information through a questionnaire that is completed independently in this research, and completing the questionnaire will be self-administered by the nurse. The participants will be provided with the questionnaire in addition to a simplified explanation of the nature of the study and its purpose. Their consent to participate will be guaranteed.

In this study, we use two questionnaires to collect comprehensive data on our research topic(Di Muzio et al., 2017; Jafaru & Abubakar, 2022).

The first questionnaire includes 36 items divided into the following sections:

Demographic and professional characteristic section 1

In this section, participants’ personal information, including age, sex, years of experience, and other relevant details, will be collected.

 Continuous professional development section 2

concerned with the self-development of nurses and continues to provide educational opportunities such as the extent of their knowledge of the English language and the availability of the internet in the workplace.

Nurses’ knowledge of the use of IV drugs: Section 3

It includes five Likert scale items to evaluate nursing knowledge of drug calculations, as well as the availability of protocols, policies, and other related factors.

Nurses’ attitudes toward the use of IV drug section 4

It consists of five Likert scale items to evaluate nurses’ awareness of error prevention, the management of clinical risk, and how motivation can enhance performance in medication administration.

Nurses’ behavior in the use of IV drugs: Section 5

It includes five Likert scale items to evaluate nursing behavior during the administration of intravenous medications, such as handwashing and checking vital signs before administering drugs such as dopamine.

Training needs section 6

The training needs section includes self-assessment questions for nurses regarding their knowledge of intravenous medications and the importance of enhancing their practical skills in preparing intravenous medications.

Nurses’ barriers to the use of IV drugs: Section 7

This section is adapted from another questionnaire used in a previous study(Jafaru & Abubakar, 2022), which employs a five-section Likert scale to identify obstacles nurses may encounter during the preparation of intravenous medications, such as work pressure, professional practices, and other factors.

Official approval for the use of both questionnaires was obtained from the corresponding authorities for each questionnaire separately (available on request).

5.3 Statistical analysis methods

The received data will be checked for completeness and accuracy before coding and entry.

The data analysis process will then be performed via the IBM Statistical Package for Social

Science program version 20 (SPSS), and the data are expressed as descriptive statistics.

Frequencies, percentages, averages, and standard deviations will all be used to summarize the data. Chi-square tests will be employed for inferential analyses of dichotomous variables, and Student’s t test or the Mann‒Whitney U test will be used for normally distributed or nonnormally distributed continuous variables, respectively. Several multivariate logistic regression models are created to predict knowledge, attitudes, and actions related to IV preparation and administration. Age, sex, years of experience, year of graduation, degree type, location, and frequency of education of IV drug review subjects were examples of independent variables. Furthermore, as covariates, “relevant knowledge” and “favorable attitudes toward prevention” are explored with the models. A significance threshold of p < 0.05 was applied.

6. Working Plan

7. References

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