sections of the research, the majority of it being within the introduction.
Abbot & Sapsford (1998) recognise that ‘the introduction may include the literature
review.’
Due to the article being published in 2000, it is expected that the literature used will
be relevantly recent.
From reading the reference list of the article, it can be seen that this is the case and
only one reference before 1990 has been used. It was also felt that the references used
were relevant to the subject of the research.
The literature did appear accurate and when necessary, the reader found easy access to
the references using the information provided by the researcher.
The researcher does state that there are only a few published studies that have
evaluated the various techniques for the subcutaneous administration of heparin,
therefore the objective was to validate the practice of changing needles before this
procedure.
The researcher has included published recommendations for the administration of
subcutaneous heparin with various literature being referred to throughout. This
provided valuable knowledge regarding the administration of heparin.
Study aim
According to Clifford (1997) ‘the starting point for correlational and experimental
research is to formulate an hypothesis.’
The researcher has clearly formed an hypothesis which is included at the beginning of
the article.
In addition to the hypothesis, the aim of the study is also clearly stated in the abstract.
The aim of the stud is described as ‘determining if changing needles before
administering subcutaneous heparin would cause less ecchymosis at the injection
site.’
Robertson (1994) suggests that ‘the research problem is normally expressed as a
formal question using either the present or future tense.’
On reading this article this feature was noted, the question posed was ‘is changing
needles before the subcutaneous administration of low-dose heparin a valid nursing
action that decreases ecchymoses at the injection site?’
Overall, the aim of the study was easy to understand which provided the reader with
an expectation of what the research would contain.
However, it was felt that a definition of ecchymosis could have been given so as to
eliminate any confusion of this term.
Study design
The design of the study is clearly pointed out as being quantitative.
According to Polit & Beck (2004), ‘the research design of a study spells out the basic
strategies that researchers adopt to develop evidence that is accurate and
interpretable.’
The study design does implicate that the results are standardised and numerically
analysed which supports that the study is of a quantitative approach.
It is believed that the design adopted was an experimental technique.
Young et al (2001) states that experimental studies ‘manipulate an independent
variable to determine to what degree the outcomes are influenced.’
It is felt that this definition reflects the approach undertaken.
Fawcett (1999) suggests that ‘the researcher maintains greater control over the
research environment in experimental studies, therefore these studies are the most
powerful.’
The design that the researcher has used is felt to be appropriate and applicable to this
study as the results will primarily consist of numbers and measurements.
Study sample
Descombe (2000) states that ‘research studies almost always rely on a sample of
subjects who are a subset of the population.’
An admission criteria for the study was used on each patient. (Appendices 3).
The setting was a large, north-eastern, urban non-profit tertiary care medical centre.
Over a period of eight weeks, computer printouts of medication orders were reviewed.
When an order for heparin was identified the patient was interviewed to determine
whether they qualified for the study’s protocol.
Voluntary consent to participate in the study was obtained from each patient. Consent
is defined by Pape (1997) as ‘the voluntary agreement by a person with sufficient
mentality to make an intelligent choice about allowing an action proposed by another
person.’
31 of a possible 54 patients completed the study, due to 13 not being competent to
sign the consent.
Kennedy & Grubb (1994) state that ‘in order to give consent, a person must be
deemed to be competent.’
17 patients were also unable to take part as they would be discharged before the 4
days needed to complete the study.
One patient also refused to enter the study and 2 were eliminated because of a drop in
platelet count. Robertson (1994) believes that ‘you must respect the right of any
subject to withdraw from the study at any time.’
This shows that the researcher has provided the patients with a choice of withdrawing
from the study and has also respected the decision of the patient that did.
The sample of men and women were of almost equal numbers.
A small convenience sample from one hospital setting was used. Blacktop (1996),
identifies convenience sampling as ‘the least rigorous form of sample.’ If this is the
case then this may result in the study becoming less reliable.
However, the researcher has noted this fact and has suggested proposals to improve
the sample.
From reading the choice and technique, it is felt that the research has been carried out
honestly but may not be very reliable due to technique.
Hammersley & Mairs (2004) state that ‘ensuring that we have made a full attempt to
find a representative sample is an essential part of honest and reliable research.’
Data collection
The data collected resulted from the diameter of the ecchymotic area being measured
48 hours after each injection of heparin was administered.
The exact order used for the data collection is illustrated in appendices 4.
The results are shown in a pie-chart and a table.
Robertson (1994) believes that ‘use of tables and charts to summarise statistical
information can be very useful.’
The presentations of the results are simple to read and further information is provided
alongside the chart which prevents confusion when interpreting them.
