In a coronary care unit, each procedure and healthcare provider’s decision can determine the patients’ condition. Cardiac arrest is a serious threat to the patients that reside in this unit, and it is a medical emergency that can lead to long-lasting permanent health problems. Therefore, there exists a need to find and implement the techniques that improve patients’ outcomes during cardiac arrest (Mader, Coute, Kellogg, & Harris, 2014).
Capnography is a procedure that provides vital information about a patient’s condition, measuring one’s coronary perfusions pressure and coronary blood flow (Novais & Moreira, 2015). Its purpose is to assist in the prediction of new cardiac problems (Novais & Moreira, 2015). The effectiveness of this procedure in preventing and examining a wide variety of patient issues makes capnography a vital addition to the nurses’ range of diagnostic tools.
In the United States, capnography was introduced to the clinical setting in the 1970s, but its history shows that the approach was used earlier to aid patient care (Harper, 2005). During that period, capnography was integrated into the field of anesthesiology, becoming a major standard for patient monitoring. Nonetheless, one may consider wider use of capnography a fairly new idea since it had not evolved outside of anesthesiology for decades. Later articles examined the potential of capnography in other areas, finding that it may benefit the process of resuscitation.
However, the research also demonstrates a limited implementation of capnography in coronary care units. A variety of studies show that this measuring process can be utilized for both intubated and non-intubated persons, and that it is useful for obtaining such information as respiratory depression, early defibrillation, airway management, chest recoil, and more. Nevertheless, a lack of recognition for capnography exists in practice (Cook & Harrop-Griffiths, 2019). Thus, the need arises in searching for potential barriers to use capnography in a medical setting. One of the proposed angles is nurses’ knowledge of capnography.
The skills of medical professionals have a direct impact on the success of all procedures. For example, nurses’ ability to interpret the measurements presented on a capnogram may contribute to the patient’s treatment plan. Thus, the link between capnography and nursing knowledge is a valuable subject for clinical research.
Nursing practice and its effect on patient outcomes is an extensive part of clinical research. The knowledge of nurses in various areas has been found to affect their performance and patients’ outcomes directly. However, the area of capnography has not been explored adequately using this viewpoint. Moreover, the utilization of capnography in areas other than anesthesiology is lacking. Due to the discrepancy between theoretical data and nursing practice, an in-depth look into nurses’ education and behavior is crucial for the advancement of evidence-based practice implementation. The examined research reveals a gap in the analysis of nurses’ knowledge of capnography and the use of this procedure in critical care units.
This project will address the relationship between nurses’ knowledge of capnography and the frequency and success of its use in the coronary care unit. There exists a potential benefit of nurses having a deep understanding of this measuring process and interpreting data. First of all, it is possible that in-depth knowledge will improve the quality of care for the patients. Second, their health-related outcomes may be influenced, as well. Finally, the exploration of nurses’ knowledge may open new applications for capnography and future research in the field of resuscitation and cardiac arrest.
The evaluation of the existing scholarship shows that some gaps exist in the field of nursing research. Thus, the main purpose of this research is to provide insight into underexplored areas. First of all, this quantitative project will evaluate the connection between nurses’ knowledge of capnography and its use in coronary care units. The results of this project may be helpful for other scholars and healthcare providers, including nurses in the explored field of practice. The test of nursing knowledge lies at the basis of this investigation, and the problem considered by the project is directly linked to the consents and applications of nurses’ acquired education.
Importance of the project
The findings of this project can provide new information to fill the identified gaps in current literature about nursing education. Furthermore, the results of the investigation may open up new discussions of capnography in nursing, potentially benefitting not only professionals but also patients. The effect on patient outcomes, for instance, is possible if the project identifies the role of nursing education in the use of capnography in areas of resuscitation.
The significance of this project for the investigator’s professional practice is substantial. First of all, it improves one’s understanding of exploratory projects in nursing and deepens one’s understanding of why such investigation is essential to nursing practice. Second, it provides extensive knowledge about capnography and helps to learn about its potential in a clinical setting. The significance also lies in the projects’ addition to the field of nursing education and possible improvements to the academic sphere of medical care.