Ethical considerations
Polit& Beck (2004) define ethics as ‘ a system of moral values that is concerned with
the degree to which research procedures adhere to professional, legal, social
obligations to the study’s participants.’
There is no designated section allocated to ethical considerations, however, it is
evident that procedures have been put into action in order to ensure that it has been
carried out ethically.
All participants provided their consent to the study and the researcher has also
demonstrated respect for the choice of the participants by noting the withdrawal of a
patient.
Confidentiality and anonymity were also maintained when the findings were recorded
and presented. Patients were recognised by the medical record number and the results
were recorded in percentages with no participants being referred to by name.
Study results and analysis
The results were presented neatly in a pie-chart and table which were simple to
interpret and an explanation of the results was also provided alongside the chart.
The findings were read with ease and were understood with no problem.
Results were also explained and summarised alongside which according to Clifford
(1997) is ‘a form of descriptive statistics.’
The results indicate that changing the needle before administering subcutaneous
heparin did not decrease the size of ecchymosis at the injection site. Therefore, the
hypothesis formed by the researcher (page 2) was not supported by this study.
Application to practice
This study has shown that the size of ecchymosis resulting from subcutaneous heparin
injection is not related to nursing practice of needle exchange after withdrawing the
heparin solution from the vial prior to administering to the patient.
This does not reflect practice in some hospital protocols because as mentioned in the
protocol of this study, there are a number of hospitals that include changing the needle
as part of the procedure of administering heparin.
Even though the findings indicate no effect of changing the needle, it is not felt that
practice could reflect on just these findings as the sample size used was not of a great
number and it was only carried out in one hospital, therefore it does not truly
represent the population., so a replication with a larger sample using more than one
setting is recommended.
The research does have important clinical practice issues for reduction in cost,
hazardous waste and time. This factor is noted by the researcher and a
recommendation of eliminating the changing of the needle could result in an
economic benefit.
This does seem logical because not changing the needle would eventually mean the
amount of hazardous waste reducing and also less time being needed when preparing
a syringe for this procedure.
The researcher states that it may cause ‘significant savings in time management.’
The reader would not use this research alone for future practice but would keep its
findings as a reference for any situations of administering subcutaneous heparin.
Overall the article was quite simple to interpret and has provided interesting facts and
issues regarding this area of nursing.
It is recommended that it should contain a section of ethical considerations even
though the use of this is evident throughout.
The findings were interesting but it is not felt that they could be relied upon to have
an effect on practice, it would become more reliable and have more of an impact if it
was replicated using a larger sample size using a different technique and over a wider
area.
This research has influenced understanding in the techniques used in the
administration of subcutaneous heparin and the effects of this procedure, such as the
appearance of ecchymosis.
It has also brought awareness to the fact that even though techniques are followed in
carrying out this procedure, they may not necessarily have an impact on the outcome.
References
Abbot, P. Sapsford, R. (1998). Research methods for nurses & the care professions. 2nd edition. Open university press. Milton Keynes.
Bennett, G. (2001). Questions for evaluating research. University of Glamorgan.
Blacktop, J. (1996). Nurse researcher. A discussion of different types of sampling techniques. Volume 3(4). pp5-15.
Burns, N. Grove, S.k. (1997). The practice of nursing research; conduct, critique and utilisation. 3rd edition. W.B. Saunders. Philadelphia.
Clifford, C. (1997). Nursing and Health Care Research; A skill based introduction. 2nd edition. Prentice Hall International ltd, Hertfordshire.
Descombe, M. (2000). The good research guide for small-scale social research projects. Open university press, Buckinghamshire.
Fawcett, J. (1999). The relationship of theory and research. 3rd edition. Philadelphia.
Hammersley, P. & Mairs, H. (2004). Nurse Researcher. Volume 12(1). pp4-6.
Kennedy, I. & Grubb, A. (1994). Medical law: Text with materials. 2nd edition. Butterworths, London.
Mallet, J. Dougherty, L. (2000). The Royal Marsden Hospital. Manual of clinical nursing procedures. 5th edition. Blackwell science, Ltd.
Pape, T. (1997). The Association of Perioperative Registered Nurses. Legal and ethical considerations of informed consent. Volume 65(6). pp1122-1127.
Polit, D.F. Beck,C.T. (2004). Nursing research- principles and methods. 7th edition. Lippincott Williams & Williams. London.
Young, A. Taylor, S.G. Renpenning, K.M. (2001). Connections Nursing Research, Theory and Practice. Mosby inc.
. Website accessed 01/01/05.