Two theories are considered as the foundation for this project. The first one is the conceptual model of nursing (CMN) that details how nurses’ choices and activities mediate the relationship between population health and upstream, population, and system factors affecting it (Fawcett & Ellenbecker, 2015). The use of this framework allows the researcher to examine the influences on nurses’ behavior and offer a complex perception of the workflow in a coronary care unit.
The second one is the middle-range theory of self-efficacy (NTSE) that argues that the competences of nurses have a direct impact on their abilities to perform tasks. In turn, the philosophy poses that this relation further influences patient outcomes. This theory helps the investigator in developing the clinical questions as it supports the view that nurses’ actions and patient outcomes are connected.
The questions raised by this research call for specific measurements to determine the effect of nursing knowledge on their practice decisions. Thus, out of the two approaches, qualitative and quantitative, the latter was chosen for the project. The quantitative research methodology is designed to collect and analyze data in a transparent and quantifiable way, presenting numeric or statistical findings (Watson, 2015). In comparison to qualitative studies, the quantitative methodology provides a higher level of reliability of data since the results are based on calculation and not a subjective analysis of textual information (Watson, 2015). Furthermore, the chosen methodology is in line with the clinical questions as they require one to examine connections between variables and show potential connection and correlation.
The literature review and the identification of clinical questions and gaps in knowledge lead the project to consider the presented PICOT question. The specific population under investigation is patients residing in coronary care units. It was chosen because these patients are at increased risk of cardiac problems and may benefit from capnography. The intervention is nursing knowledge of capnography – a variable discussed previously. It is compared to the non-evasive method of tube placement. The central measured outcome is the quality of delivered care. The period for observation is 24 weeks, during which nurses’ activities are documented.
The project’s central topic is nursing knowledge of capnography, making it the independent variable for the investigation. It defines nurses’ awareness about such notions as capnography, proper techniques of its use, and the purpose of the procedure. Furthermore, nurses’ understanding of the benefits that capnography has for patients is also included in this variable. Next, the dependent variables are the use of capnography during resuscitation and the correctness of the technique. The latter variable requires nurses’ not only knowing about the principles of capnography but also following the established guidelines and procedures during all processes. It is assumed in the project that nursing knowledge will positively impact the use of capnography and improve related processes.
The participants of the study include 120 nurses working at a coronary care unit of a slam community hospital in the central part of New Jersey. The nursing population as chosen to due to the posed clinical questions. The proposed sample size can be explained by the time limitations and outreach limitations of the investigator. The restriction of the study to one location means that nurses do not have to travel to complete any tests, and their work will not be interrupted. The sample size was chosen to ensure that nurses’ workflow will not be interrupted, thus lowering the risk of influencing the project’s results. One particular factor is listed in the inclusion criteria – only certified nurses who are qualified to provide resuscitation can participate in the project. As nurses’ knowledge of capnography is measured to see its impact on resuscitation, examining unqualified staff could make the results unreliable.
The study involved human subjects, and the collected data contains private information as well as individuals’ professional skills and job performance. Therefore, the project has to consider a number of ethical issues and address them to protect participants’ privacy and confidentiality (Zyphur & Pierides, 2017). First of all, the approval of the hospital will be obtained to complete the project. The anonymity of all recorded data should remove any connection to the participants and prevent a breach of confidentiality. All identifying information used for communication with the participants will be stored on one computer with password protection. Furthermore, it will be destroyed one year after the project’s completion. Data collection and analysis will utilize identification numbers instead of names. The project will not involve patients in any way, thus protecting their privacy as well.
Moreover, it is vital to ensure that nurses’ workflow is not disrupted as it would not only skew the results but also affect patient outcomes and the hospital’s productivity – nurses will complete all required tasks at the hospital before or after their shifts, and participants with busy schedules will be questioned separately.
Methods of data collection
The first method of data collection is a tool developed by Kiekkas, Stefanopoulos, Konstantinou, Bakalis, and Aretha (2016) – The Nurses’ Knowledge about Capnography Test (NKCT). It is a questionnaire, the contents of which fully align with the clinical questions of the present project. The NKCT will be distributed to nurses participating in the investigation, and they will complete it outside of work hours. The second method is observation based on the guidelines of the Bureau of Emergency Medical Services, Trauma, and Preparedness (BETP, 2017). The appointed raters will assess nurses’ compliance with the proper capnography techniques. Moreover, they will document whether capnography was or was not used during resuscitation.
The project will implement several validity instruments when examining the projects’ data. First of all, as one of the tools, the Nurses’ Knowledge about Capnography Test (NKCT) has been previously assessed for validity during earlier studies, its use does not require additional evaluation. Kiekkas et al. (2016) developed the questionnaire that fully aligns with the project’s clinical questions. Therefore, it can be used to measure nurses’ knowledge of capnography. Second, the validity of data will be ensured with the help of the content validity index and feedback about the proposed observation criteria. Finally, as two data collection methods will be engaged in the project, the validity of the collected information will increase.
Apart from validity, the reliability of data collection methods has to be assessed. The NKCT was evaluated by Kiekkas et al. (2016), who reported on the high internal consistency of the test. The authors applied the point-biserial correlation index to find good and acceptable discriminatory values (Kiekkas et al., 2016). Next, to ensure the reliability of the survey’s scores, inter-rater reliability will be used. Finally, the investigator will employ the observation criteria to the documentation to create a sample of comparative data sets and ensure the objectivity of observations made during the project.
The variety of information collected using several methods will be presented using descriptive statistics. These data presentations will show the bases for scattergrams, which will demonstrate the basic connections between variables. Then, the correlation coefficient r will be determined using the two scattergrams and XLSTAT. Finally, regression analysis will be performed to investigate two pairs of variables.
The main limitation of this project is its small sample size. The participants are recruited from one small community hospital, and only nurses from a specific unit who have the necessary qualifications are included. Therefore, accounting for the rate of agreement to take part in the project, the final sample may be very small. Furthermore, as only one location is considered, the results may fail to represent a broader demographic adequately. The lack of a financial incentive for nurses to complete the questionnaire is another limitation that may decrease the scope of available data. Finally, as the project requires observation and interaction with nurses, some unforeseen ethical issues in workflow and communication may arise. Overall, the majority of ethical concerns are addressed in the data collection and analysis steps.
Bureau of Emergency Medical Services, Trauma, & Preparedness. (2017). Procedures: End-tidal carbon dioxide monitoring.
Cook, T., & Harrop-Griffiths, W. (2019). Capnography prevents avoidable deaths. BMJ, l439, 1-9.
Cronin, P., Coughlan, M., & Smith, V. (2014). Understanding nursing and healthcare research. Thousand Oaks, CA: Sage.
Fawcett, J., & Ellenbecker, C. H. (2015). A proposed conceptual model of nursing and population health. Nursing Outlook, 63(3), 288-298.
Harper, C. (2005). Capnography: Clinical aspects. Journal of the Royal Society of Medicine, 98(4), 184-185.
Kiekkas, P., Stefanopoulos, N., Konstantinou, E., Bakalis, N., & Aretha, D. (2016). Development and psychometric evaluation of an instrument for the assessment of nurses’ knowledge on capnography. Collegian, 23(1), 39-46.
Langham, M. L., Li, F. Y., & Lichtor, J. L. (2016). Respiratory depression detected by capnography among children in the postanesthesia care unit: A cross-sectional study. Pediatric Anaesthesia, 10, 1010-1017.
Langham, M. L., Li, F. Y., & Lichtor, J. L. (2017). The impact of capnography monitoring among children and adolescents in the postanesthesia care unit: A randomized controlled trial. Pediatric Anaesthsia, 27, 385-393.
Mader, T. J., Coute, R. A., Kellogg, A. R., & Harris, J. L. (2014). Coronary perfusion pressure response to high-dose intraosseous versus standard-dose intravenous epinephrine administration after prolonged cardiac arrest. Open Journal of Emergency Medicine, 2(1), 1-7.
Novais, P. M., & Moreira, M. M. (2015). Capnography: A feasible tool in clinical and experimental settings. Respiratory Care, 60(11), 1711-1713.
Smith, M. J., & Liehr, P. (Eds.). (2018). Middle range theory for nursing (4th ed.). New York, NY: Springer Publishing Company.
Watson, R. (2015). Quantitative research. Nursing Standard, 29(31), 44-48.
Zyphur, M. J., & Pierides, D. C. (2017). Is quantitative research ethical? Tools for ethically practicing, evaluating, and using quantitative research. Journal of Business Ethics, 143(1), 1-16.